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I have a third grade student from a questionable home with encopresis and a concerning fascination with feces. I am looking for ways to address problems that we have in school. Its a very complex problem dating back as long as this student has been in school. In first grade, we had problems with him squatting in the bathroom and having a BM on the floor in front of the toilet. At the present time, we have frequent problems with incontinence (and student refusing to change, denying that its him, hiding when he is sent to me, etc.). He will also carry feces in his hands, rolling it around between fingers and throwing it down the hallway.

Making the situation more difficult are the social problems. I have had frequent conversations with mom requesting a daily change of clothing, visits to MD, etc. At times, i cannot get in touch with mom as her phone will be shut off, at one time no running water, she moved and told no one (changed number)...lots of those type of problems. The family has (pretty much at all times) had a lot of services involved, such as CPS. I am aware that this type of behavior probably indicates some type of abuse, but as that is already being investigated...I am looking for suggestions to attempt to handle this child being in a classroom with other children around.

Any help would be great.

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Wow. This makes me super sad to hear. Have you tried just sitting down and trying to build some kind of rapport with him? Let him know your office is a safe space (in every sense of the phrase). I don't have any experience with encopresis, so I feel commenting on it would be done blindly. Does he have any mental deficits that would cause him to not understand his behavior is unaccepted or is it simply a way for him to get any kind of attention? Bad behavior always catches the most attention. I sincerely hope you can get some great advice to help him!

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Specializes in Pediatrics Retired.

I would revisit the CPS route. They can identify and facilitate needs for the home environment...as well as assessing if the child needs to remain in that environment. Parent participation is the only thing that will resolve this.

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Specializes in school nursing, ortho, trauma.

I agree, CPS needs to be given "an update". This rings especially true if there still is no water in the house, no clean clothing being sent in and no way to contact a parent. It sounds like a behavioral plan needs to be put in place. Even if its something as basic as using a monitored bathroom and being send every half hour to start. Not saying he will go in the appropriate place, but it sure gives him less opportunity. Now granted, a plan like this required follow through at home, which unfortunately it sounds like is not happening here. Even if you can make progress just during school time, a long weekend or winter break can undo all the hard work.

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Specializes in Community and Public Health, Addictions Nursing.
I would revisit the CPS route. They can identify and facilitate needs for the home environment...as well as assessing if the child needs to remain in that environment. Parent participation is the only thing that will resolve this.

Agreed. I have a kiddo on my radar right now with a milder presentation of encopresis and concerning home issues. Managing encopresis involves behavioral/social-emotional interventions as much, if not more than, medical interventions, and we need parents on board if that's going to happen. If the parents aren't doing anything to get help for their kid who needs it, then it's time to call CPS.

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Maybe incorporate a plan that gives him a sitting time (on the toilet) of 10-15 mins after breakfast and again after lunch with a book of his choice. Set the timer. Keep a record of sitting times and whether or not a BM was deposited.

If you have the facilities at school - have him wash his own clothes out after a BM and put in the washer. Then have him wipe down all surfaces he sat on while pants were dirty. This will force him to take responsibility for his actions.

Consistent bathroom schedule.

Hope these ideas help.

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My son has had encopresis 6 years. He is not abused, but stressed. The child loses the ability to "know" when they have to go as the chronic constipation has stretched intestines , colon and rectum..the loose poop leaks around the hard poop, as it has no where to go. Their anal sphincter is distended/ flabby and has little to no tone. Manometry is the test. The child cannot smell himself and will deny its him. Will hide clothes as shameful. Main thing is DO NOT GET MAD or BLAME child. This makes it worse. They CANNOT control and do not even know when it happens. My pediatric GI has us doing. Miralax twice a day and clean-out once a month. Restrictive diet.Lots of water. Have child toilet and push 10 min after every meal. Exercise. Get psychotherapy thru public school. Get 504 /IEP. Will not grow out of it. Big picture, could become life long problem and have to wear a colostomy bag. Childrens Hospital of Colorado Yoy Tube ' The Poo in You"

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Specializes in CPN.
My son has had encopresis 6 years. He is not abused, but stressed. The child loses the ability to "know" when they have to go as the chronic constipation has stretched intestines , colon and rectum..the loose poop leaks around the hard poop, as it has no where to go. Their anal sphincter is distended/ flabby and has little to no tone. Manometry is the test. The child cannot smell himself and will deny its him. Will hide clothes as shameful. Main thing is DO NOT GET MAD or BLAME child. This makes it worse. They CANNOT control and do not even know when it happens. My pediatric GI has us doing. Miralax twice a day and clean-out once a month. Restrictive diet.Lots of water. Have child toilet and push 10 min after every meal. Exercise. Get psychotherapy thru public school. Get 504 /IEP. Will not grow out of it. Big picture, could become life long problem and have to wear a colostomy bag. Childrens Hospital of Colorado Yoy Tube ' The Poo in You"

All this! I had a student with a similar issue last year. Talk to CPS about medical neglect/need for safety plan that involves seeing a GI doc to help formulate a treatment plan. Even if parent isn't on board (which is really needed), at least you can get a solid plan in place for the student at school.

Even though the mom of my student was helpful, I ended up keeping two sets of clothes at school along with several pairs of underwear and would wash them there as needed. My student didn't have full BMs with his encopresis, so solid waste wasn't an issue (thus making it easier for me to throw in the washer).

Obviously with your kid there is also a behavior aspect to it, but don't completely rule out medical and work out a 504 plan allowing frequent bathroom breaks at the clinic and water in class.

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There is almost always s a behavioral component. First , when the conditIion is taking hold .Kid's will hold it in for various reasons. If not diagnosed and treated , it can turn into il years of having to deal with shame, blame, not being like others. For my son being bullied for years ....before school would even help. Sounds like you're doing a great job. Empower the child to be in control of his body, will gain self confidence. There are encopresis support groups around the country. Yes access to bathroom at any time and water. Goes to school clinic after lunch for privacy.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

Know the difference between signs of poverty and signs of abuse.

Phone getting shut off, lack of running water and moving frequently are signs of poverty.

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Specializes in 8 years as a school nurse.

I have a vey similar situation with a student and I feel your frustration. We had the student shower at school due to no water at home and wash clothes here as well. Acknowledge the aspects that are out of the student's control and focus on what you can change. Behavior expectations for safety such as consequences for handling stool should be made clear. Make a contract with the student for bathroom time after all meals. Try to get the parents to understand what is expected at school. The funny part of my student is that all school year long we have issues (since kindergarten and though 5th grade now) but I see this student at the public swimming pool during the summer and apparently "it's all better now." according to the student. ugh

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