For a school in Hampshire, talking about, looking at, keeping records of and considering problems with poo is something of a feature. With the help of ERIC, many children and their families have been supported to better understand bowels and bladders and be on their way to continence. Now they want to pass that knowledge on....

Wee and poo characters wearing mortar boards We are a primary special school in Basingstoke with over a hundred pupils aged from 4 to 11. The majority of our children have autism and all have learning difficulties. Working with children in school and at home with their families, the Home/School Team have over twenty years of experience of trying to help children learn one of the most important of life skills – how to poo and wee.

Finding solutions and helpful resources

Sometimes the solutions can be found by considering the way a child is affected by their autism. This could mean:

  • A child can't enter a bathroom
  • They smear their poo because of sensory issues
  • They can't stop to go to the loo because of rigid thinking

Of course, there are many other considerations that need to be made when a child has autism and perceives the world differently. We recommend downloading ERIC’s Guide for Children with Additional Needs and taking a look at this blog on tackling toilet training problems in children with autism.

We would also urge those who would benefit to try and attend a training event delivered by Lorraine MacAlister, a training consultant for the National Autistic Society and Dr Eve Fleming, a Community Paediatrician and ERIC trustee which are invaluable.

Mixed advice from doctors 

However, in our experience, one of the greatest challenges has been when a child has an acknowledged difficulty with poo and parents have contacted their doctor. There are numerous occasions where parents have been given advice by their GPs that has included: “It’s just a phase….all children get constipated at times… she’ll grow out of it…. Get him to eat a more varied diet….. it’s because of the learning difficulty……..it’s a behavioural response….” and so on. 

There have also been times when advice has been sound – where GP’s have listened to parents and taken into account the child’s development. It is, we believe the delay in recognising and treating children’s constipation that has led to some of our children experiencing discomfort and pain with the added challenge that they may not be able to communicate this. Also, consider that if a child has suffered long term, they do not know any other way of being and they may not understand that it could be any different. So teaching them to recognise how they are feeling and how they communicate this is essential.

What do we do in our school? 

In a nutshell we talk about poo! We raise awareness of school staff by:

  • “Let them eat cake!” We make a Bristol Stool Chart cake following this recipe. Staff know it’s made of chocolate, but it is amazing to see how many folk just CANNOT eat it because of the resemblance to poo. Take the flake or maltesers off the cake and they devour the lot!Bristol stool form scale cake
  • Place Bristol Stool Charts and images of how to sit on the loo properly in the toilet areas along with an assortment of step stools and toilet seats, chairs etc. See ERIC's guide to children's bowel problems for these images. 
  • Invite staff to a training and advice sessions for families held in afternoon and evening.
  • Promote Poo Patrol – having record sheets and the Bristol Stool Chart close to hand in the toilet areas so staff can record what they have seen straight away – in a busy school this can often be forgotten.
  • Encourage staff to play with poo related objects – too numerous to mention (thanks to the poo emoji – but at least it has a smile on its face…). These can include soft toys, a poo snake and ladders game, a catapult game, a light up poo, and a favourite “pick your poo” game.
  • When thinking about a child’s behaviour – always consider toileting issues especially constipation.

Lets talk about poo

We raise awareness in families by:

  • Hold training sessions for parents/carers. We refer to ERIC's resources, the excellent and informative film by the poo nurses and the video of the unicorn using a squatty potty to be most useful and great fun. Both videos can be watched here.
  • Ask about their children’s toileting routines and any past experiences of tummy pain or history of constipation. When relevant – ask parents to keep a record for a couple of weeks, consider the findings and meet them to discuss next steps. They can use ERIC's bowel and bladder assessment chart for this. 
  • If a plan is agreed – support parents with this and give them reading materials, refer them to the ERIC resources, website and helpline. Record keeping is vital and interpreting those records invaluable and at times we have shared them with the wonderful ERIC helpline – just to reassure us and parents that we are on the right track.
  • Use visual systems to help children express how they are feeling and develop understanding. This can range from feelings charts and schedules for going to the toilet to social stories that explain what is going to happen - from taking medication to hospital admissions. If hospital visits are necessary – liaise with the Play Specialists if you have them – they have been very helpful for our children.
  • We use this story simply called "Poo" in our school to help children who need to take laxatives. 

Making a difference to children's lives 

Finally, here just two accounts from many, of how, together with school and the resources from ERIC, families have been helped to improve the quality of life for their children:

Ben’s story:

Ben is a 10 year old boy with autism. He's been constipated since a baby needing many GP visits and ongoing treatment. Finally, following Mum’s confidence to advocate for her son, increased by school advice and ERIC resources, he was admitted for disimpaction. School used visual stories to help him understand and liaised with the hospital play specialists. In school he followed his routine and we began to see a happier, more communicative boy who is full of fun. As his Mum says “The absolute best part is that he is no longer in pain, at all, right now, he has a new lease of life and a sense of freedom he has never known. This has changed his life”.

Manny’s story:

Manny is an 11 year old boy with learning difficulties and speech and language disorder. He has a long history of constipation and what Mum thought was diarrhoea. Frequent soiling in school. Repeated visits to his GP advised short term use of laxatives. Behaviour records showed that he became challenging prior to soiling episodes but never communicated he needed the toilet and refused all help to get changed. Mum attended an information session. School advised a visit to the GP with poo records and reference to ERIC. Positive response from the GP. Longer term use of laxatives and 1:1 sessions in school to explore and talk about feelings, bodies and all thing poo have brought about changes in Manny’s behaviour and toileting. All recognise there is still a way to go but it’s a start!

Download ERIC's Guide for Children with Additional Needs