Dr. Gwenn Schurgin O'Keeffe, MD, FAAP

Dear Dr. Gwenn,

My 6 yr old granddaughter absolutely refuses to wear underpants. When she's in the car with me, she actually tugs at her slacks until her butt is out and she's sitting on her bare butt. I talked to the school guidance counselor but she blows me off. I'd like some answers or suggestions why and how to deal with it. My daughter acts like she'll "get over it".

Signed,
Kathy

Dear Kathy:

This is a difficult situation and as you are not the custodial parent there may be little you can truly do beyond offering some well intended advice. That said, let me offer some ideas. First, talk to your granddaughter, if you haven't already, and ask her why she does this. The best time would be when you are not in the car and relaxed doing something else - such as reading books or enjoying an outing. See what she says and try to remain neutral and nonjudgmental.

Second, take a look at the panties and see if this is a logistical issue - perhaps they are too small or cut in a way that is uncomfortable. Some 6 year olds do better picking out their undergarments and enjoy that small element of control. That may work well with your granddaughter if this ends up being about her not liking the particular undergarments she is being asked to wear. What about her pants? Do they fit correctly? Some kids have a thing about clothes that are too tight and shorts and skorts may work better for her.

Third, there does need to be some boundaries about appropriate and inappropriate behavior. Try some sort of positive reinforcement chart. She can earn stickers every day she wears underwear and at the end every week get a special treat.

Finally, medical issues should be ruled out. This can be done by you or mom in the bath - if the private parts look red or there is discharge on her underwear, consult her pediatrician and make an appointment. But, if everything looks normal, this may be a behavioral power play and the big question is why.

As with all childhood issues, if this becomes more intrusive and starts to interfere more with home or school life, professional counseling would be the next step.

Best,
Dr. Gwenn

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About the Author
Pediatrician, Dr. Gwenn Schurgin O'Keeffe, MD, is a board-certified pediatrician and Fellow of the American Academy of Pediatrics. Dr. Gwenn is an experienced columnist, educator, and practicing pediatrician. Dr. Gwenn strives to write as if she were talking to a parent. As a parent herself, she knows how important it is to obtain information but also understand how precious little time parents have to find that information on the internet. Pediatrics Now was developed to fill that gap and provide a bridge between the parenting and pediatrics worlds.

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