In some cases, loose bowel movements or constipation contribute to fecal smearing. If this is the case, I recommend that you talk to your pediatrician about these issues. I suspect that your doctor would suggest dietary changes before medication.
A child may also fecal smear because he/she has difficulty cleaning after bowel movements. In these cases it is important to patiently teach the child how to clean correctly. I also find that flushable wipes make the task easier.
Some children smear feces because they enjoy the sensation. In these cases, I recommend beginning with careful monitoring in the bathroom. Interrupt any attempts to touch or manipulate feces. You might also consider a reward system for clean bathroom trips. If your child is smearing feces at other times (e.g., in bed at night) it will be more difficult to supervise adequately. In these cases, I recommend checking on your child frequently and implementing a reward system for no fecal smearing. If the problem is consistent enough, you might also consider purchasing a cheap video monitor now available along side audio baby monitors in many stores. If it is an appropriate time, you might also consider offering you child an appropriate alternative source of stimulation (e.g., play dough) at the times that he usually smears. But, do not give your child something fun to do immediately after he smears.
Some children also learn that they get a big reaction from their parents when they smear feces. In order to avoid rewarding this behavior with attention, I recommend that you minimize your reaction as much as possible.
You must also decide whether to clean the mess yourself or have your child participate in the clean-up. The answer is that it depends. For some kids, participation in the clean up might provide an enjoyable type of attention that will actually reward the smearing. For other children, participating in the clean up would be a consequence that discourages fecal smearing.
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