Sneaky Poo

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Unfortunately, despite all efforts relapses are common, and final remission probably depends on physical maturity.

In most cases, the child is not aware that this happening. They arenot being lazy and punishment will not help solve the problem.

What can happen when children hold their poo?

The bowels play an important role in maintaining your child’s general health from birth. Poo can tell us a lot about our body such as are we drinking enough and eating enough fibre. We humans have evolved as a species to use mental narratives to organize, predict, and understand the complexities of our lived experiences. Our choices are shaped largely by the meanings we attribute to events and to the options we are considering. A problem may have personal, psychological, sociocultural, or biological roots–or, more likely, a complex mix of the above. Moreover, young persons and their families may not have control over whether a certain problem is in their life. But even then, how they live with it is still within their choice. As Aldous Huxley once said, “Experience is not what happens to you. It is what you do with what happens to you.” A PLAYFUL APPROACH The more puzzling and difficult children to deal with are those with no apparent physical problem, and who do not suffer from constipation, but who pass small amounts into their pants most days. It is easy to see this kind of soiling as having a psychological cause, but my impression has always been that there must be some kind of subtle physical factor which affects bowel sensation and/or control in these children because of the chronic and persistent nature of their soiling, and in the absence of any obvious psychological cause. White, M. (1986). Negative explanation, restraint and double description: A template for family therapy. Family Process, 25(2), 169-184.

Breaking the stool withholding cycle needs a two pronged approach - sort the physical first and then you can work on the behavioural side effects of being scared to poo. Linking stories and initiatives: A narrative approach to working with the skills and knowledge of communities Encourage your child to sit on the toilet 10 – 15 minutes after eating (eating activates the gastro-colic reflex which stimulates faeces to move through the bowel), Looking like they are straining on the toilet, when they are actually trying to stop themselves from passing a poo. be positive and encouraging – you could use a star chart to reward your child for sitting on the toilet (whether or not they do a poo), or leave some toys or books next to the toilet

Tips for healthy bowels

Epston, D., & White, M., &“Ben” (1995). Consulting your consultants: A means to the co-construction of alternative knowledges. In S. Friedman, (Ed.), The reflecting team in action: Collaborative practice in family therapy. (pp. 277-313). New York: Guilford. It's really important to remember that children don’t soil or withhold on purpose or to be naughty.

Most parents begin toilet training their children at about the age of 2 - 2 1/2 years, and by 4 years of age more than 90% of children are reliably clean and dry during the day. It is important to state at the outset that night-time dryness is achieved as the result of neurological development and maturation, not as the result of daytime toilet training, and only about 80% of children will be reliably dry at night by the age of 4, as compared with the daytime figure. SOILING Whichever method is used, once there have been a few successes the problem usually disappears. Even without any kind of intervention, in my experience it is very unlikely that the behaviour will persist past the age of 5.Be active in as many ways as possible; for example, through play, cultural activities, dance, sport and recreation, jobs around the home. Encourage your child to have some exercise daily. This also helps stimulate movement of faeces through the bowel. The write-up of a community gathering that took place with the Narrandera Koori (Aboriginal) Community in April 2002 and documentation of the follow-up to this gathering. Also included are a number of songs that were written and recorded during the gathering.) Some children are generally slower in all aspects of their development, and toilet training is just another example of this. With these children there is no physical problem causing the soiling, and no anxiety about using the toilet. They are quite capable of passing a motion into the toilet, and are happy to do so on request, but sometimes they just don't make it in time. For these children the term "accident" seems to be an appropriate description for the nature of the incidents.

Children who continue to wet during the day past the age of 5, and in the absence of any identifiable source of stress, are likely to have a physical problem with the retention of urine. If a child continues to wet after appropriate medical assessment and treatment, they may respond to a variation of the "Sneaky Poo" programme directed at being dry rather than being clean, but once again any success with this programme tends to be temporary until the child reaches an appropriate level of physical maturity. Night-time wetting Epston, D. & White, M. (1992). Experience, contradiction, narrative, and imagination: Selected papers of David Epston & Michael White, 1989-1991. Adelaide, Australia: Dulwich Centre Publications. Seeming vacant and not responding to instructions. It can take a huge amount of effort and concentration to hold on. Your child may get cross if you interrupt them at this point or seem 'unreachable'. When children stop the urge to do a poo it’s very easy for them to get trapped in a vicious circle of withholding.When their poo hurts or they are fearful of the toilet, they find it hard to relax and are anxious it will hurt.

For the child, externalization is like playing a game of “pretend.” Implicitly, or sometimes even explicitly, we are saying to the child, “Let’s pretend the problem is outside yourself and we’ll play with it from there.” As Paley (1990, p. 7) writes, “‘Pretend’ often confuses the adult but it is the child’s real and serious world, the stage upon which any identity is possible and secret thoughts can be safely revealed.” Movicol can be used in all stages of treatment, but particularly for initial disimpaction. The dose will be adjusted as required to maintain regular bowel motions. Faecal Incontinence is the medical term for soiling in children over the age of 4. In many cases, it develops as a result of long-standing constipation (Proctor and Loader, 2003). It is estimated that constipation occurs in up to 10 percent of children (Leung et al, 1996).