As a result of stool holding, a child's appetite will drop. Kids can withhold stool for a variety of reasons, but one reason is something I call the "DDD cycle"--Discomfort-Dread-Delay. Kids have an uncomfortable stool, they get afraid of the next one, hold it for a while, the next one hurts worse, and the cycle continues--and gets worse. It can start at any point, often with delay (if they are busy playing, for instance). They can also do it from anger or fear--as with a new baby.

If the DDD cycle is the problem, the best way to break the cycle is often with medicine, such as mineral oil, that will soften the stool and make it impossible to hold in. The dose is gradually adjusted until kids have a soft stool daily, and then left at that level for about two weeks while they learn that stooling doesn't hurt and while the intestines shrink back to normal size. (Often kids who have withheld for a while are so stretched out that they can no longer feel the urge to go until it is too late.) Taper the mineral oil off after another two weeks. The starting dose of mineral oil for a 4-year-old is usually about 4 teaspoons per day, but sometimes people need to go as high as 12 teaspoons before seeing the results. Have the parents check with their pediatrician to see if this might be a good approach for their boy.