Supporting a child who cannot control bowels.

[heidishubrook]

Hi,

 

Please can I ask for some professional/legal advise. We have a child in our class ( reception - class of 30) who has a 'medical' problem and cannot tell when she is going to the toliet. It is deemed mecial however we haven't yet had any evidence from doctors etc. She can have poo accidents up to 17 times in one day ( although the maximum we have had is 7). She is happy to sit in her own waste and when we ask her to go to the toliet she refuses. I am blessed to have a wonderful TA and part time NN who take her to clean her up however we have to change her, wipe her and make sure she is clean as she will not do it herself. I feel in such a difficult position, as its medical I don't know where we stand with doing this. As you can imagine I lost my TA/NN for at least 30 minutes every time she has an accident and it haven't an impact on her learning and the whole classes as any group work has to get scrapped as I don't have the adults to hand to support.

 

There is nothing educationally wrong with the child and she is quite articulate, however she will not tell us when she has had an accident. I called her mum to come in and collect her after four accidents in two hours however she felt taking her home would do nothing to help the situation (which I can understand). Mum also gives her 'medication' on a night before school which includes stool softeners and as you can imagine has a huge impact on her visits to be cleaned with the TA's.

 

To cut a long story short - has anyone ever experienced this? Mum says she is trying to get support however is there anything we can do to help this situation? I feel along side the medical problem it could be pyschological - is there anyone who could assess her? I really don't know as a teacher what I should be doing but I know it is having an impact on not only the child but the other 29 children (and my staff) moral!

 

Thanks in advance.

[Guest]

In somerset we have a Physical Impairment and Medical Support Team (PIMS)who are there to help and advise in such circumstances within the nursery environment. Do you have such a team in your area?

[heidishubrook]

I've never heard of such a team but will look into it. Thanks for the advise.

[finleysmaid]

Have you spoken to the school nurse...or asked Mum if you can speak to the HV? I would expect to have information on this from the doctors....and i think i would be demading it! Why is she giving stool softners if the child is going this much...has there been a history of constipation in the past. The problem is that this medication is available over the counter. I think i would be sorting out a care plan and insisiting on written info from a health source. It may be that Mum is overdosing in which case the child will have little control. Once you have the medical issue sorted then the mental issues can be dealt with by the Camhs service (children and mental health??? or the equivalent in your area.

Did she come from a local nursery? do they have info?

Also i would be concerned about your staff taking so long changing her....gosh if they worked in nursery they would never be out the loo! That amount of 1-1 attention may be counter productive?

[HoneyPancakes]

Have a look at the Eric website. I had a child who became very constipated. Compacted poo stretched bowel so that it lost sensation to go. Took about six months of softeners, massage and new soft poo leaking out around impacted poo before things improved and discharged from outpatients. I read it can take much longer.

 

We used inserts in his pants like sanitary pads. Available in supermarkets near the nappies.

 

My take on it is that it was caused by anxiety. Wouldn't poo so then couldn't poo.

 

Best of luck

 

Honey

[Susan]

I have dealt with 2 children like this, although neither quite as extreme as yours and both boys. We called the parents to come and change the child as my HT said we didnt have the staff to cope. One family came readily, the other mother was very aggressive about it but her child often needed showering down and we didnt have those facilities so she would take him home and bring him back. Neither child seemed particularly aware, either of the need to go or that they had!

 

We were told that both had a medical need, but saw no doctors reports at any time. One chap did have a statement for language needs and of the two, he definitely had less problems, especially once his mother stopped giving him laxatives!! The other lad continued to have problems throughout his time in Infant school and we suspected emotional issues.

 

Good luck.

[SueJ]

I currently have a child on roll who (due to medical complications) "doesn't know when she needs to go". Currently gastroenterology and hospital paediatrician are involved (along with another 12 other agency practitioners but that's another story).

 

We have been working with our NHS Continence Service and have managed to get her toilet trained in respect of having a wee - are still working on the pooing - she too has medication to soften stools (we have a poo chart to compare the output for her chart - yet another of the perks of this job ).

 

We have had a bit of tooing and froing about dosage of medication and crucially timing to try to get the balance right and also to try to encourage pooing following medication to happen either early morning or early evening. To help this child develop some bowel sensation her support worker gets the plum job of encouraging her to engage in some blowing exercises whilst she sits on the loo after lunch. She has a bag of things to blow e.g., whistle, bubbles, windmill and parents have a copy of this bag at home and are meant to do the same exercises to help her develop some sensation of "pushing down on her bowels to excavate them" to put it politely.

