Tuesday 20 November 2018

Dear David Coleman: My seven-year-old soils himself daily and it is infuriating that he doesn't seem to care

Stock image Photo: Deposit
Stock image Photo: Deposit

Clinical psychologist David Coleman offers parenting advice in his weekly column.

Q. We have a seven-year-old son who continues to soil himself rather than going to the toilet. He sits on the floor if he feels like pooing, or if he actually does choose to go to the toilet, it is a last-second dash, that's invariably too late. It is a daily occurrence and a battle between him and us and has been so for three years. He goes through phases of being good, but these are rare. He doesn't seem concerned when it happens, or he says he doesn't want to miss out on 'fun'. It's infuriating for us, so any advice would be welcome.

David replies: Soiling, or encopresis as it is properly known, can be such a stressful experience for children and for parents. While many parents will report that their child doesn't seem concerned by their soiling, or seems "happy to sit in it all day," it is rarely the case that they are happily oblivious.

What is often the case is that children are not motivated to change, either because they feel unable, or because they are unwilling. They may not even see it as a problem, despite all the negativity that might surround it, or they may feel that it is too huge a problem to address.

Sometimes soiling can occur almost continuously, from when parents initially try to toilet train their child. Such soiling is known as primary encopresis and is typically because the child has just never effectively learned how and when to go to the toilet to avoid soiling.

Other times the soiling can occur in older children, and is something that starts after they had, successfully, been toilet trained. This is called secondary encopresis and can often occur in response to some kind of emotional trauma or emotional distress.

It isn't fully clear from your query whether your son was ever successfully toilet trained, but it seems like the soiling may have been continuous, since you tried training him. If so, then you and your son have probably got quite an established habit built up around the soiling.

I think, due to the established and, by now, chronic nature of his soiling that you might want to attend a clinical psychologist who specialises in working with children and adolescents. The problem seems very intractable and has dragged on for so long that you probably can't see the wood for the trees, and might really benefit from a fresh perspective on the problem.

Often the issues, after so many years, are as much related to the dynamic of what goes on between you and your son, as it might be about the soiling itself. The soiling may have some unconscious meaning for him, or it might have some secondary gain for him, that goes beyond simply knowing when and how to use the toilet.

In the comparatively short space that I have here, and not being able to ask further clarifying questions of you, I may not be able to guide you, or advise you fully. I think a consultation with a professional will really help you.

In preparation for such a consultation it might also help to go to your GP for a check-up first, just to rule out any physical problems that might be leading to the soiling. For example, some children become constipated, causing a blockage in their system.

Further, often sludgy or liquefied, poo can build up behind the blockage and can leak out. This is called overflow soiling. Because the blockage may prevent the child getting the message that there is poo coming, they don't even notice the leakage until perhaps there is a smell that they, or others, get.

Once you have ruled out or treated any physical cause (like constipation), you can then be clearer that any soiling is related to a psychological issue. The issue may be that your son hasn't taken on the learning about pooing in the toilet, or that the soiling meets some other emotional or psychological need.

For example, you mention that your son comes to sit on the floor to poo, which sounds almost like a defiant act, perhaps consciously or unconsciously driven, but with the understanding that it will upset you and cause a repeat of whatever "script" has developed for your family's response to his soiling.

So please do seek more focused and specific help for your family.

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