Older Child Having Accidents

If she's holding in poo, that's encopresis. It's a medical condition and the doctor should have given advice on countering it. Our son had encopresis but didn't have pee issues combined with it, though, but I can see if she's holding one, she might do it with the other.

Your friend needs to get her daughter in with another pediatrician for a second opinion. It may be encopresis that's the problem or it could be something else. But to send her home with a "good luck" and no solutions isn't ok.

ETA: Doesn't sound like she was that late training. Our kids are sound sleepers and didn't stay dry at night until around six. The pediatrician said it can run until around 10 for some kids and that his own son was one of them. Four isn't all that late to day train, either. It just isn't a breeze with many kids mastering potty training.

You are thoughtful to be concerned, because this IS reason for concern. Girls of 11 are sensitive about things like how they look and smell and she likely will be devastated if a classmate, or someone at summer camp etc., says to her, "You smell like pee."

The doctor found no physical cause but did....nothing else at all? No recommendation to the parent to deal with "holding in pee and poo"? Sounds like a doctor who is not very proactive. The mom should pursue having another doctor check into whether the girl has physical issues with holding in urine and poop; and then the mom also needs to have open communications with the girl about other, non-physical reasons -- Is it possible that the girl has always tended to "hold it" too long since a younger age? Or that she might have wet herself more seriously once in front of others and now just holds and holds until she leaks, out of fear of urinating at all? Have there been any changes in the girl's life at ALL -- divorce or parental strife, a new job for mom or dad that has changed the family schedule, a new sibling or a sibling who has needs that demand mom and dad's attention, issues at school, issues with friends? The mom might rack her brains and say "There's nothing to stress her," but you'd be amazed at how kids can internalize stresses that an adult would just not even see as a reason for stress.

If this started about a year ago, what changed then? Was there some possible trigger like starting a new school, getting more pressure about homework, again--a new sibling or change at home, anything?

If this were my daughter, and I have one just a bit older than this girl, I would first see a different doctor; then I'd think hard about her history with toileting and whether this is a possible case of weak bladder/uretha from years of holding pee; and for sure I would investigate whether there is something psychological and emotional going on that I as the adult didn't recognize. I hope your friend does not hesitate to investigate all that and get the girl help including counseling if needed.

Meanwhile, if the girl can admit to the fact she does "leak" at times -- it would be good if mom can get her to wear mini-pads (or maxi if needed) and change them regularly to reduce the smell.

I don't know the answer to your question.

But I am curious about your terming her a "late potty trainer". Is that based on the fact that she had night time accidents until age 5-6? Because night time has nothing to do with potty training. My son continued to have occasional night time wetness off and on until he was 9! It has to do with physical growth and deepness of sleep. He was fully potty trained by the time he was 3 years old and rarely had accidents during the time he was awake after that. Night time is a whole 'nother ball of wax.

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Not offensive at all. Just not very clear what you meant.

Does she appear to be daydreaming near this time?