Faecal smearing is an uncomfortable subject but it is a problem that many SEN Teachers, teaching assistants, parents and carers have to deal with. Whilst it is not a very common behaviour, it is a challenging one that is seen in children who are autistic or have other sensory needs. Given the nature of the subject, there isn't often a lot of support or advice on how to stop this behaviour.
What causes faecal smearing?
There are several reasons as to why autistic children could engage with faecal smearing. Most commonly, it is meeting some sort of sensory need, but it could also have behavioural or medical causes. In order to address the behaviour, you need to know what the cause is.
Sometimes, there could be a medical cause to faecal smearing. It could signify a medical issue, including things such as abdominal pain or issues related to the gastrointestinal system. It could also be a sign of sexual abuse and damage to the reproductive organs or anus, so be sure to rule this out immediately. If it is a medical issue behind the smearing, the child is often using smearing behaviour to communicate to you that something is wrong with their body.
Faecal smearing can also be a behavioural need. A child may do this if they are trying to delay a demand that has been placed on them or they are seeking attention. If you think that smearing could be have a behavioural cause, keep a record of when and where smearing occurs and anything that may have preceded the event to identify possible triggers.
For autistic children, faecal smearing often has a sensory cause. There are various sensory systems at play and many autistic children struggle with sensory processing, and smearing may be a way of expressing this or engaging in a sensation they enjoy. Some sensory causes include;
Wanting to avoid toilet paper due to tactile discomfort
Seeking soft tactile input from the faeces
Wanting to have olfactory input, i.e. the smell
Trouble with interception awareness
Sensory triggers can be the hardest ones to combat as engaging in smearing is automatically reinforcing for the child, so you need to replace this behaviour with something that is just as good or better than smearing to meet their sensory needs.
How to Stop Faecal Smearing
Whether you are caring for a child at home or in school, faecal smearing is a problematic behaviour wherever you are. It is one of the most difficult behaviours to manage as a parent or teacher, so undoubtedly you are going to want to know how to stop it.
Stopping the behaviour firstly depends on what is causing it, so try to establish this before deciding what strategies to use. It is important to rule out medical causes, including sexual abuse, as soon as possible.
Don't reinforce the behaviour.
Sometimes, no matter how hard we try, we are unintentionally reinforcing behaviours we don't want to see. For example, if a child acts out, you deal with that specific incident but then you keep a closer eye on them for the rest of the day, inadvertently giving them additional attention.
However, if we apply this to faecal smearing, especially if a child is doing this for attention seeking reasons, then you are actually giving them what they want and therefore reinforcing a troubling behaviour. This is why keeping a behaviour log can be extremely helpful in understanding why a child engages in smearing, and if there are any situations or circumstances that trigger the behaviour.
Promote proper bathroom use.
Any parents out there will know how problematic and challenging potty training can be but establishing a proper, hygienic bathroom routine will help children build independence and also teach them about cleanliness.
Social stories and visual aids can help establish clear hygiene rules and a bathroom routine for children as well as helping to reduce smearing behaviour. Always keep visuals in the bathroom to remind children of what is expected.
Address Sensory Needs
Sensory challenges can be very distressing for autistic children and it's important that we try to help children overcome these challenges in order to prevent faecal smearing. One of the sensory reasons a child may engage with smearing is tactile defensiveness, where they may find tactile aspects of a hygienic or 'normal' bathroom routine uncomfortable or even painful. This could be aspects like sitting on a toilet seat, or using toilet paper. Signs that a child might be being tactile defensive are;
getting upset when exposed to certain sensations (certain clothing, materials etc)
strong reactions to light touch
avoiding or becoming distressed during hair brushing, hair cuts or nail clippings
On the other end of the sensory spectrum, some children could be sensory seeking and want to have more sensory input than they are currently getting. If a child is smearing in particular rooms (e.g. the classroom), it could be that they are under-stimulated, so a few things you could do to make their environment more sensory focused are;
As well as making your classroom or other spaces more sensory stimulating if needs be, you should also provide additional sensory play opportunities, especially messy play. If this is the type of sensory input your child needs, instead of smearing, they can obtain this from messy play.
See here for 10 messy play activity ideas.
Interoceptive awareness refers to the awareness one has of the sensations happening inside one's body, e.g. thirst, hunger, need for the bathroom. Children who are autistic can struggle with interoceptive awareness and therefore could miss the signals that their body gives them telling them that they need the bathroom. This can lead to them smearing as a way to check if they do need a bowel movement.
Supporting a child with building interoception awareness skills could help with this - try reading this guide on potty training children with autism. A key part of potty training is helping children know when they need the bathroom, so even if a child is older, the skills and lessons taught during potty training, will be beneficial.
Also ensuring that a child drinks enough water and eats enough fibre throughout the day will make it easier for a child to know when they need to go to the bathroom.
If all else fails, you can look into restrictive clothing that physically prevents children from smearing. This really should be the last resort as it does not treat the cause of smearing, it just stops the behaviour and could lead to even more frustration or challenging behaviour. Restrictive clothing isn't getting to the bottom of what is causing a child to smear, but if the smearing is a severe and ongoing issue, it can be a temporary solution until you can figure out suitable techniques to stop the behaviour and address the causes in the long term.