Q My 10-year-old son won't stop pooping his pants. This has been an ongoing problem (along with bedwetting and on and off daytime pee accidents) since he was 4. We have tried everything we can think of, reward systems, punishment, gentle reminders, scheduling time to potty etc. We have been to several GI doctors (he did have constipation at 4-5 but does not now), urologists, behavioral health specialists etc. He has been diagnosed ASD. Is there anything we can do? We are far beyond the end of the rope.
Toileting challenges are so difficult, for children and parents alike. It can be common for some children with autism or neurodevelopmental disorders to have recurrent accidents. Typically, when toileting accidents are not due to an underlying medical condition and continue past early childhood, a combination of strategies are used.
First it is important to make sure a child is not constipated and if they are, they will need a clean out regimen that is prescribed and overseen by a physician. Then it’s important to collect data so that you have an idea of when the bowel movement accidents are occurring in the highest frequency. If a child is not constipated, expect 1-2 soft formed bowel movements per day. The morning and after meals are most commonly when bowel movements will occur. Urination is different and commonly children will need to urinate every couple of hours, and more frequently depending on fluid intake and bladder size.
Once you’ve collected data on the timing and frequency then you’ll need to put your child on a strict, timed schedule for sitting on the toilet. If a child is having frequent accidents, then the time schedule may start at short, 15- to 30-minute intervals, and that means every 15-30 minutes a timer will go off and the child has to sit on the toilet for a few minutes. This is labor intensive for parents and requires very close oversight, especially the first 3 days.
You will need to limit your child’s screen time during this training phase. Screen time maintains a child’s attention in a way that will make it difficult for the child to stop to go to the bathroom and may make it harder for the child to attend to the cues in their body alerting them when to go. Also stay very close to the bathroom. If you notice that your child is showing early signs of a bowel movement or urination before the timer has gone off for sit time, then quickly usher them to the bathroom.
Praise and reward your child for sitting on the toilet. And then repeat. It is time intensive and requires very close oversight from parents but once your child is successful for several days in a row then you can start to slowly increase the time.
Expect to keep your child on a timed schedule for a few weeks up to several months before your child is ready to comfortably hold urine for several hours and go to the bathroom for bowel movements when their body signals.
Finally, keep in mind the importance of managing constipation. If your child has any history of constipation or stool withholding, he may have difficulty knowing when he needs to go and may have backed up stool and not realize it. Medication and/or a bowel regimen can sometimes be a necessary and helpful component to a behavioral toileting plan.