How to stop autistic child from smearing feces

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The reasons for smearing

The reason an autistic person might smear their faeces could be medical, sensory or behavioural and include:

feeling unwell or in pain
being reluctant to wipe because toilet paper is too harsh
not knowing where faeces need to go
seeking out sensation from texture, smell or movement of arms during smearing action
seeking attention/wanting a reaction
fear of toilets.

What you can do

You could try to:

visit the GP or dentist to make sure that there are no physical reasons involved, like being in pain
replace toilet paper with wet wipes, or a tepid shower
teach them the wiping process, ‘hand over hand’ ie putting your hand on top of their hand as they wipe
provide an alternative with a similar texture, eg papier-mâché, Gelli Baff, gloop (corn flour and water), finger painting, play-dough
provide alternative activities at times when the smearing usually takes place
make a structured timetable of the day, showing times when the person can do appropriate smearing activities
avoid asking the person to clear up after themselves, or telling them off, as this may reinforce the behaviour
use minimal interaction, avoid paying too much attention or showing too much reaction
set up a toileting routine.

Further information

Toilet training and the autism spectrum, Eve Fleming and Lorraine MacAlister, 2015.
Challenging Behaviour Foundation, 0300 666 0126.

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Last reviewed and updated on 14 August 2020

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"It Happens" - Autistic Individuals and Fecal Smearing

I receive a lot of questions every month about toileting difficulties. One question I am asked is what to do about fecal smearing. It’s an upsetting behavior because of the smell, mess, and unhygienic situation. Parents worry that fecal smearing will happen when their child is outside of their home – at school, daycare, or in a public place. It can cause isolation because the family will be reluctant and fearful to go places. Siblings don’t want to invite their friends over. It’s not a topic parents are able to discuss with friends and family. They may not have the confidence to speak with a professional about it because they worry about being criticized or judged.

I can remember my mother issuing an ultimatum over my son’s fecal smearing – extinguish the behavior or no more weekly Sunday dinners at her house. We never went for regular Sunday dinners again because it took me years to get this problem in control. I wish I had the understanding of fecal smearing that I do now back when it was a daily occurrence. I used to get so disheartened over the mess, smell, and clean up. I felt I had no one to talk to and felt really alone.

There is very little research that shows how common this problem is with autism and other related disorders. Because you can’t find much information about smearing, parents feel that other children don’t do this, they feel embarrassed, or they feel it is a part of the disability and nothing can be done about it.

What Is Fecal Smearing?

Smearing covers a variety of behaviors such as:

Rolling feces in the hands, then hiding the pieces
Taking feces of out of the toilet to play with or smear
Choosing a spot in the house to play with feces
Undressing in the school toilet, smearing feces on themselves, then getting dressed again and returning to class
Using smearing as part of masturbation
Smearing and shredding diapers at the same time
Defecating in the bath, then smearing the surrounding area

What Causes Smearing?

Smearing can be caused by a variety of things. Sometimes there is one than one cause, making it more difficult to resolve because the behavior is complex.

Some causes of smearing may include:

Medical issues (constipation, GI issues)
Psychiatric issues (OCD, exposure anxiety, mental health issues)
Sensory factors (interoception problems – not knowing you have to go, enjoyment of smell and texture)
Difficulties around teaching toilet training skills
Dietary factors (limited diet may lead to constipation)
Emotional factors (response to anxiety, the reward of a hot bath, sense of autonomy, understimulation/boredom, an expression of anger)
Sexual factors (gratification, a sign of abuse)

Managing Smearing

Smearing can be both emotionally and physically draining for parents and caregivers. They need support from professionals to understand and develop toileting skills for the individual. This is the most important step in reducing or eliminating smearing, after ruling out medical or psychiatric causes.

Smearing can be reduced or minimized no matter how long it has been happening or how much it has occurred. Strategies will need to be individualized as every person has their own reason for smearing. Parents will need to work with everyone who is involved with their child (school team, caregivers, family members) to get everyone using the same approach. There should be no punishment involved as this will not reduce smearing episodes.

Use low-arousal responses which involve being as emotionally neutral as possible. This means having neither a positive or negative reaction to fecal smearing.

Some ways to do this are:

Focus on your own breathing prior to clean up – calm, steady breaths
Clean up quietly with few or no words
Go somewhere alone to have an emotional reaction if there is the need to vent frustration, but make sure the individual is not present
Clean the furniture, floor, walls etc. when the individual is not there so that they can’t see or hear your responses to the cleaning.
When cleaning the individual, do so with as few words as possible or in silence. Keep your responses low-key and behave calmly so that your emotions don’t come through in your actions (like brisk scrubbing).

When Smearing Occurs

If you support an individual who smears, the first thing to do is seek advice from your family doctor. The cause of smearing has to be determined before any strategies can be put in place. We found out that our son was chronically constipated after having an abdominal ultrasound done. He had also experienced weight loss and vomiting with any increased food intake as a result of being constipated. Our son would dig in his anus and pick out bits of stool to relieve pressure and itching and that is why he smeared.

