3rd Grader Pooping Pants to go Home

[lifelearningrn, BSN, RN]

Ug! This is my first year as a school nurse and it's been eye opening. At my school, just about every morning I see kids crying and begging mom to take them home. EVERY. MORNING. The first week, I expected it. We're going into week 6 and I'm still getting kids coming into my clinic because they've been crying all morning to go home. Nothing else is wrong. They just want mommy. Apparently, there is no social stigma anymore to crying in class all day. There is one boy who screams and cries and grabs his moms legs, we literally have to peal him off his mom every morning.

The one that is really starting to anger me is the 3rd grader that I see 3-5x a week for silly reasons who will poop his pants in the hopes of going home. His mom, rather than bringing him clothing, just picks him up. He did it again this week, so I gave him a change of clothes, package of wipes and a bag and made him clean himself up and go back to class. He was locked in my RR for almost 30 minutes before he got the message I wouldn't be calling his mom and got himself together. I'm full on expecting a phone call from mom this week asking why I didn't call her.

Is this normal elementary school or do I have an especially babied population?

[FolksBtrippin, BSN, RN]

My sister pooped her pants in first grade several times. It was driving my mom crazy trying to figure out how to stop it. As it turned out, My sister was so shy that she was afraid to raise her hand and say she had to go to the bathroom in front of all the other kids. The kindergarten room had a bathroom in the classroom where she could just go. Once they found out the cause, they worked it out.

I think it's good that you gave the kid wipes and a change of clothes. Try to keep compassionate communication with the mom. Don't blame her. If the behavior goes away, then you've solved that part of the problem.

But there may be something else going on here. I don't think what you are describing is normal for elementary school beyond kindergarten.

I suspect another problem. Some possibilities: curricula too difficult, hostility in the school between teachers/administrators, unreasonable expectations.

What do you think is going on?

[cayenne06, MSN, CNM]

I'd be cautious in assuming that this kind of behavior is necessarily manipulative or a result of being "babied." You should not be angry at a 3rd grader for soiling their pants.

It's possible that the situation you are describing is a calculated attempt by the child to get excused from school, but if so that is a very maladaptive behavior and potentially a sign of some other problem, at home or at school.

Just don't forget that elementary age kids are still very very young.

[SnowyJ, RN]

I have a 4th grader who still poops his pants to earn his "get out of jail free" card. Like you, I just have him get cleaned up and change. When he was little, I called mom to let her know.

Some issues like chronic constipation can cause soiling accidents. This child does have that issue. But by now he should be old enough to realize he needs the bathroom.

As for the tears, same thing is happening here. It's a huge change from even a couple years ago. I have to wonder if children are just feeling so much pressure these days due to changes in curriculum, etc. (?) Every day we have children who are despondent about going to class.

I will say, I feel that a lot of children simply don't know how to work through it. They view feeling anxious as "bad" and have no self calming skills. Our poor counselor is in tears by the end of the day herself!

[RatherBHiking, BSN, RN]

Any excessive accidents of any kind I always refer for a medical evaluation first to rule out any medical issues. I also think it's helpful to use a medical exam to determine if any type of abuse is going on. It also lets the parents know we're taking this seriously because it truly shouldn't be happening at school. Once I have a medical statement on file and if it continues I refer to school counselor so they can figure out any issues behind it, as well as, setting up a bathroom plan with the teacher. I ask them to ask the child every 1-2 hours if they need to go, or tell them to try. I have them keep track of any accidents. I ask the parent to send in extra clothes and ask the teacher and parent to reward the child for each day they go without an accident with a sticker chart or something. Usually this helps. I swear sometimes parents use the school to potty train their kids.

I also notice an increasingly larger amount of kids who have trouble coping and feel more pressure in school. I also think the type of teacher has a lot to do with it. I've had students one year that practically lived in my office to get out of class to the next year barely see them and when I ask why they tell me they really like their class/teacher this year.

[CalNevaMimi, LPN, LVN]

I was a teacher in another life. Taught 3rd grade twice. It's weird for a 3rd grader to be pooping their pants without a medical diagnosis.

[100kids, BSN, RN]

I would definitely talk to mom and see if these accidents happen just at school or does he have frequent accidents at home as well. At that age there are reasons it could be happening that are totally out of his control. If he is having accidents outside of school it can sometimes be related to constipation and leakage around something in the bowel. This can hinder a child's ability to feel the urge to go so they don't know they need to go and then have accidents. There are practices that work with children with these issues but you have to seek it out and find the right one. I know here a local Nurse Practitioner has this in her wheelhouse. Anyway talk to mom and if this is happening all the time maybe you can help her find a local resource or even help her by knowing that there may be a cause even if her physician hasn't been able to find one as of now. Good Luck!

[jdub6]

Like the post above, depending on where you live there may well be a nearby clinic, whether a primary care provider who has a niche or a fancy specialist comic. Whether jr's insurance covers this is another story.

Another thought as an fyi, though in this case it may not apply. (I was just reading the cps call thread). If the child is adopted, is or has been in foster care or (less commonly) has had a death or divorce of his parents, intentional peeing/pooping "accidents" in pants or other inappropriate locations in children who are fully potty trained without a physical problem is a common sign of attachment disorders. This diagnosis is getting more common and regardless of what you think if it there are some manifestations that can be very disturbing to others. Some other signs would be kids who hoard food, even eating out of trash or sneaking to the coat room and emptying the whole class's lunches. Sometimes eating until they puke. Literally. Sometimes older girls who despite education etc hoard or hide their used menstrual products in desks, lockers (their own or not), etc.

Just a thought as your average school has at least one of these kids at some point, though they may not be this obvious. Excellent idea to have a team approach with counselor, teacher, and parent, regardless of cause. If it is a behavioral issue this will greatly increase chances of success as none of you will be able to be manipulated. If physical, it will help have a cohesive and sensitive plan.

[tining, BSN, RN]

I suggest to the parent to have the student wash the soiled undies themselves. This worked for my son who did not want to stop playing to use BR at 4yo. I bought one of those old washboard things and he scrubbed the undies - did this twice and miraculously stopped. Of course there are those that have a medical problem and should see MD.