This post has been written by June Rogers, Children’s Specialist Nurse at BBUK. Constipation in children is often unrecognised. Over time, this can result, in a large backlog of poo so that the child becomes ‘faecally impacted’. This is the medical term used to describe so much poo stuck in the bowel that it cannot be passed easily). When this happens children often develop soiling (poo leaking into their pants). It is the soiling which then becomes the trigger factor for families to seek help. However when the child has additional needs it is often the assumed that the soiling is a result of the child’s ‘condition’ rather than because there is an underlying problem with constipation.
As a result of this misconception many children with additional needs, along with their families, suffer unnecessarily. The following case study is typical of some of the families who contact us.
Tommy (not his real name) is a 10 year old boy with autism whose mum contacted us because of his soiling and the problems he had been having with his bowels since he was 2 years old. The family had been told that this was probably due to his autism and he may well ‘grow out of’ the problem. However, constipation does not get better on its own. In fact it gets worse as time goes on and causes more problems. Tommy also had a problem with day and night time wetting and no one had thought that constipation could be the cause.
He was soiling on a regular basis and this was causing some stress within the family. Tommy was also becoming more aware of the issue and was feeling very embarrassed by it all. The picture his mum painted of the problem very much reflected an underlying constipation with overflow soiling.
Healthcare professionals usually know that overflow soiling happens outside the child’s control. However Tommy’s family did not know this and did not believe Tommy when he said he did not know that he had had an accident. Once this was explained his mum was upset saying:
…I know that this is something we have all since felt guilty over, not believing him when he told us he didn’t know. To us it’s like, “how can you not know?
NICE sets out clear guidelines for healthcare professionals about the management of children with constipation,so we suggested mum take Tommy to the GP as soon as she could for him to be seen and started on some treatment.
To support Tommy’s family we wrote an email for his mum to take to the GP. We suggested that the soiling could be caused by constipation and what might be the right treatment. Following the visit to the GP Tommy’s mum wrote the following:
I got Tommy into the doctors and she was lovely!! She had been through the same thing with one of her children and she loved your email and advice. She was very impressed and said that’s exactly what process she went through and what she was going to recommend… So we have been given Laxido. 1 sachet a day for at least 3 days then 2 a day depending on how he’s getting on. I’ve been given a follow up appointment in 2 weeks to see how he’s getting on.
Tommy’s progress was reviewed 2 weeks later. He was opening his bowels on the toilet every day and the number of accidents was greatly reduced.
So, by seeing the child as a child first, rather than the ‘condition’, listening to the story and taking note of the signs and symptoms, the problem of constipation can be recognised. In fact if any child presents with soiling we always consider constipation to be the cause until proved otherwise.
Tommy and his family had endured the problem for nearly 8 years. But a simple solution helped him to start to get better within a few weeks. Tommy’s Mum has since written:
…I really am over the moon I found the organisation and appreciate all the help you have given us.
The key message is do not presume that any soiling is because the child has autism or learning difficulties and then do nothing about it. All children have the right to appropriate assessment and treatment.