Start with a developmental pediatrician. Make the appointment and you will have to wait. That’s important but long term.

I would pick one thing to work on and I’d pick holding poop and pee because that’s a medical risk. My kid did best if we pushed on one issue at a time. Feeding therapy will help in the long term but take it from an experienced parent- it will be a looooong time before he’s eating appreciably differently. I don’t understand the recommendation for OT. Our experience with OT was not helpful and it really only seems to work when there’s a very specific area of need. Saying do OT generally is not helpful.

So on the elimination issue-

My child (who is 2e) had other challenges but was also very verbal at 3 and surprisingly able to discuss things when not upset. Have you asked him what he doesn’t like about peeing/pooping? Do you have a sense it’s turned into a battle? I’m just wondering if you can give him back some control. My child was capable, even at 3, of explaining what felt bad and brainstorming how we would help her feel better but also accomplish something necessary. Not always the first time but after a couple rounds we could often make some progress.

Just trying to think. Apparently my younger sibling would only poop in the shower for like 6 months around this age. My mom is a saint but also had 3 older kids and I think just figured it would itself out (and it did). If he’s afraid of the potty you could say wouldn’t it be so funny if you pooped in the shower? Or make it a game. Or just tell him he’s in charge now and be kind of nonchalant about whether he poops or not.

Is there any chance the preschool is applying a lot of pressure or shaming him about not potty training? He may be trying to circumvent the whole discussion by just not doing it. I would try to figure out if there’s something going on there if things are getting worse instead of better.

Since you’ve ruled out medical concerns, I think step one is to find a very experienced BCBA that can provide home services and parent training. I’d also find another SLP that specializes in feeding disorders. A good BCBA should be able to address the toileting and eating issues and can work with the SLP if more serious feeding concerns. If possible I’d focus on having services at home right now as you can have more control over the environment vs preschool or daycare. Can you possibly hire a nanny with some special needs experience? If you haven’t already had a developmental assessment get one of those- theBCBA and SLP Can do some assessments that will help identify strengths and weaknesses and give you a good starting place but those assessments won’t provide a diagnosis. Sometimes, however, you can review assessment results and concerns with your developmental pediatrician to get a diagnosis if that’s your goal. With your list of concerns I’d go with KKI for the full assessment. Child find May be able to help connect you with additional resources as well.

I second child find.

OP may not have the luxury of waiting on potty training. Many day care centers require it around age 3. They will accept infrequent accidents. My child (dxed late with ASD) was officially trained the day she turned 3, saving her spot. A classmate missed the cut off and was not allowed to return the next month.

Where is he at during the day? Home, school, daycare?

Start with getting on the waitlist for a developmental pediatrician. 3 is young for a neuropsych. Our developmental ped said they typically do it at 5, but the waitlists are long so you can put your name down now.
I wouldn’t overly stress about potty training right now. My ASD daughter was just past 4 when she finally trained.

Don't try to potty train, at 3 he may not be ready. Wait closer to 4. Having any kind of negative associations with potty training throws back your progress, you have to be very positive and gentle about it.

He definitely needs to see a dev. pediatrician.

Is he in any kind of childcare setting or just at home with you?

If in childcare - there maybe stuff going on there that creates bad associations with feeding, toileting, etc.

This sounds very stressful! I’m going to add my own two cents as an educator and mom of autism kid. What about calling Child Find for an evaluation? Just google your county and Child Find. You do need a KKI evaluation, but I believe waitlists are long. Same with neuropsychological evaluations. You need immediate help. I also recommend looking at this through an autism lens - pursuing therapy with a psychologist, ABA or OT provider to address this unsustainable withholding. The restricted eating, the constipation, and withholding are red flags for autism. So those would be my steps:

1) Call KKI 888-554-2080 https://www.kennedykrieger.org/patient-care/centers-and-programs/center-for-development-and-learning

2) Call Child Find

3) Call a therapist. I don’t have personal experience with this practice but it looks like they can help you or point you in the right direction. https://skillsonthehill.com/physical-therapy-treatments/occupational-therapy/

I would fix the elimination issue first - what specialist is expected to be able to help with that? Agree to stay far away from potty training but he needs to be able to pee/poop without fear.

Hugs to you! Lots of kiddos are not potty trained at 3. He is not behind! You are a good mom! Some kids are just not ready. I agree with others to get on the wait list for KKI and the dev pediatrician.

