4 YO, soiling problems. Don't know what to do next.

[FallingWithoutStyle]

My DS is soiling himself everyday. multiple times some days.
he is 4.5. He has been toilet training for 2 years.
he's generally good with wees.
he's not constipated.
star charts don't work
removal of toys doesn't work
we went to GP a few months ago and got lactolose. that started to work. we were down to a few accidents a week. then ds was very ill, put lots of anti -b's. which effected his tum and poo (very loose) and now we're back to square one. Ive had him back to the GP but his not constipated. DR gave more lactolose (said it won't harm), but DS is producing lots of poo so appart from initial week i've not given it.

to complicate things, he has speech & language delay (he's under SALT) so he can't tell me if there is a problem (trust me I've tried asking, but he doesn't know what the problem is)
he's at nursery and the teacher wants the SENCO to review him, as she has concerns. BUT he was seen by a SENCO in oct (in a different setting) and she said his problems were limited to speech.
I'm at a loss of what to do next. I don't think he has control over it so please don't say reward chart. he starts school in sept and he's going to have enough problems as it is (with speech), that I don't want him know as the boy that poo's himself.

HV were useless (came in for 5 mins, handed me an information sheet, then left). So I think that avenue is closed.

Oh poor little boy . Try cutting out wheat from his diet, he can have pure rye bread or ryvitas, also rice pasta is nicer than wheat IME (read the labels though there's wheat in so many things) instead. I

f that doesn't improve things, then maybe dairy is loosening his bowels.

Have you had him tested for coeliac disease? It is quite common, 1 in 100 people, most of whom are undiagnosed.
Dont make any majordietary changes without getting tests first. Eg test for coeliac wont work if you cut out gluten, which is in wheat, rye and barley.
Go back to the Gp or find another one as lactulose is obviously not the solution.
My ds had speech delay and it took a year to persuade them to do coeliac test and he turned out to be coeliac, so dont be fobbed off.
Common symtom of coeliac disease is loose stools which can improve after diagnosis after only a week on gluten free diet, the change is amazing.

He is not floppy or Un coordinated . His physical side is one area he has been ok in .
He does have developmental delay. I've been told it's just in relation to speech and language but his nursery teacher has raised further concerns and wants a senco to see him (he's been seen by one already). I don't know what that means in terms of what they think is wrong.
I've considered allergy but feels like I'm grasping at straws tbh.
His stools aren't consistently loose. Sometimes they're formed, sometimes hard.

I think I do need to take him back to gp. but I've been fobbed off so much . One visit I told gp he was soiling himself 4 times a day (this was its worst) and they asked me have a tried a star chart

sorry I digress.

Ask for a paeds referral. Regarding all your concerns, not just the poo.

A SENCO can't diagnose anything, they can just suggest a referral to someone who can. His teacher will see lots of children, including those with speech delay, so if she feels there is something else going on I would consider it.

Has GP checked for faecal impaction? My DS had similar problems with soiling (he's 5), he didn't seem constipated at all - soft poo every day etc but turned out he was impacted higher up so still had constipation soiling. He was initially prescribed lactulose which helped a bit but what has really sorted it out is Movicol - he initially needed a large dose over several days to clear the blockage, now on lower maintenance dose. I had to really pester GP though to get the right diagnosis/treatment as several GPs we saw didn't seem to know much about the problem or best way to treat it (despite it being apparently quite common esp in little boys). If it does turn out to be linked to constipation/impaction issues then don't bother with star charts/punishment etc - we tried this at first but made everything worse as they can't help the soiling and he just got upset.

Does his poo look normal other than being loose? Is it the right kind of colour? Does it ever cause severe rashes e.g. red raw skin around bum? Some of those things might give more clues about whats going on.

Does your DS drink much milk? You mentioning that it flared up after a bad tummy bug made me think of temporary lactose intolerance (common-ish problem after severe stomach bug, associated with bad nappy rash due to acidic poos, DD1 gets this). If that fits, try switching to lacto-free milk for a week or so and see if that improves anything.

Accidents can be sign of chronic constipation (loose poo is leaking around a hard blockage further up, also DD1). So I think your doctor is right about keeping going with the lactulose. Have a look at the ERIC website www.eric.org.uk/Parents/information_constipation_parents for other ideas.

I can't suggest anything to help with the soiling, but please agree for the school SENCo to see him. As another poster has said, the SENCo can't diagnose anything, as that's not what they are qualified to do, but will be able to refer on to other services which may be able to get you some help and support.

Oh, also, with DD1 we set up a regular 'toilet' time. At a prime time for action (after dinner in our case) we would sit her on loo, no pressure/comments and just give her 10mins peace/colouring-in time (the ikea step-stool is an excellent toilet-side table/footrest www.ikea.com/gb/en/catalog/products/30178879/). If no action in 10mins, then we'd take her off, no pressure/encouragement etc.

