Soiling at school - what support can we expect?

[MyCatHatesWhiskas]

Not sure where to post this but happy to move it (with the obligatory disclaimer that I’m not a poo troll.)

If you had a child who had soiling or toileting issues, including at school, what support did they receive from school, if any?

I’m asking because I’m at my wit’s end with DC1 (6). He has had toileting problems for a long time (but used to improve then get worse) and has been under a paediatrician since the spring. They diagnosed constipation, and he has medication to help with this. Just including this to explain there is a physical element as well as a behavioural element.

So DC1’s toileting has naturally got worse since school started. We have gone from maybe one accident every two weeks days to accidents two or three times a week, which is where it was last school year. He won’t tell anyone at school that he has had an accident so he sits in it all day. (And yes, we do suspect some undiagnosed additional needs and school aren’t being very supportive with that as “he doesn’t show any signs”. )

We are struggling in terms of support from school. We have asked them if they can remind him to use the toilet, drink his water, and have previously asked in Year 1 if they can discreetly check with him at the end of lunchtime whether he needs a change (as he won’t tell but will sometimes admit if asked). But none of this happened consistently last year - in terms of checking whether he was clean, they would always stop after a couple of days, even though the problem was still there.

It is upsetting me that he is left in his own poo for hours because he doesn’t feel he can tell anyone.

What support can we reasonably expect from the school? I am due to have a chat with his new teacher. I would like them to check in with him at the end of lunchtime to see if he needs a change, to remind him to try for the toilet at break and lunch, and to remind him to drink water (as he was coming home without having drunk all day). Is this reasonable? Are there other things I should ask for? Do I need to get the SENCO or school nurse involved? His paediatrician is very happy to write to the school - would this help?

Just to be clear, I don’t expect his teachers to be able to stop him having accidents. But I am really concerned that he is being left in his own poo all day, especially when we know there is a medical issue.

Checking if he needs a change and reminding him to go to the loo definitely. Engaging with the school nurse or any professionals working with you is the norm too. In reality I find reminding children to drink water very difficult as they typically only take a sip or two and you need to ask them many many times in the day for them to drink a meaningful amount. Normally there are several children that this applies to at any time. Not saying it's right but it's the thing I slip up on. No way should your son be left in his own poo regularly.

My friend has had massive issues with this.....from her experience yes get the paediatrician to write to the school. Push and push for inclusion on the SEN register - if the problem is resolved he can be removed. Find the support group for further advice....Eric. This can be a hard issue to resolve and you need the school on board with whatever you need. They have to support you with this. It is not just an issue of a little boy messing occasionally. You need to shout and scream to get the support your child needs. Good luck.

Your child needs a lot more help. Soiling himself at school is a massive red flag. He’s not coping and is probably feeling very anxious and isolated. The other children will know and be giving him a wide berth. The adults will know and not want to be dealing with poo. He needs way more support than a teacher on her own with thirty kids can manage.

Our son is 7 and has exactly the same issues. Definitely agree with sen register. Also worth looking into sensory issues as I am pretty certain my DS can't tell when he needs to go very easily. Hoping some extra proprioceptive feedback will help him learn the feelings better. We have also started helping him to help himself i.e. check his pants when he goes to the loo and change himself into new pants. He generally leaks a bit rather than full poos though.

Yes I have had these problems and similar experience to you.

One thing, not quite related but helped us is messing with the time of the movicol. We found if he had it in the evening it made his bm the morning, while otherwise he favours an after lunch poo which didn't work out with school.

My nearly 6yo is a bit better now. Massive reduction from many accidents to only a couple a week and normally on the way back from school rather than at school, so clean up and change can happen at home. It is not great but these things are all relative!!

Thank you so much for the replies. I agree with the pp who mentioned anxiety and him needing more support - this is absolutely true. And I also agree he may well have some sensory issues.

School say he shows no sign of need so doesn’t qualify for support, and their support is based on need, not diagnosis. But I think they’re fobbing us off. We are currently looking into private assessment (I think he has ASD, sensory issues and possibly other aspects of neurodiversity, apologies if I’m not using the right terms here).

