c Suggestions for appropriate changes to the diet and Further useful reading...

fluid intake
c Establishing a regular routine of sitting on the toilet for a
few minutes, 15-20 minutes after every meal
c Checking that your child is positioned comfortably and
securely on the toilet (using a child seat if necessary), and
ensuring that feet are firmly on the floor, or supported on a step
c Teaching your child the technique of gently rocking forwards
and back when sitting on the toilet (see ERIC’s leaflet
‘Get Going!’)
It is always important, at any age, to discuss whether your
child is constipated, as this will require treatment before
the problem can improve.
Get Going!: Hollins, G., Flynn, F., (2002) Re-published 2007.
Produced under licence from Guy’s and St Thomas’ Hospital
NHS Trust
Childhood Soiling -
Childhood Soiling - A Guide for Parents: Dobson, P., (1998).
a helpful guide for parents
Re-published 2004. Published by ERIC and carers...
We can do it! Helping Children who have Learning Disabilities
with Bowel & Bladder Management: A Guide for Parents:
White, M., Rogers, J., (2002). Published by ERIC
Bowel & Bladder Management in Children with Special
Physical Needs: A Guide for Parents: White, M., Dobson, P.,
(1999). Published by ERIC

What if a child has special needs?
Children with special needs (physical or learning difficulties),
can sometimes take longer to achieve bowel control, and a step
by step programme may be required to encourage success.
In all cases a full assessment should be made to exclude
constipation.
Meet the Poo Gang: Short, C., Weeks, J., (2007).
Published by ERIC.
Poo Go Home: Black, T., and Sneaky Poo: Williams, I., Wright, Y.,
(1998) Published by Northumberland Mental Health Trust
(available from ERIC)

How can ERIC help?

ERIC (Education and Resources for Improving Childhood
Continence) is the national charity that provides information
ERIC (Education and Resources for Improving
and support for children and young people with bedwetting,
Childhood Continence)
daytime wetting and soiling problems, including children
34 Old School House
with special needs, and their families.
The ERIC Helpline is available Monday to Friday from
Britannia Road
10am until 4pm on 0845 370 8008. Further information and Kingswood
moderated message boards are available on the ERIC websites Bristol BS15 8DB
www.eric.org.uk and www.trusteric.org (for young people).
A range of useful products and resources can be Tel: 0117 9603060
viewed and ordered via Fax: 0117 9600401
ERIC’s webshop Helpline: 0845 370 8008 (Mon-Fri, 10am-4pm)
www.ericshop.org.uk Email: info@eric.org.uk
www.eric.org.uk
www.trusteric.org (website for young people)
ERIC (Education and Resources for Improving Childhood Continence)
is a registered charity (No:1002424) and a company limited by
guarantee (No:2580579) registered in England and Wales.
Registered office: 34 Old School House, Britannia Road, Kingswood,
Bristol BS15 8DB