Setting up a kind of routine like this was really helpful for us with DD1. We also had to resist giving her loads of positive praise for success, as this also added to DD1's stress about it all. So poos were just treated like any other normal daily event (although of course we felt like jumping for joy when she did a poo in the loo not her pants!). Same with cleaning up accidents, keep a neutral expression, no discussion of trying to go to loo next time, just matter of fact sorting out like how you would deal with a runny nose.

Try this www.eric.com, advice for continence issues in childhood. Be reassured that this is more usual then you think.

early medical intervention is key if there is a genuine sensory difficulty here and I don't really see what good SENCO would do.. needs referral from GP to specialist paeds unit for assessment. constipation can appear to not be constipation, especially if frequent. Also spina bifida occulta is quite common 10% or so of births and normally completely subclinical but sometimes it can present with sensory issues - & of course allergies, intolerances, or celiac disease may all cause difficulty. Don't worry it will be fixed, early days really don't panic.

I dealt with this for four years with one of my dc. He wasn't badly constipated but he was withholding which caused the soiling. I recommend the ERIC website as there are other people who know what you are going through. Our GP was excellent - absolutely brilliant - and worked out what the problem was and prescribed movicol. This made it impossible for ds to hold it in and we were able to establish a routine for him. When we got into the routine we lowered the dose to one a day and he stayed on movicol for four years. During that time we had ups and downs particularly when he was anxious or unsettled or after illness. We also had to resort to bribery for poos in the right place. But we got there. The book recommended to me by another mner was this www.eric.org.uk/Shop/product/20

My DS was like this - he was 3 months premature & a little behind with some things. He got the hang of wee's reasonably quickly but regressed when he went to nursery. It was over 18 months after that before he stopped soiling. We also tried lactulose, but it just made his bowels too loose.

The only thing that worked for us was incentivising with IPad time, or buying him a toy he really wanted. And to keep incentivising, or he went backwards. Prior to that we tried sticker charts, etc.

He was nearly 5 by the time he was fully toiler trained. My GP said it wasn't unexpected in premature boys. One of DS's fellow nicu friends was referred to paediatrics & was found to have an anal fissure, so there could be some merit in that for your DS.

Hello Falling. Lots of good advice here. DD1 is a withholder and became impacted. It took a long time to get a proper diagnosis because she did a poo most days. We had over a year of almost daily poo in pants and it wasn't until we got to see a consultant that we got on the road to recovery. Push for a referral and don't take no for an answer. It takes a long time for an impacted bowel to get back to normal so you need to be prepared for a long haul. Lots of pants will be required.

Good luck and hang in there. It will get better in time. I didn't always find it easy to be relaxed and easy going about it, but I wish I had, as I'm sure the stress of me being stressed didn't help DD1.

Lots to think over here so thank you for such a response. I need to digest it and come up with a plan of attack.

I am totally agreeing to the senco review. I pushed, pleaded and begged for his first review (which was Oct last year and the senco only agreed to 'because I can hear your upset')
she said there was nothing apart from the speech that was the problem. that assessment was at a different setting (for clarity he goes to private nursery on my work days, for childcare purposes, and he goes to the school nursery 2 sessions, to get used to the school)
I've been biding my time in getting the school to put a plan in place of how they are going to support him in reception, as I had planned to push for this in earnest after the place is confirmed (which is end of this month).

I had sought a senco assessment initially because I was concerned he isn't responding to speech therapy as well as anticipated; the toileting; and some behaviour issues.

After being told by the 1st senco he has no additional problems, it knocked me sideways when the nursery teacher raised concerns in parents evening.

as a side. those who give children movicol ... how do you get them to drink it? my eldest was on it but I couldn't get him to drink it because it tastes so bad. I can usually talk him into anything so can't see me convincing ds2 to drink it at all (he rarely does things that he doesn't want to do)

We never got ds to drink movicol in water, but we managed to get him to drink it in milk. It doesn't taste of much, and ds didn't know it was there. Another tip is to mix it with half a cup of milk and pour it onto cereal out of sight of the child :)

The senco thing might not help with the poo - with many children it's not related to any developmental difficulty. With ds the withholding was just down to some early episodes of constipation and he'd got himself into an unhelpful cycle. Now, 18m on from the last sachet of movicol, he's just like any other 7yo.

DD1 had always managed to take her movicol. I started with it through a straw and made it up with twice as much water to dilute the horrible taste. She flat refused to take it in any sort of fruit juice. We use the movicol song a la Madagascar to throw it back to ... "You've got to move it, move it, you've got to move it, move it, you've got to MOOOOOOVICOL". Along with accompanying silly dance.

DS age 5 has had phases of soiling since he was otherwise toilet trained. He also has speech problems and some balance and coordination issues and is a bit behind with writing but no formal
Assessment has been done, so your post struck a chord, op. Lactulose helped a bit but he began having stomach pains every day for months. Go did nothing so I removed gluten from his diet and no more pains and no more soiling, although obv, no diagnosis possible now. I'm just glad he's better, but it's costing me a bloody fortune

I mean GP did nothing!