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.

I think at 6 he should be able to wipe himself up after an accident. With some wipes and a bag etc.
Practise that at home if he does have an accident.
I see both sides in that i feel generally schools seem to have too few toilets and expected from a young age to go and q during their playtimes. Our school has 2-3 toilets for 60 kids!!
Then yes they are likely not drinking enough. And say at home they might have more fruit. Then there are birthday parties with a lots of sweet stuff that constipates.
It's really not set up for reluctantly drinkers or those that need instruction not gentle reminder.
Imo he shouldnt be being allowed to play at school at breaks till he's been to the toilet.
I dont think a teacher should generally be sorting it though as they have 30 kids. Past say reception age and barring severe needs
I thought you need to get to the point it's relatively loose for a while so the hole shrinks a bit so kids have more sensation.
Is he also holiding wee too long?
I agree about trying to get into a pooping routine.
Even a reward chart at home for say drinking whole bottle.

@Motherchicken

It’s is a classroom teachers job to clean a child who has soiled themselves? Not sure where that’s written into the Teacher’s standards.

You've been told repeatedly that schools have a duty of care to children even if they have toileting issues.

You've been told not all children can cope with cleaning up.

Yet, you are still arguing and you aren't helping the OP.

Just stop it

@SweetBabyCheeses99

“we would really prefer to avoid that. Technically it would be possible as one of us is usually working from home or looking after DC2 ”.

I think that you’re right that’s it’s not fair of you to put all the responsibility for this on your child, but you’re looking to the wrong adults to help. Think about how hard it is for you manage two children - then multiply that by x15 for a teacher responsible for 30 all day. Plus, to put it bluntly, the teacher is there is educate these children, not to wipe bottoms! The obvious and natural solution would be for you or your husband to pop in to the school to change and clean your son; this is going to be the most comfortable option for him too. I would be concerned from a safeguarding point of view if you persist in reluctance about this. The more that you push this with the school and make out that poo is their responsibility, the more likely it is that they will say his needs are too complex and you will have to find him a special school place.

I agree with that. However your ds does need adult help,of some sort

@soapboxqueen
I have never once claimed they do not have a duty of care. Please read what I have written carefully.
To look at something from a different perspective is not a crime. OP asked for opinions, I didn’t take that to mean only opinions from certain people. I don’t know why you and @BabycakesMatlala have jumped on my comments. I have also seen other posters agree that a 6/7 should be able to clean themselves up after an accident.

In my school, the Y2 classes do not have toilets within the classroom (unlike Y1 and FS) so the class teacher would be unable to leave their class to go and change them. We have no shower either.

Some schools may be better kitted out with more adults, toilets in close reach and showers on site.

Our school nurse referred us to the continence service but there was a long wait. Luckily the issues started to resolve around age 6 once the specialist help kicked in.
A bowel stimulant was key to our success, alongside movicol.

[quote Motherchicken]@soapboxqueen
I have never once claimed they do not have a duty of care. Please read what I have written carefully.
To look at something from a different perspective is not a crime. OP asked for opinions, I didn’t take that to mean only opinions from certain people. I don’t know why you and @BabycakesMatlala have jumped on my comments. I have also seen other posters agree that a 6/7 should be able to clean themselves up after an accident.[/quote]
I have read what you have written and I still don't see how your comments are helpful.

The OP asked for help not a critique on what her child should be able to do.

Other posters may agree with you, doesn't make you right or negate the fact that not all children are the same and some need extra help.

It's not rocket science

Hi OP my son has similar issues and is autistic. The school absolutely is responsible for dealing with his toileting, I would suggest you approach it as a disability (which it is) and request a personal care plan. They need to take steps to manage his toileting just as they would if your son was e.g. a wheelchair user. It's the sort of reasonable adjustment they are legally required to make. Posters suggesting it is not part of a teacher's job frankly don't know what they are talking about.

We have been referred to the continence service and also psychology to deal with the problem. The most helpful thing we've done is to establish a routine whereby DS sits on the toilet 10 minutes after every meal and stays there for 5 minutes. This happens at school as well as at home. It's important to wait the 10 minutes as this is the time the bowels are most likely to open.

We also have a special green card my son shows if he has had an accident. This makes it discreet for him and staff can also ask "do you need the green card?" Which saves others in the class knowing.

I thought you need to get to the point it's relatively loose for a while so the hole shrinks a bit so kids have more sensation

This can take as long as the child has had the issue to fix it. So, years.

