What do we mean by ‘smearing’?

The term smearing is used to describe children spreading poo on walls, furniture, themselves…anywhere apart from the toilet/potty or pants/nappy.

Why does it happen?

The first time a child smears is likely to be their way of communicating with parent/carer, for instance:

  • Constipation – the child may ease uncomfortable stool stuck in the anus/rectum.
  • The child may be aware of poo in their nappy, and reach inside to relieve discomfort or simply out of curiosity.

The child may then attempt to remove the faeces from their hand(s)…by wiping it on the nearest available surface, such as the wall or themselves. Even the calmest parent/carer is likely to exclaim on finding the smeared poo, which some children find gratifying. That may lead to repeated behaviour.

There are other reasons why smearing becomes habitual behaviour:

  • The child may enjoy the sensation of poo on their hands/on their body
  • The child may find the smell of poo pleasantly stimulating
  • Cleaning up after smearing may involve showering/bathing – which the child may enjoy. It may therefore be interpreted as a reward.

What can be done to stop it?

  1. Work out why it happened in the first place.
  • Use the continence assessment form (link) to check out the child’s bowels. If constipation is suggested use the Flowchart – Constipation (link) to treat it, and to prevent recurrence.
  • Consider toilet training. Use the Flowchart – Children with Additional Needs (link) to check for toilet training readiness. Awareness of poo in the nappy may well indicate the child’s readiness for toileting.
  1. Think about how you respond to episodes of smearing.
  • Deal with smearing calmly, especially if the child is excited by angry/distressed adult behaviour.
  • Provide alternative sensory stimulation e.g. play dough/gloop to keep busy hands occupied, something strong smelling readily available e.g. perfumed hankie/half a lemon in the child’s pocket.
  • Avoid showering/bathing to clean poo off the child. Deal with smeared faeces calmly with wet wipes or a cloth. Encourage the child to enjoy showers and baths at other times.

As with other aspects of continence care, there is no magic wand available to change the child’s behaviour; success will be the result of perseverance with positive behaviour change.

Case study from the ERIC nurse

Jonah’s Story

Jonah was six years old when his mother approached me for advice. He had a learning disability and was non-verbal, he was fully mobile and a very busy boy.

Jonah was fully toilet trained and independent with his toileting. Although this is of course commendable, it made it hard for the family to keep track of his toilet visits…and if they didn’t get there quickly and flush then Jonah would fish the poo out and smear it all over himself, quite literally from neck to ankles. Since he stripped off to use the toilet it didn’t take him long to rub the poo all over himself; he actually made a very neat and thorough job of it!

When I met Mum the family’s management of Jonah’s habit was simply to try and get to the toilet flush in time. Mum realised that his habit wasn’t going away though, and that action was needed.

Unsurprisingly, the first thing Mum always did when Jonah had smeared himself was shower him – the problem was he LOVED the shower so it seemed his poo behaviour was being rewarded. Hard though it was, I suggested cleaning him up with wet wipes, and in a very matter of fact way, and showering him regularly but at other times.

I suggested daily messy play, trying a variety of ‘poo like’ substances such as play dough and jelly. Mum found that Jonah loved the feel of gloop (cornflour and water) and playing with it replaced the sensory stimulation previously provided by the poo.

Finding something to replace the smell of the poo was not so easy, but after trying lots of different things Mum eventually found that Jonah was happiest sniffing a raw onion!

Overall, this was no quick fix, but Jonah did eventually seem to forget his poo smearing. He continued to strip off before sitting on the toilet, but Mum was optimistic that the family would eventually change that habit too.

Download print-ready version of Smearing - the causes and approach (PDF file)