OCTOBER 2007
What is understood by soiling?
Children soil when they empty their bowels in their
pants, on the floor or other inappropriate places. For the
younger child this may be because they are still learning to
recognise when they need to poo, or have not learned to wipe
themselves properly. But some children have a more regular
and persistent difficulty.
This leaflet outlines what might cause the problem, what
can be tried at home and when and how to seek medical help.
Words...
Of course, ‘emptying the bowels’ is talked about in many
ways - ‘having a poo’, ‘passing motions’, ‘doing number twos’
are just a few. The words used for soiling similarly differ; parents
and children may call it a ‘pooing accident’; professionals now
use the words ‘faecal incontinence’ 1 for this difficulty in
children over the age of four years.
How many children are affected?
Soiling affects 1 in 30 children between the ages of four
and five years and 1 in 100 aged 10 to 12 or older. It is more
common in boys. The social consequences can be devastating,
leading to teasing or bullying and loss of friendships.
Families often feel socially isolated and the whole situation
can become overwhelming for both parent and child.
Why does soiling happen?
Constipation is one of the most common causes of soiling.
When children do not poo regularly the bowel can become
loaded with large (retained) stools that are hard to pass. This
is sometimes called faecal impaction. Soiling occurs when
runny stools leak around the hard lump that is blocking the
way. The runny poo comes out without the child being aware
and can happen several times a day; it can even appear as
diarrhoea. In other cases there may be poo visible around
the bottom area that is difficult to wipe away.
What can cause the problem?
c Withholding stools (avoiding going to the loo)
c Fear of the toilet (toilet avoidance is sometimes associated
with pain or discomfort)
c Lack of a toilet routine (some children have such busy lives
that it can be difficult to find time to sit on the toilet in a
relaxed manner)
1. Faecal incontinence may be ‘retentive’ and associated with constipation
and withholding stools, or defined as ‘non-retentive’ - the passage of
stools in an inappropriate place by a child with a mental age of four years
and older - with no evidence of constipation by history and/or examination.
In the past ‘non-retentive’ soiling was referred to as ‘encopresis’.
c Resistance to toilet training and insistence that the nappy
be put back on to poo
c Too little fibre or low fluid intake in the diet
c A change in routine
c Anxiety and emotional upset
c Some medication might cause constipation
What can parents do at home?
c Talk to your child about poo and what it feels like when
they need to go
c Try not to imply that passing poo is dirty or wrong (be pleased
that poo has come out - even if it is in the wrong place!)
c Create regular times to sit on the toilet (wait 15-20 minutes
after meals)
c Make toilet times relaxed and fun (use incentives, such as
star charts and lucky dip bags; party blowers and bubble tubs
can also be effective in helping your child to push)
c Use a step to support the feet and a child-size seat for the
toilet to ensure the child can sit securely
c Use the ‘Get Going!’ technique to help to push poo out*
c Encourage six to eight drinks a day and a diet that includes
a balance of fruit, vegetables and cereals to avoid constipation
c Give the recommended amount of milk for the child’s age, but
avoid excessive amounts as this can have a constipating effect
c Encourage exercise
c Suggest that children who insist on using a nappy do so
in the toilet area. Then make steps towards sitting on the
toilet with the nappy on and over time,
gradually remove it
c Involve younger children by
letting them flush the toilet
themselves and give praise for
‘sending Poo back to Pooland’
(‘Poo Go Home’ & ‘Sneaky Poo’
books are available to purchase
from ERIC)
*ERIC’s ‘Get Going!’ leaflet is
available to download from the
ERIC website www.eric.org.uk
Who can help?
Most parents seek help initially from their health visitor,
school nurse or GP. A frequency record of soiled pants, poo
passed in the toilet and the type of poo passed will help
health professionals to assess the problem and offer appropriate
intervention. If the problem is persistent or complex, referral
to a paediatric gastroenterologist, or the involvement of an
expert in child psychology might be helpful.
What about older children who soil?
Approximately 1% of young people over 12 years have
difficulties with soiling. It may be that the problem has existed
from an early age, without being resolved, or it may suddenly
start at a later stage. It is not unusual for older children to
deny there is a problem, or to hide underwear. The problem is
not associated with laziness, so it is helpful to remain positive
and calm. If possible, the young person should be encouraged
to discuss any worries or anxieties and be reassured that
something can be done to help.
Managing the situation in school can be helped by
providing a personal changing kit, with underwear, wipes and
sealable bags. The school nurse or head of pastoral care can
often support the young person in a confidential way. ERIC’s
website for young people provides information and also has a
moderated message board to encourage the sharing of ideas
and tips: www.trusteric.org.
What treatment might be offered?
It is very important that your child has an assessment,
including a full medical history, to exclude the possibility of
constipation, or, in rare cases, a problem that has existed since
birth. If there has been a longstanding problem, a reassessment
will often be helpful, with a return to the basic principles of
treatment. The treatment routine is likely to include:
c Medication to relieve any constipation and clear
faecal impaction (this could be a stool softener,
stimulant laxative or bulking agent). The medicine
is then continued to ensure that the stools remain
regular and easy to pass (the maintenance dose
should be continued until reassessment, because
stopping the medication too soon can result in
the constipation building up again)