Fecal smearing is undoubtedly an uncomfortable subject. I know people don’t like talking about it, but it’s a challenge that many parents with autistic children encounter. Because of the subject nature, there’s not a lot of information out there to actually help parents solve this problem.
Causes of Fecal Smearing in Children With Autism & How to Stop it.
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What Causes Fecal Smearing
The medical term for fecal smearing is “scatolia.” There are several reasons why autistic individuals may engage in this behavior. Most commonly, scatolia is a sensory-related issue. However, it can also be medical or behavioral.
It’s important to determine the cause of the behavior in order to address it correctly.
Sometimes fecal smearing is a sign of a medical condition or gastrointestinal problem. It’s important to bring this behavior up with your child’s pediatrician to rule out or treat any medical causes.
Possible medical causes:
When a medical issue is behind your child’s scatolia, usually your child is using the behavior to communicate to you that something isn’t right.
Sometimes fecal smearing is only a behavioral issue. Your child may do this if they:
If you suspect behavioral reasons for your child’s scatolia you should try keeping a behavior diary. Each time it happens, make a note of when it happened, where it happened, and thoroughly describe the events before and after the fecal smearing occurred.
This will help you discover behavior patterns surrounding the scatolia.
It’s difficult but important to have a very minimal reaction to fecal smearing. Just clean it up, don’t talk, don’t yell, or even look at your child.
Experts recommend that you don’t involve your child in cleaning the mess. They say that your facial expressions and body language will show shock and disgust. This may reinforce negative feelings your child may have about themselves, worsening the problem.
There are various sensory systems at play here and therefore various possible sensory causes. For children with autism, sensory issues are the most common reason for fecal smearing.
Some possible sensory causes include:
Sensory behaviors can be very challenging to stop because they are automatically reinforcing for your child. Since you can’t take away the reinforcement, you need to replace the behavior with something that works better at meeting their sensory need.
How to Stop Fecal Smearing
Like any parent who’s ever walked into their child’s room after nap time, only to be greeted by a horrifying mess – you want to know how to stop fecal smearing from happening.
How to stop the behavior ultimately depends on what’s causing it in the first place. First of all – rule out medical causes or treat any underlying medical conditions.
Make sure you aren’t reinforcing the behavior
Sometimes as parents we unintentionally reinforce troubling behaviors. For example, maybe you raise your voice at your child and then keep an extra close eye on them for the rest of the day.
But, if the reason your child is smearing feces is that they are attention-seeking, then your reaction is reinforcing their behavior because they’re getting extra attention from you.
Or, perhaps this is an avoidance technique. If they’re doing this because they want to avoid going to school and you then make them wait while you clean it up, then their avoidance technique is working.
This is why a behavior journal is important for tracking behavior. The cause is not always what it appears to be.
Make sure you are reinforcing correct bathroom use
When your child does use the washroom correctly, make sure you acknowledge them with positive reinforcement. Positive reinforcement for doing the right thing is more effective than punishing for the wrong behavior.
If this usually happens outside of the bathroom, for example, the bedroom is another common location, use positive reinforcement frequently when your child plays or sleeps in their room without engaging in scatolia.
Use visual cues and social stories
Visual reminders about appropriate and hygienic bathroom use, along with social stories can help reduce the behavior. A visual is always there to remind children of expected behavior.
You can learn more about how to create your own social stories here.
Address sensory needs
Sensory challenges can be very distressing for children, and it’s important to address them to help your child overcome fecal smearing. There are a few different things you can try if your child’s dealing with sensory processing issues.
One reason children may engage in scatolia is due to tactile defensiveness. It’s possible they find the feeling of toilet paper uncomfortable or even painful.
Some signs of tactile defensiveness include:
Try switching out your toilet paper for a softer brand, or using flushable wet wipes as a more gentle way for your child to clean up.
The opposite end of this spectrum is that your child could actually be sensory seeking. Does your child love messy sensory play?
Fecal smearing often happens at nap time, and that’s because at nap time your child’s bedroom can be understimulating. If your child is under-stimulated, they will engage in sensory seeking behaviors. Making your child’s room more stimulating can help.
Make your child’s room more stimulating & sensory-friendly
Provide messy sensory play opportunities
Outside of nap and bathroom time, make sure you’re providing lots of opportunity for your child to participate in messy sensory play.
Often because this type of play is so messy, parents restrict or avoid it. But, if this is the type of input your child needs and they aren’t getting it – they will turn to other options to meet those needs.
Interoceptive awareness is your awareness of the sensations happening inside your body. Interoception is responsible for everything from bathroom needs, hunger, thirst, breathing, and emotions.
If your child has poor interoceptive awareness, they may not be able to tell when they need to use the washroom based on the signals their body is giving them.
This may lead to fecal smearing as this may be their way of checking if they need to have a bowel movement.
Ensuring your child is drinking enough water and getting enough fiber may help if your child has poor interoceptive awareness. This helps bulk up your child’s stool making it larger and formed, which makes it easier for them to feel when they need to go.
If your child is a picky eater, one way to add fiber to their diet is with kid’s gummy fiber supplements.
Restrictive Clothing to Prevent Fecal Smearing
Lastly, if all else fails you can try using restrictive clothing to prevent your child from smearing feces. Personally, I feel this should be your last line of defense. The reason being, it simply doesn’t address the cause of the behavior.
Behavior is communication, so it’s important to address the underlying causes of any inappropriate behaviors to determine your child’s needs and help them.
Although restricting clothing prevents the behavior from occurring, it doesn’t get to the bottom of what your child needs.
However, the clothing itself doesn’t cause any harm and if this is a severe and ongoing issue then this may be a reasonable temporary solution.
Fun and Function is a retailer for children with sensory needs and they sell these shorts called “Keeps Me Clean: NoPu Shorts”. They do exactly what their name implies.
Other Resources for Scatolia: