Undies, take 'em or leave 'em. (Underpants refusal and how to manage)
July 11, 2018 1:05 AM   Subscribe

This is a question for a non member friend, who will be reading and can answer questions if necessary. She's in Sydney Australia and is happy to have both specific but also international advice/support. Thank you in advance. My 3.5 year old daughter has recently escalated her refusal to wear underpants (or anything around her bottom) stating that they hurt. Whilst she has always preferred to go without pants (she is allowed to take her pants off when she is home) in the last few weeks this has escalated to the point where we are missing outings and pleasurable activities because she will not put clothes on. Getting dressed is taking up to two hours. NB It is currently winter here so clothing is needed.

We have tried different types of underpants, just wearing track suit pants without underwear, turning leggings inside out to avoid seams and have ordered seamless underwear to try.

Other information:
Daughter was adopted having been removed from her birth family at 8 weeks of age. Information about removal is vague but includes drug use, homelessness and mental health issues. She has been in our care since 6 months of age. She has displayed some issues around shoes and sox but these have been resolved through negotiation.

She has some issues with emotional regulation and can get very frustrated if not given her way. She has occasional tantrums involving hitting, biting, hair pulling and her getting very upset and emotional.

Otherwise she is a delightful, warm, intelligent and curious child.

I have read up on sensory processing disorder and am seeking further assessment regarding this but this is taking time and am seeking thoughts about how to manage this behaviour in the meantime so as to not further entrench this behaviour or escalate anxiety but also allow our family to function.
posted by taff to Health & Fitness (22 answers total) 3 users marked this as a favorite
Firstly, have they gone to the doctor to rule out a urinary tract/bladder infection or other infection, irritation, or digestive issues? Girls are more prone to UTIs.
posted by Crystalinne at 1:16 AM on July 11, 2018 [25 favorites]

Yes, I think a trip to the doc is in order to rule out physical causes first. Any particular area of pain? Crystalinne’s thought is a good one. I’d also want to rule out abdominal issues that might be aggravated by a waistband. Or excessive “self exploration,” not uncommon at that age, that might cause irritation in the underpants area.

If physical causes are ruled out, it might be time for some pro help. I knew a couple of socially anxious/stress prone kids whose anxiety at that age manifested as pain. Which might translate as, If wearing pants means you can leave the house, then pants hurt.

If you still don’t have an answer, then what about trying layers of skirts with leggings? You may not be playing in the snow, but you could get to the car and back okay.

Gosh, parenting can be hard. Sending you support from a parent whose child had serious sensory issues. (He eventually desensitized a bit, and, unbelievable, I noticed my now young adult wearing shirts with the tags left in!)
posted by Nancy_LockIsLit_Palmer at 1:54 AM on July 11, 2018 [10 favorites]

Is it possible she has a long labia? That can cause discomfort from a young age. Can she wear something loose like boxers?

Also, my son, 3 years old will not even entertain the THOUGHT of underwear. He’s just like: NOPE.
posted by catspajammies at 2:57 AM on July 11, 2018 [2 favorites]

My kid with sensory issues liked pull ups and diapers in part for that reason. Boystyle boxers work better amd silky material (had to be changed frequently because they weren't as absorbant as cotton). Can you get her a range of types of underwear styles to try so she can pick what works? Including thin pull-ups?

Ditto for irritation - the medical checkup helps and sometimes just regular sitz baths are enough.

If this is turning into a battleground, conceed. I'm strongly of the opinion that children should get to choose their clothes and outfits as far as possible (appropriate to occasion, like you gotta wear black of some sort to a funeral) because they aren't dolls and it teaches them independence, bodily boundaries, social ettiquette and fashion. And it's not an argument you will win longterm anyway. If she's smart and stubborn, 3.5 is an age when they want to make choices and have some personal control. Clothes are a good area to give them that experience safely.