If the child has a medical problem then the school need to facilitate helping with that just as they would with any other child.

We had the same problem, it wasn’t until we got the continence nurse and SENCO involved that we came up with a plan of care that involved regular toileting at the same time every day (so after food, which is important). Plus being encouraged to drink more.

Speak to ERIC, they were not impressed that school were phoning us everyday to leave work and come and clean him up. So we sorted a plan of care and things improved massively. Part of the problem was that the teachers didn’t understand his medical needs, rather than him just being lazy, which isn’t the case.

@MyCatHatesWhiskas

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.

The person you need to meet with is the Senco, not just the class teacher. I’m a Senco (albeit retired) and here’s what I’d be doing. 1 referral to the encopresis service who will come into school to support the family and staff 2 inclusion of child on SEN register and commencement of IEP / HCP 3 drawing up of a detailed daily care plan to include a comprehensive toiletting programme.

I’d implement support to take child to the toilet at regular intervals (hourly?), encourage child to poo, positive praise + reward system, regular check up of child and immediate change of clothes when necessary.

I’m surprised school are saying they don’t know when he’s soiled. I don’t believe them TBH. When dealing with this matter, it’s always obvious when an accident has happened. I believe they are allowing him to sit in soiled clothing as they are reluctant to change him. Judging by the comments made on MN last week about this very matter where a school staff member was questioning whether she should be expected to change a soiled child or not, I wouldn’t be at all surprised.

When you do meet with the school, don’t be fobbed off with “we can’t possibly change him, it’s not our responsibility’. That’s unacceptable, and discrimination on the grounds of disability.

People who are suggesting that a 6yo should clean himself up have possibly not dealt with soiling, which is different to normal poo accidents or failure to wipe. Blockages in the bowel mean that very sticky liquid poo flows past and this is what comes out when a child is soiling. It’s a nightmare to clean up as it’s incredibly sticky. It also smells terrible, and makes the child’s skin very sore. Poor DC. Chronic constipation is a problem which most families are lucky never to have to understand.

Is it partly dietary?

What would happen at secondary

If finances allow I'd pay for a private OT assessment- you need an OT with sensory integration training. You can get the sensory issues identified as well as look and fine/gross motor and coordination issues. It will look at things like whether he can wipe himself etc.
In my experience schools step up when you get reports and recommendations in writing.
Assessments from OT and SLT are often more useful than a diagnosis as they often have more detail on the child's difficulties and more recommendations which school can implement.
Also start creating a paper trail. Start emailing school about any issues and recording how many accidents each week/month. This will be useful evidence if you need to push harder for more SEN support or an EHCP.

@LemonWeb My thoughts exactly, cleaning up soiling is a completely different ball game. I actually feel really sad reading some of these comments which essentially suggest kids just can't be bothered to wipe their bums. My daughter is nearly 6 and the thought of her trying to clean herself up after a soiling accident is heartbreaking.

@SweetBabyCheeses99 lol at the suggestion of a special school place. Do you know how difficult those are to get, especially at primary age! You are talking about 2 years plus collecting evidence and obtaining an ehcp, then finding a special school who will agree they can meet your child's needs, which is impossible if they have an IQ in the normal range and even then the school is unlikely to have spaces. It costs councils 3x more to give a special school place than it does to employ a full time teaching assistant to look after them in mainstream.

Wow, this took off in my absence. Thank you for the wide range of opinions and the more constructive suggestions. I really appreciate the contributions of those who have been there.

I don’t think it’s unreasonable to say it would not be ideal to be summoned to school with a toddler to try to change him - not least because he would have to wait until I arrived, which could take up to half an hour, and then I have to manage both of them in a confined space while dealing with poo. I’m not unwilling, and if school ask, we would.

It would be less of an issue if one of us was WFH. However, there are some days when we’re both in London, which is a minimum of 90 minutes journey. That strikes me as too long to be a reasonable ask for him to wait.

Frankly, at the moment, my issue is less with who cleans up the accident and more about how staff can help identify that he’s had an accident and help give him the confidence to be able to ask for help if it happens.

You’re quite right that working on wiping is important. He has a strong reluctance to wipe but can manage it. This is something we do make him do at home for normal bowel movements. But a larger accident where it’s all over his legs is difficult.

I would have no problem with a member of staff supervising him and directing him rather than doing it for him, even if he’s not completely clean. I do appreciate the numbers issue and the safeguarding factors. But at the moment, the issue is how we can get school to know/realise that an accident has taken place. Then we can discuss what happens next!

