A very interesting blog topic request this week from a regular blog follower and commenter is a behaviour called “scatolia.” In simple terms, “poo smearing.” Whilst I have a child who can “protest vomit” (read: vomit at will), thankfully neither of my kids have ever done this. I have so much sympathy for parents who have to deal with this behaviour, so Leticia – this article is for you. It has happened once to one of the doctors in one of the private practices I work in (during a consult!)… we jokingly refer to the incident as a “Code Brown Emergency.”
Why (oh dear God WHYYYYYYYY!?!?) does it happen? What can we do to stop kids from doing it?
This highly undesirable behaviour occurs fairly frequently in children with significant developmental delays (eg autism, ADHD, intellectual disability) and in children who have a history of other kinds of trauma (eg abuse, PTSD) or mental illness (for example, bipolar disorder, schizophrenia, anxiety, OCD). Sometimes it occurs in normally developing (“neurotypical”) children for no apparent reason. I am not going to go into psychological causes for poo-smearing, as these can be really complicated, and are best dealt with by your health care professional (eg your paediatrician, GP and/or psychologist). Instead I will focus on a couple of approaches and interventions that can be tried to discourage the behaviour no matter the cause. For parents who have children who engage in scatolia, it is stressful, tiresome, off-putting and downright gross.
When this problem has presented in clinic, I usually take a history to rule out any possible medical causes for the problem. Some of these problems might be (but are not limited to):
- Worms (or other parasitic infections): Infections like threadworms can cause an itchy bottom (particularly at night time). IF your child has an itchy bottom around the same time they have a full nappy (or even if they don’t) and end up with muck on their hands… hey presto.
- Chronic constipation (that can cause tummy pain, impacted stool and soiling) can cause discomfort that children may seek relief from by “rectal digging” behaviour
- As related to chronic constipation, other conditions like haemorrhoids (dilated blood vessels around the anus that can be itchy, painful or bleed), anal fissures (little tears in the mucosa around the anus) and rectal prolapse (when the rectum (the last part of the large intestine) slips out of the anus, often due to excess straining when constipated) can also cause poo-smearing behaviour
Obviously these issues are often entirely treatable, so seeking the advice and assessment of your friendly local GP or paediatrician is important in the first instance!
Usually I first recommend trying to limit the child’s access to their own poo by using clothing that is difficult for the child to remove themselves. This can be a problem in terms of encouraging independent toileting, but given that poo-smearing often occurs when the child is unattended or unsupervised like when lying in bed for a nap or at night time, using it in these situations is usually not overly problematic. Examples of restrictive clothing includes, putting a nappy on backwards (and potentially taping over the Velcro tabs with electrical tape). Putting a onesie on with the press-studs/buttons/zips at the back.
Past this, depending on the cause of the poo-smearing, the intervention might vary. If it is occurring as a sensory seeking behaviour during periods of boredom, then allowing your child to have frequent access to safe substances that meet this need can reduce their drive to handle their own poo. This might include periods of supervised play with substances like play-dough, shaving cream in a tray, bread dough, Blu-Tac, wet sand or play slime. Smearing colourful paint can also be a useful and less smelly alternative to faeces. Mixing in a strong smelling non-toxic essential oil into the paint/dough or even ground spices can help placate children who sensory-seek strong odours.
Keeping a diary of when the incidents occur and then recording what happened immediately before and then after the behaviour is important – including what the reaction of the parent or caregiver was. This will help you (and potentially your paediatrician or psychologist) to identify triggers for the behaviour (eg boredom, lack of attention, bedtime) so that we can help to avoid them, treat a medical condition (eg if a child is getting an itchy bottom at bedtime because of threadworms) or do something to distract from that trigger (eg a new rotating night light or lullaby generator). Like many undesirable behaviours, a strong emotional reaction can worsen the problem and increase the frequency at which it occurs.
As is advisable in trying to quash other negative behaviours, dealing with the mess in an unemotional fashion (as hard as that might be, maybe try a peg for your nose?) and using as little interaction as possible (no eye contact, no conversation) is the way to go. Any attention (even bad attention) can be better than no attention at all and even getting cross at the child might be inadvertently rewarding them. Noticing and praising GOOD behaviour (positive reinforcement) then is just as important.
If the child has a history of trauma, or the parents suspect a mood disorder, or some other psychological reason, psychotherapy and perhaps psychiatric intervention might be necessary to successfully stop the problem. This will be something you need to talk to your doctor about.
I think I will stop here… but I really do hope that you found some of this information helpful.
Be sure to hit “Like” and/or “Share” and leave me a comment to help spread the word on stopping the spread of poo.
Till next time,
Stay clean!
xxDr Megs