Does she really need underwear all the time? Or just sometimes for some places/outfits? Negotiate.
posted by dorothyisunderwood at 3:06 AM on July 11, 2018 [6 favorites]

I'd go to the doctor and ask for a federal to an occupational therapist. This may be a legit painful issue for child. An experienced therapist may help you figure out the source of the discomfort and work around that help child comfortably wade through the world.
posted by Kalmya at 3:17 AM on July 11, 2018

Will she wear dresses/skirts? Doesn't solve the issues of discomfort long-term but might mean you don't miss out on outings because of pantsless child.
posted by missmagenta at 3:21 AM on July 11, 2018 [2 favorites]

In the meantime, what about skirts? If they are long, she doesn't need underpants. I concede her legs will get cold but are there little kid woolen thigh-highs anymore? Adult knee socks with the feet cut off, worn over her own socks to the top or mid thigh, maybe?
posted by DarlingBri at 3:25 AM on July 11, 2018 [1 favorite]

Nthing long warm skirts and/or dresses with knee socks and leg warmers. There are many battles; this is not a hill to die on. When it comes to a child’s physical preferences, default to their preferences if you possibly can. I raised a similar child. If I had a time machine I would go back and say yes to so many more things because it would’ve been better for my daughter and better all around. I did not understand that at the time but I do now. It’s this child’s body, so skip the underpants. If it turns out that the child is simply avoiding leaving the house, your friend will figure that out soon enough. Good luck!
posted by Bella Donna at 3:57 AM on July 11, 2018 [5 favorites]

Do you know whether it's the waistband or the leg/crotch part of the undies that she doesn't like? If it's the waistband that's bothering her you might be able to do something with a onesie or leotard (for undies) or overalls/rompers/jumpsuits. Otherwise skirts do seem like the solution. (And if it's both the waistband and the legs, dresses!)
posted by mskyle at 4:17 AM on July 11, 2018 [1 favorite]

Have you considered your laundry detergent and any fabric softeners etc. you might be using?
posted by teremala at 4:55 AM on July 11, 2018 [10 favorites]

At 3.5 is she tasked with wiping herself after using the toilet? If she’s not doing a good job, residual dampness and...residue might be causing discomfort as well, and underpants could definitely make that worse.

If that’s the case, wiping lessons, more frequent baths, and diaper cream.

But definitely find out where the discomfort is because if it’s waistband or leg band issues then it’s obviously not a wiping problem.

If it’s anxiety about leaving home, then she might appreciate feeling a sense of control over the outing. What’s appropriate for each situation will depend on your family but just having some choices can really help.

Finally, I hate to say it but if she receives any care from anyone who is not in your immediate family, be on the lookout for signs of abuse. I don’t have the spoons to offer any further suggestions beyond tread lightly and don’t ask any direct questions suddenly about that topic.
posted by bilabial at 4:58 AM on July 11, 2018 [8 favorites]

You probably have tried this already but...have you tried letting her go and select her VERY FAVOURITE CHARACTER EVER's underwear and see if that makes a difference?

If it's sensory, it won't (so only get 2 pairs). But if this is about anxiety or just a 3.5 year old THING it might help you figure that out. Another option could be the boys' shorts or (if you can find them in her size) loose boxer style.
posted by warriorqueen at 5:22 AM on July 11, 2018 [3 favorites]

Where does it hurt? Elastic along the side of the panty could abrade or rub; that would be a different spot than if she's experiencing genital pain.

Genital pain in kids can be very hard to diagnose. My friend's girl turned out to have a streptococcus infection down there. And as noted above, yes, kids don't take the best care of themselves and need to be taught and monitored on toilet habits. Not uncommon to have them irritating their own skin by over-wiping, etc.

Do try turning underwear inside out too so the seams aren't near her skin.

It's not so easy to find pediatric gynecologists but if you have one in your town (and your girl is complaining about genital pain), make an appointment sooner than later, the fewer there are the more booked up they get.

And in the meantime, skirts.
posted by fingersandtoes at 5:36 AM on July 11, 2018 [1 favorite]

As a mother who was once a child being forced to wear uncomfortable clothes, I've always been very careful and listening when my kids didn't want to wear something. Maybe first of all, sit down with her at some time that isn't getting dressed-time and talk about where and how it hurts, and what you can do about it. Maybe she has a solution. It can be difficult to explain stuff when you are 3 1/2 and can't be done under pressure. One possible thing is that her bottom is shaped in a way that means everything climbs up between the "cheeks" - for years I only wore longish skirts and dresses with nothing under because of that. Then I figured out by myself that very well washed cotton shorts with a bit of leg in them were good (because obviously I always worried that my skirts would fly up).
Another issue was scratchiness. I went to schools with forced uniforms when I was small, and during winter we would wear skirts and knee-high stockings, bare knees all year round. I loved that, because my thighs were more sensitive to scratchy materials and seams than the lower legs.
So, when my own girls were small, they made a lot of decisions themselves, but there was one issue where they couldn't decide: specially the eldest wanted to go to her playschool wearing her PJs and refused to get on her winter coverall. There were two problems with that: her not wearing day clothes could get me reported for child neglect, and it gets really cold here and snowy. But it was a huge fight every day for weeks, till I let her come out on the street in pajamas, in the snow. Then she said OK, lets go back in for the clothes. No more problems, ever. I think that she in her 3-year-old mind felt she had been allowed to make the decision herself, based on her own experience. Her smaller sister began a similar phase, but by then I was more experienced, and went directly to the snow-without-clothes action at the first sign of protest. I think it's a fairly common thing for three-year-olds.
posted by mumimor at 6:43 AM on July 11, 2018 [9 favorites]

She has some issues with...

I just want to add on to the pile that those "issues" are TOTALLY normal for 3.5 year olds. Three was the hardest age for us so far (kiddo is almost 5 now) because they know enough to know they HAVE THE POWER to do whatever the hell they want, without the knowledge that there are non-obvious consequences.

I agree that maybe long dresses with leg warmers or knee-high stockings with no underwear might be the best route. And don't feel too bad about it - it wasn't that long ago that ALL young children wore long dresses until around the age of 6.

I like mumimor's comment above as my kid is also one who prefers to do things his own way. It took a while to convince him to wear mittens in the winter and sandals in the summer. (*sigh* the mittens thing needs to be relearned each season... and socks.)
posted by jillithd at 6:57 AM on July 11, 2018 [6 favorites]

The zeroth order of business is for mom to have a good look at kid's genitalia and bottom (in the bath maybe) and see if there's obvious redness or irritation.

Second, to get you over the hump while you figure this out, I agree that a long dress without much of a waist in it is an excellent place to start. A style of underwear to try if they haven't already is boys' boxer briefs- boys' underpants have a much wider waistband than girls', and this seems to be more comfortable. The boxer brief style won't have a seam along the crease of her thigh, which is another spot that can get uncomfortable, and it won't have seams in the crotch like leggings do.

It's very tricky assessing "normal" with kids this age, because there are things that most kids do to some degree that a few kids do to an extreme degree. You should pursue investigating the sensory issues; I send all my sympathies because we have struggled with them at varying levels for a long time.

Also I will share my pro tip for assessing pain in preschoolers: When she tells you the underpants hurt, ask her "Do they make you hurt here? Here? Here?" while pointing to different parts of her body in a random mix of decoys and places you think it might really hurt. An example sequence I might use would be: anal region, ear, elbow, thigh crease, chest, nose, vulva, eye, knee, waistband region. Do this on a couple of different days, of course mixing up the sequence. If she identifies a specific, plausible area more than once, you probably have a localized pain to deal with and can troubleshoot that way. If she tells you that the underpants make her eye hurt one day and her elbow hurt another, it's more likely to be anxiety related in some way.
posted by telepanda at 7:07 AM on July 11, 2018 [24 favorites]

Another thought: perhaps applying a non-medicated diaper rash cream might help, even if nothing looks wrong and a UTI/yeast/strep infection (did you know there's anal strep!?) is ruled out. A child I care for has had a couple of periods of not wanting to use the toilet for inarticulable reasons and, maybe it's just a nice ritualistic placebo, but nightly applications have solved the problem each time. It can make a bit of a mess in the hypothetical underwear though, so be sure to warn anyone else who might be helping her!
posted by teremala at 7:20 AM on July 11, 2018 [3 favorites]

I think there's lots of good paths to consider above. I'll just add that 3.5 years was rough for me as a parent with my daughter. She had meltdowns, tantrums, bit and hit me and was generally bananas until she turned 4. And she wanted so much control at that age! I read books, especially "Your 3 Year Old: Friend or Enemy" and found that a lot of the advice about stages was right on and very soothing. It could be a physical issue that is running headlong into a stage of growth issue. Besides trying to rule out a physical issue, I advise that the parents just hang on. She won't be like this forever...or even possibly in a few months!
posted by amanda at 9:07 AM on July 11, 2018 [1 favorite]

