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Soiling

Responding helpfully to children and young people who are soiling

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About soiling                                                                                                              printable pdf

Usually children have control over their bowels by the age of four, though some children naturally take longer than this (see general information on toileting).

An occasional accident is nothing to worry about; these will happen and are completely normal. However, if the child continues to fully empty their bowels in their pants, or frequently passes small amounts beyond the age of four, it is important to examine why this happens.

At this age children generally also become aware of the social stigma attached to soiling themselves, and they notice how other children and their carers react to them. This can lead to embarrassment and anxiety, which does not help the situation.

Quite often there is (at least in part) a physical reason behind the soiling, so it is important to contact a doctor or health worker about this.

Soiling rarely occurs deliberately, and it is almost never a way of acting out. Children do not soil themselves to annoy you; quite on the contrary, they are often quite embarrassed and anxious about it. For example, if a child is hiding soiled pants this is generally because they are embarrassed and worried about punishment.


Things to think about                                                                                            
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A common reaction in most workers and carers is to try to link the soiling behaviour to a specific cause. While is it important to understand why it is happening in order to find a solution, it is probably more helpful to the child to think in the first instance about the effect that the soiling is having on the child. It is very likely that they feel anxious and embarrassed about it.

Soiling can occur for numerous reasons. Some children are just naturally a bit slower to develop. In this case it is unlikely that there is a physical problem that underlies the soiling, and the children are generally able to go to the toilet when needed, they just have more frequent 'accidents'. In this case it is important to just be a little more patient and persistent with the child, as they will develop completely naturally, just a little bit slower than other children their age. For these children it is often very useful to reward them when they are staying clean. They are in control of their behaviour and praising them for getting it right (i.e. going to the toilet) will generally motivate them to get it right more often.

Sometimes children are worried about using the toilet itself for some reason. This can happen when they have experienced a painful bowel movement in the past, for example because they were ill or constipated. The child then becomes anxious about using the toilet again because they think it will hurt them. This can lead to a vicious cycle of not passing their bowels at all, which results in more constipation, which makes it more likely that bowel movements will continue to be painful.

Children may withhold their bowel moments for many reasons, but fear, worry and anxiety are common. If this goes on for a long time, and the child continues to be constipated, this can reduce the general sensations in the bowel, which means that the child will be unable to tell when they need the bathroom. In this case the child may soil themselves without even being aware of it at all, which can make them feel even more anxious as well as embarrassed about their bowel movements.

In this case using rewards and motivators usually does not work, as the child is unable to control their bowel moments in the first place. It is generally necessary to go to the doctor to relieve the constipation, and to re-learn that going to the bathroom does not have to be painful.

When trying to help, it is important to take the social aspects into consideration. Children are worried that others might find out, and they are aware of the reactions of other children as well as their carers around them. This can lead to more anxiety, and can even lead children to restrict their social lives.

In severe cases soiling and smearing can occur as a result of extreme emotional stress, for instance if the child has been abused or traumatised. In this case it is important to involve a mental health specialist.


Think about yourself                                                                                             
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Soiling by its very nature is an unpleasant behaviour to deal with, especially if it is prolonged.  The mess and smell involved in cleaning up and the embarrassment if it happens in a public place can inadvertently lead carers to give off signals of annoyance or even revulsion.  The young person will inevitably pick up these messages and this can lead to low confidence or sense of self-worth.  The feeling that this is a deliberate act can also lead to feelings of frustration and anger.  It is important to understand how this behaviour affects you and the messages you are giving out so that you can respond positively.

For more information, see section on being aware of yourself and your own response.


What you can do                                                                                                    top of page

  • Firstly, you should take the child to see their doctor for an examination, to investigate the possibility of a physical cause, such as an injury, constipation, etc.
  • The most important thing you can do is to not make the child feel bad about soiling. Avoid showing your distaste or repulsion as this can lead to further embarrassment and anxiety. Do not punish the child or get angry with them for soiling.
  • Try to be patient and calm. It may take a while for the soiling to stop completely.
  • Tell the child that accidents happen and that they should not feel embarrassed about it. However, at the same time try to remain neutral – too much positive attention or reassurance can give the message that you are happy for them to continue to soil themselves.
  • Try to give the child the message that you are keen for them to stop soiling themselves, but that you are not disappointed if it takes a long time.
  • Talk to the child, and try to find out if there is anything that they are worried or anxious about, or something that is otherwise troubling them, e.g. bereavement, bullying, change in carers, etc (see section on counselling techniques).
  • You may find it helpful to keep a record of their soiling, to see when it occurs and what is happening if it occurs less often. For example, you might find that the child is more likely to soil themselves when they are very relaxed, such as when they are watching TV. This is especially likely to happen if they are constipated.
  • Ensure that the child has a healthy diet with plenty of fibre, e.g. fruit and vegetables, whole grain cereals, etc. and that they drink plenty of water to avoid dehydration. This makes constipation and painful bowel movements less likely.
  • Try to encourage the child to use the bathroom after meals. Our bowels tend to naturally move after food intake, so this can be a useful way of preventing accidents.
  • Make sure that the child can get to the toilet easily at any time. This means making sure that at school they can leave the classroom with the minimum of fuss.
  • Involve the child in their own hygiene, appropriate to their age, but make this as positive an experience as possible. The child should never have to clean up after him/herself as a punishment. Make sure that they are able to clean themselves properly and have access to wet wipes, clean underwear and plastic bags for soiled clothes.
  • In some cases it can be useful to offer a reward for not soiling, for example a sticker chart for when they are keeping their pants clean (see section on behavioural techniques). However, bear in mind that often the problem is that the child is not in control of their bowel movements, so in this case it can be frustrating for them if they can not repeat the desired behaviour. In any case, make sure that this is always a positive experience, i.e. getting a sticker is a good thing, but not getting a sticker is never a punishment.
  • If the child is specifically anxious about using the toilet, do not force them or put pressure on them to do so. Remember that they are anxious and worried to begin with, and any pressure is only going to make the situation worse. Instead, use little steps to help them re-learn that using the toilet is not a bad or painful experience. For example, have them go on a nappy in the bathroom, later have them sit on the toilet whilst still wearing a nappy, and then gradually remove the nappy.


When to contact a specialist                                                                               top of page

When to contact a doctor/health worker

  • If the child is complaining of pain or discomfort.

  • If the child appears regularly constipated.

  • If the child soils regularly and persistently after the age of four of five.

  • If the child starts to soil regularly after a six month period of having been in full control of their bowels.

When to contact a mental health specialist
  • If the child suddenly starts to soil and smear or soil and hide the faeces. This can sometimes be an indicator of serious emotional distress.

  • If the problem is persistent and longstanding after the age of five and is causing the child to feel distressed and embarrassed.

  • If other significant behavioural or psychological problems are present.

  • If your efforts to help uncover issues that you do not have the experience to deal with, e.g. sexual abuse.

How to contact a mental health specialist

You should get in touch with your local health centre or hospital to obtain a contact number for the appropriate children and young people's mental health specialists.

Remember - you can contact your local mental health specialists for a number of reasons, for example:

  • For advice on how to make a referral about a named child.

  • For advice about whether or not to make a referral (it is normal practice to seek this advice without naming the child in the first instance).

  • For advice about what to do (once again there should be no necessity to name the child).

By not naming the child you are protecting their right to confidentiality. This method of seeking advice also has the advantage that you do not need to get anyone’s consent in advance of your contact phone call.

 

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