Pooping 1st Grader - UG

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Specializes in School Nursing.

I have a first grader in my school who is not fully toilet trained! Apparently this has been an issue since PK with this child. Mom doesn't bother to send a spare set of clothes because the child refuses to clean himself up. This is the root of problem. At home, mom wipes him after he has a BM, so if nobody is there to wipe him, he just goes in his pants and waits for someone to come to the school and clean him up. He refuses to do it himself. He told me flat out that he can't poop on the toilet because his mom needs to be there to wipe him. I've offered to allow him to use my bathroom and assist him and he refuses, it has to be mom. We are almost done with the year, and this is a 2-3 day a week issue. What's worse, is it takes 1-3 hours for someone to come to the school to change him. He thinks it's playtime, and wants to color or pretend play in my clinic the whole time.

The administrator came into the office yesterday and demanded he try to change himself, gave him a change of clothing and wipes and sent him into the restroom, he stood in there and cried for 30 minutes, never once attempting to do it.

I'm really at my wits end. The kid is a bit below his peers academically, but definitely able physically and psychologically to do this by himself.

Any ideas? Mom and sister claim they've "tried everything". I suggested sticking clothing and wipes in the bathroom, and making himself get cleaned up every time he does this. I believe eventually he'll decide it's easier to wipe himself than clean up after pooping his pants. But something tells me mom isn't willing to take the hard line here.

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Specializes in Clinical Research, Outpt Women's Health.

He needs a therapist

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Specializes in Cardiac Step-down, NICU.

Yes, I agree with CrunchRN. Therapy might be the next option for this family.

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Specializes in ED, psych.

There are so many things wrong here I don't even know where to start....

First, if it's been going on since PK, why on god's green earth is it STILL going on now??? Why hasn't it been addressed by the school prior?

Mom's "tried everything," my sweet aunt Fanny ...

As a SPED teacher, I suggest it's a team meeting time. The child is missing instructional time, is utilizing your services and now the administration is involved. If this much intervention is needed for the student, a 504 (or whatnot) may need to be implemented. He's already behind academically; he'll continue on this trend if something isn't done. If your district has a behavior analyst, they are a great resource to help kid and mom (and staff). They can perform a functional behavioral assessment, take ABC data, etc. Has the child seen a physician? Is there anything medically wrong?

The family needs therapy. Unfortunately, I can't see that happening anytime soon (although I truly hope it does). Hopefully something in the short term can be implemented at the school.

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There are so many things wrong here I don't even know where to start....

First, if it's been going on since PK, why on god's green earth is it STILL going on now??? Why hasn't it been addressed by the school prior?

Mom's "tried everything," my sweet aunt fanny ...

As a SPED teacher, I suggest it's a team meeting time. The child is missing instructional time, is utilizing your services and now the administration is involved. If this much intervention is needed for the student, a 504 (or whatnot) may need to be implemented. He's already behind academically; he'll continue on this trend if something isn't done. If your district has a behavior analyst, they are a great resource to help kid and mom (and staff). They can perform a functional behavioral assessment, take ABC data, etc. Has the child seen a physician? Is there anything medically wrong?

The family needs therapy. Unfortunately, I can't see that happening anytime soon (although I truly hope it does). Hopefully something in the short term can be implemented at the school.

You took the words right out of my mo... fingers.

Team meeting. Parents, SW, Psych, Teacher, his MD if possible, and YOU.

This must be resolved. It's not just about cleanup. There is something deeper going on here.

Let us know?

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Specializes in Pediatrics Retired.
You took the words right out of my mo... fingers.

Team meeting. Parents, SW, Psych, Teacher, his MD if possible, and YOU.

This must be resolved. It's not just about cleanup. There is something deeper going on here.

Let us know?

DITTO...DITTO...DITTO...DITTO...GEEZ what has been going on??

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DITTO...DITTO...DITTO...DITTO...GEEZ what has been going on??

You know I counted your ellipses before liking you, OD.

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Specializes in retired LTC.

Any chance this kid was assaulted and ONLY Mom is safe to him?

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Specializes in Pediatrics Retired.
You know I counted your ellipses before liking you, OD.

Still in compliance...after your intervention...:up:

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Still in compliance...after your intervention...:up:

Ssshhh... :bag:

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Sounds like a very complex shituation to me too...

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Who comes to clean him? He's got a serious trust issue to say the least.

We know, of course, that something is really amiss in this family and that therapy is needed. He could easily end up in foster care or even institutionalized. Birth trauma history?

I expect serious dysfunction on Mom's part, abuse in this child's history, and/or psychiatric illness of the little guy, mom, other family.

Please do as suggested above and get the whole team working to correct this probem, for the little one's sake if nothing else. His classmates must make his life hell already. The teachers, you, and the Admin already can't stand it any more. Please act and get your own Sup involved and let us know how it turns out.

Maybe some art therapy.

Ask him how he would handle a child like himself if he were the adult.

Or try to make a little game of it, a little challenge. Like "I'm way faster at washing up than you are". As a young parent, I had trouble getting my kiddo moving in the morning. My father handled it in one try. He told my dawdler "I'm way faster than you at getting dressed. You should just forget trying to win because I'm way faster" or something along those lines. My boy threw back the covers, jumped out of bed and into his clothes, shouting, "No you're not, Grampa!". There was never a problem after that. He rose to the challenge because he needed the competition, not my worrying about being late.

There are several steps to the cleanup. Maybe Mom can stop doing one step at a time, over the course of a week or month or so. Eventually the lad will be doing one step, two, three, etc. He needs a ton of praise for each accomplishment.

Thorough medical, mental, and family/social evals, too, if Mom can't make the foregoing happen.

She might need to take off work for a week or more, where is Dad, and so on.

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