I was this child. All of the issues you describe affected me. It wasn't emotional or acting out, and I didnt have any physical issues like rashes (although they're common enough with children and would certainly exacerbate problems with discomfort.) I'm certain I had sensory processing issues, which were never diagnosed, and I lacked the communication skills to really explain how I felt. "This hurts" was often the only way I could explain, even if that wasn't precisely the case. I vividly remember sitting on the floor, cutting the seams out of my socks (doesn't work out so well) and lots of time spent just sobbing in discomfort and frustration. I was very picky about shoes, the aforementioned socks, I went through a period of just not wearing underwear, couldn't stand to wear jeans till I was almost a teenager, or really any kind of constrictive clothing. Rough seams and waistbands were things that often bothered me. I can't offer a real solution because my parents weren't the best, so they never addressed/seemed to be aware of these issues, or were just dismissive. I just was extremely picky about what I would wear, and my parents were hands-off enough that I mostly picked my own clothes from a young age. Things I didn't get to choose, like socks and underwear, I often went without. I eventually began to grow out of it, but not till I was 9 or 10, and even as an adult I am very sensitive to being uncomfortable in clothing.

I just want to stress that I was genuinely physically uncomfortable/almost in pain, and how vastly frustrating it was not to be taken seriously. Imagine being forced to wear a very tight, ill-fitting corset all the time, and just being desperate to rip it off, and not being allowed to. That's what a lot of clothes felt like to me. My brain just couldn't process certain types of sensations, and they were overwhelming and unbearable. It's a panicky feeling, on top of being a kid and already emotionally volatile.

My best advice is first, to take her seriously and don't force her to wear things she doesn't want to. Look for soft, loose, seamless clothing. Maybe skirts or light sundresses will work, as impractical as they may sometimes seem. If she is that insistent about not wearing certain things, believe her. I went through a lot of unhappiness and discomfort because adults around me were unwilling to listen to me. I know in public there's a certain amount of clothing that needs to be worn, especially in cold weather, but underwear aren't really necessary. There's no real easy answer, but at least today there are so many more clothing and fabric options. If you find something she likes, buy several of them. And don't be concerned about how things look if she isn't. I know nowadays they have better treatments and therapy that may help the underlying sensory issues. Definitely get her tested for sensory processing disorders. And of course, don't overlook other physical issues and possibilities people have suggested, but even if there is no diagnosable issue, it sounds so familiar to me, and I'm sure her discomfort is real.

Good luck, I can imagine how frustrating it is in all sides!
posted by catatethebird at 9:11 AM on July 11, 2018 [5 favorites]

Just wanted to add a possible variable: I'm allergic to latex, and the waistband and elastic around the legs of some types of underwear hurts the hell out of me. The skin just feels rubbed absolutely raw after wearing it for a short amount of time. Sometimes this does not show as particularly noticeable redness or irritation visually, but I can really feel it. This pain lasts for days after I remove the offending undies. If this poor kid has a latex allergy it may be manifesting in this way.
posted by DSime at 10:20 AM on July 11, 2018 [5 favorites]

I see you have a laundry list of things suggested above to consider, but I'd also add wipes if you're using a toilet-paper replacement wipe. Even ones for children/sensitive skin can be incredibly irritating and can make the vulva and peri-anal area hurt.
posted by quince at 12:36 PM on July 11, 2018 [1 favorite]

HANG IN THERE. This can send you over the edge, I know!

At that age, one of my kids did the "strip naked and scream" routine every damn morning. The only solution was for me to hold her while my wife dressed her, and then we'd take her to the car. (Once at day care, the clothes weren't a problem.) It drove us crazy, and also was dangerous (because you can't go naked in the New England winter).

We accommodated her refusal to wear any socks at all (she mostly hated the seams), and offered sandals. We tried tons of underwear, which also had seams, but she wasn't as difficult about that. The pediatrician ruled out any hard medical cause.

We ended up working with a psychologist (plus a second one who was in training) that our pediatrician referred us to. We put together a reward chart that paid off every day if certain things -- up in the morning with a smile; ate breakfast well; put on clothes & shoes for school; etc. -- were done. The day care staff also helped out with transitioning more crisply at school. Our child also helped select the rewards, but the big one turned out to be one-on-one time....which made sense, in a family with four kids!

Anyway, after maybe a month with sessions and the reward charts, the problem was simply gone. Morning drop-off was easier, there were no tears or nudity, and it just...went away. She is still mildly picky about socks, but not often, and it's been years now.
posted by wenestvedt at 1:02 PM on July 11, 2018 [1 favorite]

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