Urgent - advice needed re: toileting!

[boombangabang]

Hi there
I am a cm and have recently taken on a nearly 4-year-old (July birthday). He only wees on the loo because I take him at least once an hour, and every day!!!! he poos his pants no matter what I do, sometimes twice. Have tried putting him on loo at the sort of time he usually 'goes' and encouraging him to poo, but he just waits til pants are up and then does a big sloppy one. Mum point blank refuses to put him in nappies, which I can understand, but the clean-up job today was extreme to say the least. Have googled the subject but it seems advice is a bit sketchy. Anyone cracked this one? BTW he has been doing this consistently at home and nursery ever since starting potty training age 2.
Would be so grateful for your experience / advice!

If he is doing sloppy poos twice a day then he is either costipated and it is leakage or he has dietry issues like coeliac or lactose intolerance etc or he needs re-training. Regarding his weeing, taking him so often actually has the opposite effect and his bladder will not get used to holding wee.
I would get mum to get him referred to the continance clinic at his local hospital for advice, they will do a scan to check the size of his bladder before and after a wee.
Presumably he will be starting school in which case they will be more sympathetic if expert advice has already been sought.
The clinic will give good dietry advice. I wouldn't use star charts until he has been checked out by the doctor as it really is beyond his control and it can have a negative effect on him.
I had a problem with my son until recently and the biggest problem for him was that he didn't feel the need for a poo hence we had leakage and the pressure on his bladder caused him to wee. We had excellent advice from the clinic and the ERIC website. He was taught to rock forward on the toilet, we had to make sure that he was comfortable and that his legs weren't dangling but on a step. It was a lot of hard work and it took a couple of years to sort out.
We didn't give lactolose though as that can cause even more uncontrolled leakage but we did keep a close eye on his diet, no sweets, apple juice or blackcurrant squash, but a good balanced diet.
Good luck

The doctors will also check his bottom for any fissures that may have caused pain in the past hence he might now be holding.

have you a tried star charts !or would the parents agree to you putting anappy on just for him to poo in!i know lots of kids who will not poo in the toilet.i had one little girl at about 4 oclock she would hide behind my shed to poo,then i would encourage her to sit on the potty with her fav snack or treat.maybe its his diet is he eating too much fibre that makes it sloppy.has the mum spoke to a dr this cant be very nice to clean up!good luck

Well it's not really that sloppy, just that it's all squished about up and down his bum, and once his pants are off, all over his legs too!
Taking him to the loo so often is what his mum does, if I don't do this he does wee himself too.
I will ask her to seek medical advice I think - he never seems to know when he needs to go, either that or he doesn't want to do it on the loo for whatever reason.
I could cut the pants off at the sides and chuck them I spose, but seems a bit of a waste.

Just cleaned up poo number 2 - produced 2 minutes after getting off the loo... DH has taken them to the park btw, not MNing whilst minding!
The poor thing starts school in September, but I am more concerned about the summer school he is supposed to be on because I know they're not even prepared to put sun cream on the kids so they're unlikely to get down n dirty with the pooey underwear.

These sound like classic signs of chronic constipation, where there is overflow and a big back-up of poo; the bowel gets overstretched and the child loses the sensation of 'needing to go', and the pressure on the bladder can cause wee issues as well. The poo appears sloppy because fresh poo flows around the blockage and presents almost as diarrhoea, so constipation is not the fisrt thing that one thinks of

They need to get him referred to get it looked at - as HSMM says, a scan can show how far 'backed up' the child is and a programme of treatment started, partic as he is going to school in Sept

Horrible for the child, parents and of course for you

Hmm well maybe I shouldn't have said sloppy - the poo seems fairly normal as poo goes.
His mum says when she has him at home and sees him about to poo his pants she makes him sit on the potty for 15mins during which time he holds it in. Then he gets off the potty and tries to go again - when she puts him back on the potty again for 15mins. This cycle can go on for 5 hours! Apparently he will eventually do it in the potty using this technique.

It seems like he really doesn't want to use the potty for some reason, ather than it being a constipation thing

if he is withholding then he needs to get medical help

Did you know about all this before you took this LO on?

Yes I did know about it but she said that he 'sometimes' has an accident. However on day one mum gave me a bag with 7 changes of clothes in which I thought was a bit suspect. The truth is he does it daily without fail.
Havn't managed to bring up the medical help bit with her yet, will try later...

My little boy refused to use the toilet to poo until he was 4.5yrs. He sorted out wees himself but took him from 3.5 to 4 to be reliable with wees. With him I think the pooing issue was linked to his autism- does this boy have any learning difficulties?

Personally I wouldn't say sloppy poo necessarily means constipation if he is going regularly. I found with my son his seemed a bit mushy but that was because it got squished by him doing it in his pants, gross I know! He definitely had no dietary problem.

We tried loads of things with my DS. HV pretty much dismissed it as it is not outside realms of normalness at 4 even though 4 is late. We tried sitting DS on loo after every meal, using a Thomas toilet seat, even giving him a portable DVD player to make him stay on the toilet (extreme I know but he is ASD so needs a lot of persuasion). We also kept saying to him push for poo and I watched his tummy to make sure he was pushing. We also bought a book called "Liam Goes Poo In the Toilet". It is a brilliant story book very simple with a stick man picture for each stage of toileting. It is part of a series of books which are targeted at autistic children but are also great for any child as they are so clear and simple.