Constipation happens more often than we realize in people with ASD due to low fiber diets and limited fluid intake. You can keep a stool diary using the Bristol Stool Form Scale to record what bowel movements look like. This information is helpful for physicians to determine what is going on.

If underlying medical causes have been ruled out and the root cause is sensory (enjoys the smell, texture, feel of feces), you can try offering substitutions for the feces such as:

Touch – warm play dough, pudding, toothpaste, shower gel, clay, sand and water mixture

Visual – finger painting, shaving cream, clay, bread dough

Smell – Marmite, vinegar, essential oils, spices, scented lotions

Sound – the texture will tell you the sound the material will make when squeezed

Substitutions should be offered throughout the day and consistently used until they become routine. Have them accessible where the individual usually smears.

Toilet Training Skills

I have written numerous articles on toilet training and recommended books on the subject. Difficulties around acquiring toileting skills can be part of the reason a person fecal smears. Impairment in interoceptive awareness may be the reason someone doesn’t know they need to defecate.

I am a proponent of getting rid of diapers when toilet training. Using diapers can prevent a quick response to the urge “to go”, some may not even know you use a toilet to eliminate in, and remaining for any length of time in a soiled or wet diaper can cause the anal area to become sweaty or damp leading to anal itching, then picking and smearing.

You can learn everything you need to know about smearing by reading Kate E. Reynolds book, What to Do About Smearing. It is a highly accessible book that explains all aspects of smearing and provides answers to questions so many of us are afraid to ask. The important points for each chapter are summarized at the end and there is an extensive reference list provided for further study. I wish this book had been written years ago because it would have saved me much heartache. It is Kate’s book that I used for the basis of this post as well as my own firsthand experience.

Victoria Mironova's Kindergarten Club |

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An uncomfortable problem: playing with feces

There can be many reasons for this behavior. Among them are sensory features, age and psychological factors, emotional disorders, behavioral problems, and so on. First you need to understand what can cause such behavior and what are the ways to overcome it.

Possible causes

The reasons why a child plays with, eats or smears feces depend on his age and developmental features.

Age interest. Until about two years of age, it is normal for children to be interested in their own excreta. Toddlers learn the functions of their body and waste products. At the same time, the reaction of parents to the interest of the child can permanently reinforce this behavior.

Manipulation method. Smearing stool can be a way to avoid something or get something you want: to evoke a certain emotional reaction, to draw attention to yourself, to get away from an unpleasant situation or demands. Also, children who have communication problems can use these situations as a way to communicate. They quickly learn which behavior leads to the most active interaction.

Sensory features. Stool smearing can be used by toddlers who like strong smells and messy games and have no other way to satisfy their needs. Playing with sticky and soft materials such as glue, shaving foam, play dough, and sand can reduce the need to spread stool. Strong-smelling substances - aromatic oil, spices, cheese - will help to satisfy cravings for smells.

Psychological and mental problems. Fecal smearing problems can occur in children with OCD (obsessive compulsive disorder), bipolar disorder, schizophrenia. These behaviors can also be seen in children with autism, anxiety, child victims of sexual abuse, or children experiencing post-traumatic stress. Donna Williams, author with autism, points out that poo games have many goals that can be overlooked:

this activity gives a feeling of control over the body and environment, while other areas of life are uncontrolled
makes you feel in control of your own actions
contributes to the expression of anger, frustration, helplessness
prevents unwanted social contacts
may be associated with another emotionally calming process
may be part of an obsessive-compulsive disorder that gets out of hand

In any of these cases, you need to pay attention to the quality of life of the child and make sure that he has the opportunity and an acceptable way to meet his needs (including emotional and sensory). In severe cases of mental disorders, medical attention may be needed.

Medical cases. Doctor's consultation will rule out possible diseases:

protozoan infections causing rectal itching
parorexia or pica - the desire to eat inedible, can be caused by a deficiency of certain substances in the body
constipation and stool problems which may lead to a desire to explore the anus
hemorrhoids due to difficulty in emptying the bowels
rectal prolapse - prolapse of the rectum associated with decreased muscle tone of the pelvic floor. Symptoms include encopresis (fecal incontinence), a feeling of incomplete emptying resulting in anal exploration and smearing of feces.

All of these conditions are treatable.

How to find out why a child is doing this?

To stop any behavior, you need to understand its function. One of the effective ways not to speculate, but to shed light on a child's motivation, is to discover a causal relationship, the so-called ABC behaviors.

A Cause. What happens right before the unwanted behavior occurs? For example, a mother leaves the room to do other things, or a child is given demands that he does not want to fulfill. There may be many options.

B - Behavior. (In this case, the child is smearing or eating feces)

C — Consequence. What happens immediately after the behavior occurs, including the first adult reaction? Whether the parents exclaim, rushing to wash the child and the walls, or the demand to remove the toys is losing its relevance.

Once the cause and effect that reinforces a behavior is understood, there is a chance to change it.

Practical advice

Reward what you want, ignore what you don't. The baby must learn that he gets a lot of attention and positive emotional communication when he behaves well, and does not receive any attention when he is smeared in feces. Of course, it is hard for a parent who has to wash walls and carpets to maintain icy calm and equanimity. But this is a necessary measure to stop unwanted behavior. Pay attention and reward the child when he behaves well - sits at the table, eats, shares toys, builds a tower. You can also reward the child when he was able to resist and did not smear the feces. This strategy will help reduce the frequency of unpleasant incidents, but requires persistence and time.

