Child T case study

4 yr old boy (prep next year) – now at kindy 3 days/week
Youngest of 3 children – 2 older sisters
Passed a sticky poo in undies every day- small/medium in size and <4 times daily
Had been soiling for 18mths – never properly toilet trained for poos but can take himself to toilet if made to go by a parent
Can take self to toilet for wees often
No nappy – only wears underpants usually
Usually leaks small- medium wees each day in undies
Usually refused to be told to go to toilet as he is too busy playing with lego, friends, watching tv
Hates being told what to do – stubborn personality and vague at times
High pain threshold and tolerates discomfit easily

Treatment

Seen 4 x in therapy
Introduced laxative daily – advice given on weekly basis re appropriate dosage
Commenced routine of sitting on toilet after every meal until poos happen
- if T refused to cooperate, he is given “toilet time” with door closed and no attention from parent for designated time (3mins) until he cooperates with sitting
- Other specific strategies as directed by the OT
Introduced new meaningful reward for poos/wees in toilet
Specific education regarding digestive system and importance of softer stools using poo poster given to T and parent
Behaviour management strategies given to mother to encourage better cooperation and more responsibility given to T for his choices and actions.

Outcome

Poos became softer and more regular (1x large daily) as a result of the laxative
Eventually became more cooperative after he realised he wasn’t able to stop poos/wees after laxative was given and not enjoying the mess/consequences that happened after a more significant soil
No soiling evident
Dry pants each day
T was taking full responsibility for taking self to toilet with few reminders from parent
Continued with laxative indefinitely with advice given to wean this gradually