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Mom must exercise care in letting son hold baby

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Question: I have a 7-year-old son and a daughter who was born prematurely a few weeks ago and is still in the hospital. Her big brother and I are very much looking forward to bringing her home next month. When we do, will it be OK for him to hold her, or should we hold off until she's bigger?

Also, when I'm asked about how old she is, how should I answer? I know that her size will make her seem smaller than her age. — A.M., New York, N.Y.

Answer: Of course your son should be able to hold his new sister. This is a wonderful way for him to get to know her and to nurture her. But he and you will probably feel safer if he is nestled back in a deep armchair when you hand the baby to him.

You must of course stay by his side when the baby is so small. Over time you and he will find out how robust she is becoming and how he is handling inevitable feelings of jealousy.

Just be sure that no one who holds her now has a cold or infection, since a premature infant is more susceptible.

You obviously will want to give your daughter's age in terms of when she was born, but you'll need to think of her as younger in your expectations for her development. I always suggest that parents subtract from a premature infant's actual age the number of weeks by which the birth preceded the due date, as well as the number of weeks the baby was in the hospital.

Question: On occasion my 5-year-old son has bowel movements in his underpants (during the day) and refuses to tell anyone until hours later. Could this be that he is "too busy" or "lazy" or could it be an underlying problem? This started a few months ago. — No Name, via e-mail

Answer: Sometimes this occurs when a child develops chronic constipation. As stools get larger and larger and are retained longer and longer, the child's intestine stretches and is less able to respond to the reflexes that normally stimulate a bowel movement. As a result, the child may have less control and may have bowel movements unpredictably.

Though occasional constipation is common in young children, chronic constipation can be a more serious problem. In rare cases, constipation can be caused by medical disorders, such as appendicitis, lead poisoning or celiac disease, though usually other symptoms are present. Some medications can also cause constipation.

But the fact that this started a few months ago and in a child who had previously been successfully toilet-trained, makes me worry that there has been a distressing event or a trauma that has led him to withhold his stools.

Upsetting events that leave a child feeling that control has been taken away or with anger that he cannot express, sometimes lead to this kind of trouble. Another possibility is that your son may be telling you that he is facing a new challenge — or what we like to call a "touchpoint" — that he does not yet feel ready to take on.

His refusal to do anything about his soiled underwear or to tell anyone for hours could go along with such concerns. (For more on this, you may want to read our book "Touchpoints 3-6: Your Child's Emotional and Behavioral Development," Perseus, 2001.)

Your son must feel ashamed, and it will be important to help him save face. Don't put pressure on him to stop. Let him know that although you are there to help him if he wants help, any wish he has to handle this on his own will be respected.

He may feel relieved if you give him pull-ups to wear. This would also help prevent struggling over this. The sooner everyone around him can relax about this, the sooner he is likely to rebound from what is likely to be a temporary regression.

We recommend that you look for upsetting recent events that you may need to help him face. You should also consult your pediatrician for treatment and to be sure that there is no other cause. If this problem does appear to be due to recent distressing events, your pediatrician may refer you to a mental-health specialist.

A child who avoids moving his bowels will eventually also develop a stretched and unresponsive intestine leading to more constipation and unpredictable bowel movements. (For more information, see "The Children's Hospital Guide to Your Child's Health and Development," Perseus, 2001.)

But an otherwise healthy child's intestine should return to normal after constipation has been successfully treated.

Questions or comments should be addressed to Dr. T. Berry Brazelton and Dr. Joshua Sparrow, care of The New York Times Syndication Sales Corp., 122 E. 42nd St., New York, NY 10168. Questions may also be sent by e-mail to: nytsyn-families@nytimes.com. Questions of general interest will be answered in this column. Drs. Brazelton and Sparrow regret that unpublished letters cannot be answered individually. Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child's health or well-being, consult your child's health-care provider.