Create unwanted effects. One way to create unpleasant consequences for a child is to involve him in cleaning. Smearing the faeces should not help the child avoid any demands. Eliminate any pleasant activities immediately after the incident - cartoons, favorite food, games.

Wear protective clothing. At first, special clothing, such as one-piece jumpsuits and back-fastening pajamas, swimwear or T-shirt bodysuits, will help control toilet problems. Such clothes can be worn at night or during the day to limit access to the diaper. So the child will not be able to get the excrement on his own and the parents will have more control over the process.

Satisfy interest in an acceptable way. You can satisfy the interest of the baby and explain the rules of behavior with the help of books and social stories. For example, such a book can be viewed here.

Use sensory stimuli. If a child smears faeces due to sensory issues, ensure that he is able to meet his needs in an acceptable way. Modeling dough, plasticine, finger paints, sand, shaving foam - all this can be smeared, crumpled, sculpted and even completely coated. Create a place where the baby can play "dirty" games. If the child is attracted to the pungent smell of excrement, cheese, odorous plasticine, perfume, aroma oil, spices can be used as a substitute.

Of course, the article only gives a general idea of what fecal smearing is. A consultation with a child psychologist will help you understand the causes in more detail and develop a program to get rid of unwanted behavior.

Author: Maria Labyrina

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Autism and faecal smearing | Special translations

Autism and faecal smearing

Original: http://www. autismparentssupport.org/Autism%20and%20Faecal%20Smearing.pdf

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Fecal smearing is a problem that parents rarely bring up, but that many children with autism experience to some extent. Very often, children smear feces on themselves, toys, furniture, walls, etc. This is a huge problem, but parents are often embarrassed to talk about it with relatives, friends, and even with a doctor - too taboo a topic. However, most parents wonder why their child likes to play with feces and what can be done to deal with this problem. To help you identify what specifically draws your baby into this process and how you can prevent the problem, we've recorded a few findings from an experienced mom (D.C. Fetters).

Why do children with autism smear their feces?

There are many explanations why children smear their feces. Some believe that they enjoy the sensory experience of playing with feces, some that children smear feces to attract attention and manipulate adults, and some that smearing feces is a reaction to a stressful situation, or arises from boredom.

I am sure that many children have fecal smearing problems due to one (or all) of these reasons. But if we talk about my son, the reason was that he constantly kept his hands in diapers. If the diaper was full, his palms got dirty, and then he just tried to wipe them on everything that came to hand. Unfortunately, most often, walls, carpet, toys, himself and even the pigtails of his younger sister fell under his hands. It is not difficult to imagine what kind of bedlam began in the apartment when he tried to dry his hands.

Can this problem be prevented?
The need to constantly wipe feces off walls, carpets and toys can bring anyone to tears. No matter how you look at it, there is nothing pleasant in this procedure, and it is unlikely that you will be able to return the carpet to its former cleanliness. And the worst thing is, after all your efforts, the “accident” can happen again the very next day (or even the SAME day). Fortunately, there are several tricks that can help you reduce the likelihood of such incidents.

Five steps to prevent stool smearing

Be on the lookout
The very first and most important step to prevent stool smearing in children with autism is to watch carefully when they have a bowel movement and change diapers/diapers immediately. If you delay, it increases the likelihood that the child will get to the contents of the diaper and smear it on the walls, etc. Most children make it clear in one way or another that they are preparing to relieve themselves: hiding around the corner, going behind a chair, grimacing, freezing - so be careful and try to prevent a possible problem.

Restrict access

When my son had this problem, we started dressing him in rompers or bodysuits that zipped between his legs to make it harder for him to get to the diaper. At night, we put him in pajamas with a back closure. If you have a girl, you can wear a cotton swimsuit, which will prevent you from getting to the feces. If your child is older, use sports swimsuits and leotards, or one-piece jumpsuits for adults.

Reward the desired behavior

If your child responds well to rewards, you can try to change the unwanted behavior by providing a reward when, despite the fact that the diaper is full, he managed to hold on and not smear his hands in feces. Not all children with autism immediately understand what and why they are given a reward, so this method may not work right away.

Share cleaning duties
Co-management helped my son wean himself from smearing feces. If only he broke loose and dirty everything around, I made him clean everything: I put rubber gloves on my hands, put a sponge in my hands and, hand in hand, we cleaned his feces from the walls and floor. It may seem unhygienic to you, but to me it was nothing more than smearing feces, which he was fond of. My son hated cleaning, and I think this largely influenced the fact that he still managed to give up his habit.

Give a similar sensory experience

If your little one definitely enjoys the sensory experience of playing with feces, you can provide other ways to get the same experience. Finger paint, playing with clay or slime, or simply playing around in the mud can give your child enough sensory stimulation to stop them wanting to play with feces.

And in addition to the above, here are some tips from the UK National Autistic Society:

Your child may be attracted to the texture of feces.