How can I clean a child who refuses to be cleaned??

[mummyloveslucy]

Hi, I know I've asked this before but I've tried everything and nothing has worked.

My daughter is nearly 6 and messes herself regularly. Up to 8 times a day. She's had this problem since she was about 18 months old. She's on medication for it.

She gets very sore in her privates, she hates being cleaned and fights like mad so that I can't get anywhere neer the area. She's very big for her age and extreamly strong. I've taken to bathing her each time, but even after a soak in the bath, when I ask her to open her legs it's still there! I think it's because she won't open her legs in the bath or wash herself properly.

• These are the things I've tried:

• bathing her

• asking her to do it herself

• giving her choices, eg where would you like to be cleaned, what shall I use etc.

• giving her a mirror to show her where needs to be cleaned

• Trying to hold her legs appart while trying to wipe with the other hand

• Using a flannal and warm water

• standing up, lying down

There might be more but I can't think of anything right now. The only way I can do it is with a great deal of force, holding her legs appart at the knees while she's shouting her head off.
It just feels so wrong but it's the only way I can do it.
It's hard to break the cycle of her being sore due the poo being in that area, and her not letting me clean it out. I tell her all the time that the poo is making her sore and I need to clean her, but she dosn't understand.

Should I ask the health visitor? My mum is a nurse and she dosn't know what to suggest. We've tried bribary, making it into a game, everything.

Does anyone else have this problem? If so how do you mannage?

Sorry for asking this again but I'm hoping someone will have a new idea.

What is her absolute favourite thing to do? And what are her dx/suspected SN's? I can try and come up with a reward scheme for you if you like?

Also, as social story for you to try:

Everybody poos. Everybody wees. {DD} poos and wees. Mummy and Daddy poo and wee. It's the body's way to get rid of the things it doesn't need.

Poo and wee make a mess. Poo and wee smell. Poo and wee don't belong on skin. They make the skin feel sore and itchy.

There are lots of ways to stop the skin feeling sore and itchy. One way is to wipe it off. You can use toilet paper or baby wipes for this. Another way is to wash it away. You can use a flannel or a sponge with some soap for this.

{DD} doesn't like to smell. Mummy and Daddy don't like to smell. {DD} doesn't like to feel sore and itchy. Mummy and Daddy don't like to feel sore and itchy.

Mummy and Daddy are grown up and can clean their own poo and wee from their skin. {DD} is growing up and may need help.

Thank you, she is developmentaly 2 years behind although the test was done 18 months ago and I feel she'd probubly be more behind now. She also has suspected Aspurgers.

The social story sounds good as she dosn't seem to mind having poo on her. She had her hands in it yesturday and while I was washing one hand, she started to suck her thumb when her hand was covered in it. I told her to get her thumb out quickly and she refused. I had to pull it out. How can she possibly think it's o.k to do that. [eeeew]

Her favourate thing to do at the moment is watch my little pony on DVD. This is becomming a bit of an obsession though, so we're trying to encourage other things.
She likes going to soft play centres too.

Not sure what to suggest - DS has accidents regulary (coeliac) and he cleans himself up but when its bad he stands in the shower and can be in there for ages (45 mins the other night) He has some toys in there, a radio and just plays - by the time he comes out he is clean.

can you get a my little pony for her to wash while you wash her?

I have tried that, she has a small plastic one that she has in the bath. It dosn't take her mind off what I'm doing though.

I'm sorry I don't have any magic answers for you, but your op really resonated with me because of the battles we used to have to get my dd who has severe eczema into the bath. We knew she needed to hydrate and clean her skin to ward off infections but because she knew it was going to sting she would scream and kick every time. Like you I felt awful forcing her to do something which was causing her pain and distress but knowing it would lead to more pain and problems if I didn't do it. My heart goes out to you and your dd that you have that battle up to 8 times a day.

Nothing worked for us all the time but sometimes bribery helped - if you get into bath within 5 minutes you can earn x reward. Making sure the bath was followed by nice cuddle time, reading stories to her while in the bath.

Is it possible that soap itself is also stingy if she's already sensitive there - you might find something like oilatum or dermol 600 bath emollient (very mild, cleans without drying the skin)which you add to the bath might help. You can get it on prescription.
Have you tried using a hand held shower? I don't know if she would react to that any better than a flannel, but it might be more effective than just soaking in the bath.

If she's able to rationalise it, do you find she is more compliant if you have a patch where she isn't getting as sore from the poo going in the wrong place or does she still anticipate it's going to hurt from past experiences?