We stopped the Movicol over the summer as it just didn’t work for him - we couldn’t get enough doses into him in the course of the day around school to get him going daily. He improved massively once off Movicol. He is still on Senokot. Had no issues with accidents or change to frequency of bowel movements until school started.

I don’t think it’s a coincidence at all that this has ramped up since school started. He is struggling with Year 2 (but saves it all for me on days where I pick up). There will be factors like water drinking/lack of and distraction (he will freely admit he doesn’t want to break off from playing to go to the toilet).

@Geneticsbunny, I’m interested in what you say about proprioceptive feedback, can you tell me more about that, please?

@PerseverancePays, that’s exactly what I’m worried about - he is going to get teased and be known as the kid who smells. I suspect you may have a point re adults not wanting to deal with it - the impression we got in Year 1 was that it was just too much to expect them to remember on a daily basis that he needed support. I even met his teacher to discuss how the problem would be managed on the school trip - and then she didn’t appear to have followed most of the steps and he came home having sat in poo all afternoon.

In my experience schools really vary on this issue.

I assume he's been prescribed movicol sachets or laxido. School can give him one of the doses and therefore you will know he's had a drink at least once during the day.

Get the school nurse involved and get them to write a home/school plan.

Moving forward the school are not allowed to refuse to change him or provide personal care though they may try and claim this.

My daughter has both bladder and bowel continence issues. I wrote a very clear plan of what needed to happen during the school day and sent it to the SENDCO and her teacher. I asked them to comment on any way it could be tweaked to fit in better with the class schedule but generally it was fine and they took her to the toilet at specific times and checked for soiling. I then just kept the pressure on them if I felt they were slipping a bit. At times I felt like a bit of a nuisance but it was the only way to keep the consistency she needed. After a while they got into a great routine with it and she's now doing brilliantly.

Talk to the school to see who they have available to change DS. If there is no TA with the class then the teacher can't just leave them to change him. It used to be that there were extra staff around who could help but that's not the situation in many schools.

Can he change himself?

SEN register.
Can you access the school nurse? Get a treatment plan from them, the school has to implement it.
get a TA on side.

Go to GP to start SEN diagnosis, bypass the school. Keep a diary of things which you think support this (and him maksing during the day and melting down once home is a classic example)

Ds1 had this problem at a similar age. I don't believe for a second that the class teacher can't smell it in a warm classroom. They should be discreetly sending your ds1 to get changed at a very minimum.

Ds1's school used to phone us to come and help him get changed, or to take him home for a shower if the situation was really bad. When he was a little older, he was able to clean himself up and get changed with wipes and nappy bags. It was all very discreetly dealt with.

Movicol eventually fixed it, and we managed to get a rock solid routine built in so that ds did a poo before school in the morning. I found that getting that routine was by far the most effective thing.

It's a lonely place to be, not talked about but actually really common.

I would say you need to get a proper plan in place. With all the good will in the world it can be very hard to remember all of the things each child needs when these things change daily, may be intermittent, 3 new things to remember have just been mentioned that morning and there's 30 of them.

I would get all the help you can get so yes the paediatrician letter, school nurse etc

Ask for a meeting with the class teacher and senco to create a plan. It may not be appropriate for the class teacher to help clean him up but the school do have to have somebody to do it. That should be in the plan (Specifically who and if not them, an alternative).

The school are correct that support is based on need not diagnosis, however I diagnosis can help schools to see when support is actually required. You can go via your GP but make sure you've can explain clearly the things you want investigating. Waiting lists are very long so if you can go private you'll get that diagnosis (if applicable) a lot sooner.

Teacher here, I had a very similar child in my class a couple of years ago. My TA and I asked every couple of hours if child needed the toilet and I taught child the makaton sign for toilet as well so they could show me instead of tell me because they were embarrassed to ask so much. Kept it up for the entire year. The child would also never tell an adult or confess to having soiled themself if asked at school, so if there was any suspicion at all, they were taken out the room and handed spare clothes, no questions, and the child never once said they didn't need the clean spare clothes. The adults need to tell the child its time to change rather than expect the child to tell them, they're likely embarrassed. If I had no TA, I sent said child with a friend and a note to another adult they're familiar and comfortable with to help. There's always a way.