He doesn’t need to be in a special school. He’s a very bright and articulate little boy and he’s keeping up fine academically. He is a very young summer-born as well (so only just six, rather than 7). I do think it is not as nurturing an environment as I thought. But there is no way he would qualify for specialist provision.

Sorry, I will probably miss loads of previous questions. We try to get him to sit on the toilet at the same time every day (early evening usually), but he is not always very cooperative - he’s quite oppositional and could get into a fight in an empty room in a certain mood. We’ve offered incentives like watching stuff on a tablet but that actually sometimes hinders because of how he likes to sit. It distracts rather than helps.

@HotPenguin, thank you - that’s helpful. I do think a regular sit after lunch would be a good idea. See, my problem is I don’t actually know what to ask school to do.

We stopped the Movicol after four months as things were much, much worse. We played around with the dose but it didn’t help. We stopped one week when he was ill and decided not to reintroduce it and see what happened - and the rate of accidents dropped off dramatically. Whether that was the right thing, I don’t know. I spent most of those four months chasing the 4-6 week follow up appointment it took six months to get and I couldn’t get any interim advice about alternatives or what to do.

But what I know is that his toileting was vastly improved throughout the school holidays and it has slipped right back within weeks of term starting.

@darcybeau, thank you - that’s a really good tip re OT assessment. Do you have any suggestions beyond Google as to how to find a good OT experienced in this sort of thing?

We already have a paper trail - I have all emails saved from last year.

@Soontobe60, thank you - that’s helpful and some good suggestions. We had a chat with the SENCO last year but it was more around possible ASD than toileting. She wasn’t very helpful - it was all focused on what he didn’t need than what might help, and what they wouldn’t do rather than what they could, if you see what I mean. I get there is a threshold, but I’m not sure they will feel he is showing any more need now.

Thank you to everyone who has made constructive suggestions, I really appreciate it. I feel like we gave school a lot of understanding last year in terms of how difficult it was to deliver on what they suggested (not me) and agreed to, but the problem is persisting and we need to work with them to make sure DS’s needs are being met.

As I said, I would have more respect if they point blank refused to help and just called us each time. But the positive noises followed by zero or minimal action just maddens me. And I can’t have a discreet word at the classroom door because it’s such a sensitive issue and DS is embarrassed.

DS had similar issues at a similar age.
Thankfully I can look back at it as something that gradually resolved itself a long time ago (with the help of movicol).
DS is now a teenager with no major issues.
He found y2 particularly hard, and started refusing to go into school. He found KS2 much better.

Would he use wype toilet gel to help him clean?
I told my daughter we would just bin dirty pants. Primark was my friend.

www.thepoonurses.uk/index.php is a very good source of information on the condition for people who haven’t had access to a continence nurse. Many GPs are not great at treating this (fortunately my own GP is a complete star).

For people suggesting special school: you are fortunate not to have experienced this condition in your family: it has nothing to do with intelligence, mental health or behavioural and emotional problems (although over time it can damage a child’s esteem and contribute to behavioural difficulties). It is surprisingly common and most schools will have a pupil with chronic constipation.

My ds suffered from this for a number of years (Y2 was the turning point when it got better) and is now a happy and healthy teenager heading for top grades at GCSE. It’s also not down to parents being too lazy to toilet train: it’s a medical condition which is treatable but takes time to resolve

Thanks @LemonWeb, I’ll take a look at that.

I agree, the idea we were too lazy to train - it’s offensive, to be honest. We had to push training at 3 and a bit after he refused the potty for months despite showing signs of readiness. Had to force his hand as he was making himself sick by sitting on the floor pooing into his nappy and starting to withhold. That, in my opinion, is where the problems started. It feels like we’ve been potty training for years!

Just in case you don't already know about Eric charity and movicol mummies Facebook group. Good for support. The poo nurses video as above is very helpful.

My dc is exactly the same age. And yes could wipe themself down even if it were very sticky. - with wipes.
It does depend on the child though.
But it does seem more he doesnt realise an issue/want to sort it out.
What other possible asd issues are there?
I think you need to check with gp/climic/eric about restarting the movicol. He may have reduced the accidents but it sou ds like the constipation is still there.
What happens if you have an accident at home - can you put the wipes and bags ready to wipe down? If you can get him trying to sort it them come in to check.
He is already sitting in it so any tidy up by himself and changed pants etc is an improvement.