Sorry I can't be more help. Hope someone comes along with more experience.

Smearing poo is often a sensory issue. Do lots of playdough, plasticine, therapy putty, make scones and other cooking activities that involve rubbing flour into butter - if you're iffy about how clean her hands are, get some disposable gloves

Reward scheme:

I will allow a grown up to help me get clean when I soil myself.

Every time I allow an adult to help me get clean, I will be allowed to watch 5 minutes of My Little Pony on DVD.

If I kick, bite, scratch, hit, wriggle or misbehave when a grown up is helping me, I won't earn my My Little Pony time.

I can earn up to 40 minutes of My Little Pony time every day by behaving when I need to be cleaned. If I clean myself properly without a grown up helping, I will get a bonus 5 minutes.

Mummy will record how much time I may watch My Little Pony for each day. I may watch My Little Pony at 6pm. The DVD will be stopped when my time is up and Mummy and Daddy will keep it safe for next time.

HTH

Coming from another, probably weird angle, but I'm wondering other than the soreness, does the actual poo sting her?

I know lactose intolerant people can have acidic and burning poos which can come on all of a sudden and can be hard to control.

Just a thought.

Yes, that's a thought. I've been wondering if it is an intollerance of some sort. It seems strange that she's suffered from constipation most of her life despite a good diet with plenty of fruit and vedge.

The doctor always says "just keep on with the Movicol". He dosn't seem to think it's a problem.

She also eats quite a lot of dairy food too. She has milk every day with breakfast, yogart and she has cheese about twice a week.

DS2 (asc) also loves his poo - the feeling of it; he's movicolled also. Just to add to Purple's list of things to replace the poo, ds loves a big tub of vaseline to stick his fingers into.

DD1 didn't like being cleaned. I turned it into a game. We now 'freshen up the buttercup'

So (please don't laugh at me, because it works, but it is cringeworthy just typing it)

I sing a song:

'Freshen up your buttercup'
'Freshen up your buttercup'
'Freshen up'
'Freshen up'
'Freshen up that buttercup'

All very relaxed, but I look like a hawk to see if she is 'dirty' inside. If I have seen that she is cleanish, then I just do one rendition of the song.

If I see that she is quite 'dirty' I repeat the song, and that gives me another chance to wipe.

The other thing you could try is to go to the Chemist and buy a tub of 'Aqueous Cream'. It is very cheap. It is a semi-liquid, soft gloopy soap substitute.

The beauty of Aqueous cream is that you don't actually need to wipe it off carefully, or rinse. You can use it in the bath, like soap, or you can rub it in to sore dry skin.

So, although you want to eventually encourage Lucy away from touching her private areas, because they will get sore, and she is smearing, you could do the opposite to desensitise her.

Ask her to give it a quick wipe. That will get most of the poo away. Then let her smear lots of cream on her bits (IMPORTANT: put some AC in a separate bowl so that she is not dipping pooey hands into the clean tub of cream). She will think she is playing, but she is actually working the cream into her delicate areas.

Then, ask her to wipe it off, and tell her she can have another go. Hopefully, the pull of getting another go will encourage her to wipe it off.

The second time, she will be quite clean, and the AC will just be moisturising and protecting her skin.

Do you use Sudocream? That is a good barrier to put on after cleaning, so that next time she soils the poo isn't contacting her skin.

You need to break the assosciation between pooing and being sore afterwards. It might be part of why she doesn't tell you she needs to go.

I taught DD2(7) to crouch down in the bath and splash her bits with water. Crouching down opens them up so they're easier to clean. She doesn't like to be touched there by other people so I've not been able to help her for a long time. She gets dreadful eczema there and it needs to be washed properly.

8 poos a day is definitely not normal, and movicol clearly isn't working for you guys. Go back to the doctor and see get a referral, preferably 2. [Paediatric gastroenterologist ideally, community paed or encopresis/enuresis clinic if not].

I would be going back to the doctor too, 8 times a day is not normal I would say, even for a child with these issues. Are you sure the movicol definitily isn't making things worse? I only ask as my daughter was taking it for a long time for constipation and was still marking etc. Eventually we stopped the movicol and she stopped marking etc. It turned out the contipation had resolved and the movicol was making her loose. Just thought it was worth mentioning as I was being told by the gp that she needed to keep taking it.
Wouls also recomende the aqueous cream suggestion.