Re: drinking water, it is notoriously hard to get children to drink water during the school day. I turned it into a whole class challenge, adults joined in too. The child that needed it then benefitted and didn't feel like an odd fish being the only one asked to drink because everyone was drinking. The challenge was to finish their water bottle, daily. We'd all have a pause, drink some water, check how much was left in the bottle and congratulate anyone half way there/all finished etc - everyone benefits as a result.

Definitely get the school nurse involved in your case, remind the teacher and TA again, email them as well. There's no excuse for them only following it through for 1 or 2 days. Arrange a meeting with the SENCO too.

Good luck.

Op this is such a difficult subject, my son also soils (& wets) he is 10. Is being assessed for asd after waiting 2 years plus to get to this point.

School have a duty of care whilst he is there so he should be getting checked whilst in school to go to toilet and that he’s not souled. No it’s not great dealing with it but it’s not his fault, my son was the same would come home with pants caked it was really hard. Thankfully his friends (or any other kids) have never said a word about him smelling etc so he’s been lucky but it’s still a huge worry for me.

If school won’t move forward for asd assessments ask the paediatrician, that’s who referred my son, it took some time though so the sooner you get a referral in the better or do it privately if you can afford it. Have you access to a community children’s nurse specialist in continence? My son has one who is fab. They can speak to school too!

We used dulcolax instead of movicol/maxi do as it’s not really practical on school days if your child doesn’t like it, it’s salty so not much disguises the taste, continence nurse did say eating something salty before it helps or using a straw to drink it with - I’ve done moviprep so know how bad it is. The dulcolax def helped us. We then had a fairly consistent toileting routine - (screens etc were used as rewards, lots of positivity when he tried or went on toilet etc) no negativity re accidents we just mop up and move on. he goes every hour at home, warm baths too help and exercise - both things my son hates so it’s difficult and he’s still in pull ups at 10 overnight and still floats out of his bed in the morning some days. It’s really hard op, just wanted you to know you’re not alone, it will get better, even if it doesn’t feel like it now. You do have to make yourself heard so your son can get the proper support at school as, if you’re all working together getting this under some control will make such a difference to you all. I have special sheets for bed and brolly sheets, mats for couch etc pants is my biggest peeve as sometimes they just go on the bin and I buy more.

No actuall experience but I'm thinking if it is happening a couple of times a week then plan for it to happen every day.

So send in a pack of underwear and wipes, get the child into the habit of wiping and changing a certain number of times in the day, I'm thinking morning break, lunch, afternoon break but you will know what your child's routine is.

Get him to do the change whether he needs to or not, that means he can't get too busy playing because it happens every day.

I am a teacher and have worked with many children who soil during the school day over the years. The school need to step up on this.

Personally I would speak to the teacher but ask to speak to the senco also. The school need to put an intimate care plan in place for your son. This should expect them to have regular toilet reminders, helping him check he is clean at regular intervals, and outline what happens/who will support and in what way, when he has soiled. They should also have a way of recording all incidents.

They should have some form of discreet reward system for being clean that will encourage him to try for the toilet but not shame him when soiled. He should have a trusted person that he is able to speak to when he has had an accident and a safe place to change.

Ask to see the school intimate care policy and if they don't have one, contact the headteacher as this should be in place.

@MyCatHatesWhiskas my eldest has significant disabilities and I was sent this web link to see if it might help him. However when I watched the intro video, the bit about kids with poor proprioception; always crashing about, wanting constant cuddles and wrestling, clumsy etc ; just sounded exactly like my youngest who has the toileting issues. We are starting on providing more proprioceptive input in the hope it will help him concentrate better at school and help him to recognise the signs that he needs to go better. Have got a weighted blanket and gym ball and asked if he can have a weighted mat at school. He is already on the Sen register as is very dyslexic.
www.sheffieldchildrens.nhs.uk/services/child-development-and-neurodisability/sensory-processing-difficulties/

Thank you - this is all really helpful, especially the concrete suggestions for things school can and should be doing. Alto reiterate, this is not intended to be teacher bashing - I have a huge amount of respect for the teaching profession and this is not an easy issue to deal with. But I have found some school staff easier to deal with than others on this.