 

We now think that she is beginning to get a little sensation of needing to go - just need to get her to match this sensation to sitting on the loo.

 

If you are able to access a local Continence service you would hopefully be able to enlist the services of a Continence Nurse Practitioner to help you with the child in your class - the child with my setting has a CAF and a Statement so it was put as an action on these to get the support.

[Guest]

I have exactly the same problem with a child in my class this year so I know how frustrated you feel as I feel it too! Today was a better day with 'only' 5 changes required! It really impacts the learning of the rest of the class (not to mention the child involved) as there is very often only one adult in the classroom and they are spending an awful lot of the day changing the child. I don't have the answer!

[finleysmaid]

I have exactly the same problem with a child in my class this year so I know how frustrated you feel as I feel it too! Today was a better day with 'only' 5 changes required! It really impacts the learning of the rest of the class (not to mention the child involved) as there is very often only one adult in the classroom and they are spending an awful lot of the day changing the child. I don't have the answer!

If this is impacting on the childs learning then it is an sen....ask the head for support from the sen budget You need medical info and a care plan put in place. Just think what its like for these poor kids and what their friends in reception will say about them

[sunnyday]

If this is impacting on the childs learning then it is an sen....ask the head for support from the sen budget You need medical info and a care plan put in place. Just think what its like for these poor kids and what their friends in reception will say about them

 

 

 

This 'no quote box' thing is so confusing

 

Completely agree with finsleysmaid.........

[SueFinanceManager]

Great advice given already but just wondered would the parent or child consider wearing a pull up nappy whilst in school as the cleaning up of child and area affected by these accidents would be greatly reduced and surely from a health and safety point of view and the other children it must be really unpleasant.

 

Also, a pull up would make it less obvious to all the other children that this child has had an accident. The poor little thing must be getting odd looks and comments form the other children

[heidishubrook]

We felt nappies were counter-productive and we don't have the facilities in school to dispose of them (waste management wouldn't take). We have contacted health visitor however mum feels we should have access to the child's medical records ( which we don't) HV I think is going to access them for us. Will look into a care plan and camhs. Thank you so much for all your support x

[mps09]

Have a look at the Eric website. I had a child who became very constipated. Compacted poo stretched bowel so that it lost sensation to go. Took about six months of softeners, massage and new soft poo leaking out around impacted poo before things improved and discharged from outpatients. I read it can take much longer.

 

We used inserts in his pants like sanitary pads. Available in supermarkets near the nappies.

 

My take on it is that it was caused by anxiety. Wouldn't poo so then couldn't poo.

 

Best of luck

 

Honey

HI,

 

I have had experience of this with my own daughter - and it took two years before she poo'd without any problem - although even now (at 11) I have to make sure she tries to go every day.....

 

My memories of this time were very similar to what has been said by Honey - compacted poo allows loose/runny poo to seep around the blockage and comes out (very smelly!) however the child will not be aware that they have done it - plus of course there is the embarassment of it, lots of children deny doing something! The correct treatment for this might actually be that softener to get the blockage out - and temporarily increases the problem - the trouble is that unless you keep up with it, work through the mess consistently and regularly, you just go from free to constipated and back again with out really treated the cause.

 

I would suggest that you call in parents, ask them to summarise the support/treatments that they have sought so far, and see if they had advice from HV or GP and suggest that this is followed up with paediatrician.

 

Good luck!

 

Oh - the memories of the hours (literally) sitting on my toilet floor, singing, blowing bubbles, pushing on dd's feet to give her 'leverage', comforting the tears, as she tried to poo after 3 weeks of nothing.... there is probably nothing worse and it makes them feel rotten!

[MrsL]

I am in a similar situation but have no idea what to do. The school nurse was useless and told me to tell her off basically. Mum took about 6months of asking to go to the doctors with her and now she is on constipation medication (although no one seems to think she is constipated) and the health visitor or childrens centre won't help as she is 5 and they only deal with up to age 4,

 

Any ideas where I can turn next?

[heidishubrook]

Hi everyone, HV got a referal to child development centre so that she can get a referal back to hospital. Thank you so much for all of your help. Yayawho you brave lady - I so feel for what you have been though (and for any parent going through this) It must have been hell.