I would start with OT after getting on the waitlist for KKI and a developmental pediatrician.

I'm sorry, this sounds really hard.

It's not too young for a neuropsych, and he might be 4 before the appointment actually happens anyway.

I would back off on the toilet training completely. He's just not ready and maybe needs other issues resolved before he can be ready.

What's the difference between the feeding therapy and the OT?

It sounds like you are really struggling and I'm sorry it's so hard!

We have seen a GI, no issues were found.

The OT was suggested for the elimination issues and food sensory issues.

Is 3 too young for a neuropsych eval? I don’t even know which panel (our doctor did not say).

The feeding clinic at CNMC said do more feeding therapy, give him a vitamin, feed him what he eats, and don’t toilet train until he stops holding it. But I don’t have the time to do both feeding therapy and occupational therapy concurrently.

I'm sorry, this really does sound overwhelming and stressful!

I would do the KKI waitlist, because that's hopefully a one-time task for you and not too difficult. Just some calls and paperwork.

Similarly, get a dev ped appointment on the books, so that you have it. Again, a one-time task not involving the kid, so hopefully it's doable for you.

What did the CNMC feeding clinic say and do, and what do you think might be gained from a follow-up?

Was the OT for the elimination issues?

I would rule out medical issues. Have you seen a gastro? Done allergy testing?

Our 3 year old son, who is bright, loving, and very verbal, has had multiple behavior/development challenges since birth and I don’t know what the next best step would be. Our pediatrician gave me so many suggestions at our last follow up that I felt like she was throwing spaghetti at the wall and I don’t have the bandwidth to do everything she suggested. Sorry this is long but I need help, badly.

As an infant we did early intervention in our state (physical therapy) for him for plagiocephaly, torticollis, and delayed development (not rolling). He caught up and we finished that treatment.

At 1 he began stool holding. We put him on Miralax and he’s been on that for several years. It seems to cause behavior challenges so we have tried weaning off a few times and he’s fine at first but then starts holding again. We have seen pediatric GI and our PCP multiple times about this, and tried other treatments (Enulose, enemas, magnesium, etc.). He refuses to potty train, has zero interest, and we have never been able to get him to sit and urinate or pee in the potty. He won’t even sit on it, and has major tantrums if pushed/encouraged. We have offered many incentives and this kid does not care.

Once we transitioned him to solids he started having trouble with food. He is super picky and has minimal interest in eating and self-feeding. We have worked with the infant/ toddler program through the county, worked with an SLP, and also taken him to the feeding disorder clinic at CNMC. He’s been diagnosed with sensory food aversion, limited food acceptance, and limited diet. He lives on a short list of white and tan foods and eats no meet and no vegetables (won’t even try no matter what we do or offer).

The newest issue is on top of stool holding, he’s now holding urine. He’s still in diapers because he refuses to toilet train. (We have tried.) In the last few weeks he has begun holding pee and poop all day at preschool - he’s there 7-8 hours a day. When we get home he’s now refusing to pee or poop and is trying desperately to hold it. Previously he would go to a private place and eliminate. He’s also now refusing to pee in the morning when he wakes up (dry). We had to give a laxative yesterday and he screamed trying to fight the poop coming out and squeezed his bottom cheeks together and got hysterical about pooping. This morning he woke up and refused to pee and he had not gone since 9 pm
The previous night. We have watched videos, read books, etc. about stool holding and he’s on the Miralax and he knows he’s supposed to eliminate and why but he’s now refusing to do it.

Our doctor suggested to me that I consider these options:

-take him to a developmental pediatrician
-restart feeding therapy with a different therapist
-start occupational therapy
-get him on the waitlist at KKI for an evaluation (both neuropsych and feeding issues)
-do a follow up with CNMC feeding disorders clinic
-take him to CHOP for a day for an evaluation (unclear what kind)

I am overwhelmed with these choices, DCUM. My older child has ADHD and anxiety and I have those conditions, too, so I know we have strong neurodivergence genes, but I don’t know what is going on with him and I don’t have the capacity to do all these things. Most people would not have any idea we have these issues because he’s social, articulate, and highly verbal. I am also exhausted from my caregiving responsibilities on top of trying to manage my own life, job, etc.

If you were me and could only do one or two items from this list, which would you do? Are there other things I am not thinking of that we could try, eg potty training experts? Are all these issues signs of some bigger issue like ASD? I’m just at a loss for what to do…