To answer questions - he can change his own clothes but struggles with wiping and if it’s a bad accident he needs help to get cleaned up. He has spare clothes and wipes and bags on his peg at school but requires adult supervision.

He did have a card last year saying “I need help” which he could show to the teacher but he won’t use it. Ultimately, I feel we have all put it on DC1 to solve this issue at school and for many reasons he either can’t or won’t, so it is now time for the adults to step up.

We do understand this is really difficult to manage with a class of 30 - and reading between the lines from comments DC1 makes, it sounds like quite a high needs class with a number of children who have behavioural issues. Which I think is the problem: this isn’t a disruptive issue for them so they can ignore it, if you see what I mean.

They don’t have an intimate care policy. I have looked to see whether they have any policies covering this and they don’t - my thinking being that if I was sending him into school caked in poo, that would be a safeguarding issue, and therefore the reverse means his needs are not being met.

The school has a really good reputation locally but I have always had a slight concern that they’re better at presentation than delivery. It really depends on the teacher. I’m keen to work with his current teacher as moving him would be horribly complicated logistically as well as very disruptive for him.

If there is one thing I hate, it is when people don’t do what they’ve agreed to do. I would almost have more respect for them if they said they weren’t willing or able to provide any care and we would have to come in at lunchtime and check him ourselves, as we’d know where we stood then. But all these positive noises and then zero action just enrages me.

@Geneticsbunny, thank you - that is hugely helpful and ringing more than a few bells. I have realised recently that his sensory issues may be more extensive than I thought - he has started chewing his clothes again (necklines of tops), he “hugs hard”, if that makes sense (as in it can be painful for the recipient), jigs about quite a bit, etc. He has a rabid reaction to shorts and T-shirts (hates them and we have real issues with hot weather at home - he masks this at school for PE). He is terrified of hand driers and sensitive to loud noises. He is often funny about music.

I think I might try a weighted blanket and perhaps a wobble cushion.

Also, at the risk of sounding stupid, what does inclusion on the SEN register mean? What does it give or provide access to, and what are the implications? I’m just keen to understand fully what I might be pushing for as we’re trying to arrange an in-person meeting with his teacher.

Schools dont like to see needs as needs = adjustments = money.

Look at ipsea and season websites on how you can go about requesting a ehcp needs assessment yourself. My children have a diagnosis and even that wasnt enough for help.

It means that the school have to make a plan of how they are going to support your child and have regular review meetings with you once a term to chat and update things. If the issue resolves then they can be taken off the register. Ours has set 3 targets for my son which he will work towards and their job is to show what support they are going to provide to help him. Yours would be around independent toileting.

I’m a Y1 teacher and senco. I wouldn’t put a child on the SEN register for soiling, but I would put a personal care plan in place with parents to outline what we needed to do in school-changing, checking, ensuring they drank, keeping changes of clothes
/wipes etc etc in school. I would also involve the school nurse/continence team. Having a picture for the child to discreetly point to on the teacher’s desk if they need to be changed is very useful. I would be encouraging him at home to do that at school -maybe have the same card at home so it’s really familiar.

I would see the GP for a referral for paediatrics for an ASD MDA-that doesn’t come via the school in my LEA. In my experience, children hate being ‘checked’ especially by their class teacher (we have no TAs any more) and I would be really looking at giving the child some ownership here-something really discreet that they can do when they need to change. We had a little one last year who would put a cube in a pot on the teachers table and this meant he wanted mum to come and change him (mum lived next door and was really keen to do this).

You don't need an ehcp and would be unlikely to get one unless there is loads of other stuff going on that you havent mentioned.

My friend has an autistic son and went through this. The school wouldn’t help change him so if he had an accident school would phone and she would go in. It was really difficult as she often had to leave work.