Eventually one day my DS just clicked to use the toilet for poos. Initially he did it at night time but he then asked to be taken whenever he needed to go. I think ultimately it was a case of he did it when he decided he wanted to as he had the physical control a long time ago.

Hope this helps.

Also my little boy refused the potty totally, just used toilet.

Hi henryhsmum, that's really helpful - I will look up that book as it sounds really good.
He hasn't been diagnosed with asd but he does seem a bit developmentally delayed - his speech is very unusual in that it's sort of sing-song up and down, always the same 2 notes ifykwim. It's really hard to understand him, and he copies sounds and some things we say to him for several minutes sometimes which is reminiscent of echolalia but is also fairly common in young children from what i have read - my own ds is still only 2 so no comparison as I am fairly new to CMing, though i have fairly extensive experience of asd in adults...
I had to ask his mum to provide pull-ups after 3 days of pooing pants up to 3 times per day. He has never once said he needs to go either poo or wee, and only wees in the toilet because we take him every hour or more if we know he has drunk a lot.
His mum is getting really desperate though because he is supposed to start school in september - july birthday is also a disadvantage.
We only have him for a short time so it's quite stressful as I know there's no quick fix!

His speech does sound delayed. It's not dissimilar to how my son's speech was at that age. Does he play with other children and is he obsessive about anything or fussy with food? They are all other signs of autism. Really his mum needs to get the GP to refer him to a paediatrician to assess him. In my opinion by the sound of it it is more his general development than just the toileting that needs looking at. If he is diagnosed he may get a statement if special educational needs which will give him the extra support (from a teaching assistant dedicated to him) he needs and a statement obliges the school by law to accommodate his needs. In my experience it is very difficult to get a statement without a medical diagnosis. Do you think his mum would be receptive to you suggesting that perhaps his wider development needs examining by specialists?

The other thing to add with autism is that it is a spectrum and it manifests itself in children in different ways and to different degrees.

Can his mum delay school start til January given his age as with his birthday by law I don't think he would need to be in school until then. It would give her time to get the support it sounds like he needs in place

He does play with other children but at the same sort of level as my other mindees who are not yet 2 i.e more like parallel play. His mum has mentioned that he doesn't play with other boys at nursery but i thought she meant he played with the girls instead - his play is not very creative and he has no interest in craft type activities or role-play, he will sit on the ride-ons and make car noises and say he is going to work, but this is as far as it goes, he can do the car noises for literally hours. I havn't noticed any obsessiveness and he will adapt to different situations quite easily which is not a typical autistic trait - I suppose he might be classed as a bit developmentally delayed?
If he were mine I would keep him out of school until January at least - I will bring it up with his mum but to be honest I think from what she has said she is really looking forward to having a bit of time to herself - she is doing temp work at the moment for £7 an hour and is paying me £4, and obviously I work more hours what with commute etc - to me that says she has taken the job to get a bit of a break from it?

My DS is also quite adaptable to situations but the parallel play is a sign of autism. Some autistic children are really hyper sensitive to route changes but others are more placid. Its difficult to be definitive as it is quite a wide spectrum. He sounds similar to my little boy in a lot of ways, he was 18 months behind when assessedI didn't think my DS was that bad but when he was assessed they recommended a specialist school. I think if it's your only child it's difficult to judge how far behind they are as you have no benchmark. To be honest the car play does sound a bit obsessive in that it's repetitive. My DS used to do this with trains- he would spend hours playing with them on the track, talking to them quite imaginatively but that was all he wanted to play with and he would get very engrossed in it.

I can see why his mum wants time on her own - I volunteer at a school and I know that the law has changed so that children who would normally start school in January can start in September but they have the option of just going part time initially which may suit this little boy.

DD is like this she is now 5.5 and has been with a paediatrician for nealry 2 years without success, she still wets herself and refuses to poo on the loo, she has just been diagnosed as borderline Aspergers (she has a lot of the traits but copes well). NOt sure what to do but could you gently suggest that a second opinion may be valid or a trip to the Doctors?

Wow maybe he does need some kind of professional opinion in that case, in order to get him the best help at school. I will try to think of a way to suggest this without offending the mum - any suggestions?

print out this page and hand to parents, say something like ''I have noticed that little Johnny is soiling quite often and you might like to read this, which gives information on this very common issue, and make an appointment to see his GP''

What do you think?

thanks for that BoysAreLikeDogs, it's very useful - However I really don't think he is constipated - when looking at the list of symptoms the only ones I have seen is the soiling, and his mum says he withholds poo when she tries to make him do it on the potty or toilet. He has no trouble pooing, poo looks normal (I know I confused things by describing it as sloppy but it's really just like the poo of the other kids I mind) and he regularly poos 2 times a day at the exact same time. I think he has some kind of anxiety about using the potty or toilet to poo, maybe he needs to be seen by a psychologist of some kind?

yy certainly flag up to parents as needing to be referred to someone

good luck, and you are very good to be concerned about the child