Child who plays with his bowel movements

[fetter4]

I am a daycare provider who is having trouble with one of my daycare children.  He is almost 4 and has been toilet trained for pee for almost 7 months.  However, he would never poop for me.  About a month ago, during his nap time, he would poop in his pants and then take it out and smear it on the carpet, the covers, the beds.  I am so frustrated.  He only does this when he lays down for a nap.  His hands are filthy and I am worried about disease.  He is very small for his age and he also is very slow to speak.  I have tried to talk with him about this behavior, but he looks at me like he doesn't comprehend.  I think he could be autistic and have persuaded his mother to have him tested.  However, she won't listen to me about the pooping issue.  I have had to get angry at times so she will listen to me.  Has anyone else had a child who behaves this way?  I have tried to have him go potty at certain times of the day, but he will never poop until he goes to sleep.  He has never told me that he has to go to the bathroom, I always have to ask or just take him.  I have never had a child in all my years of daycare, who has behaved this way.  The mom says that he doesn't do this at home and I think it is because they just put him in pull ups and he never takes a nap at home.  I guess I want to know first of all why he does this?  Is this normal?  What can I do to get him to stop doing this?  Is this a sign of autism?  Any help you could give me would be greatly appreciated.

Sincerely,
Wendy Fetter
Wendy's Wee Ones Daycare
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[mom@homenow]

Kudos to you for pushing the parents to allow an evaluation and get him some help. The earlier the intervention, the better. Your description of his older brother, by the way, sounds exactly like my son, right down to the scooting (never crawling) until about age 2 and chewing food endlessly without swallowing! (Oh that drove me crazy!) It was thought for a brief time my son might be autistic but instead he was diagnosed only with sensory integration dysfunction and very low muscle tone and he's making great progress with occupational therapy. In fact he is set to enter public Kindergarten next fall (with an IEP for Special Ed if he needs it.)

The young boy in your care at this time sounds to have a lot more going on and hopefully the Child Find office will set him up with therapy. At least the ball is rolling... but in the long run his parents must come to realize that THEY need to be his advocates in the system or else he may not get all the services he needs to reach his full potential. Your description of the mother as "passive" concerns me in this regard. You have gone beyond your duties as daycare provider to help this family, and hopefully now that others are involved the parents will no longer be able ignore his special needs.

If you will continue to be his daycare provider, you might ask for the parents to concent to your being able to discuss/consult the therapists about him as he starts to receive services (especially if they will take place at your daycare.) The therapists would be able to provide you with ideas (just like they did about covering his hands for nap time) as problems or issues arise. My son's OT has had all sorts of good ideas for dealing with issues that arise at home, I just have to ask.

[fetter4]

I too think the child is autistic.  The mother has finally consented to having our local Child Find do testing on the child.  I told her she couldn't bring him back to my daycare until she got him some help.  The therapist who came this morning to evaluate the child told me that he has the gait of an 18 month old and that his speech is severly delayed.  She also noticed the fisting and his general lack of interaction either verbally or physically with either me or the other children.  She too thinks he is autistic.  She also told me that they would test him for neurointegrative disorders as the playing with BM's indicate that he probably does have some type of disorder.  Her suggestion in the meantime is for me to put tube socks or mittens on his hands when he naps.  So, I am trying it out today.  We will see what happens.  I did find out from the mom that the reason he does not nap during the weekends, is because he gets so riled up during the day that she has to go out and drive him around in the car until he falls asleep.  However, when she tries to take him back inside, he always wakes up and is on the go again.  She really has no control over him because she is so passive.  I do not think in any way that they abuse the child and I know that they love him.  I think it is just a matter of not wanting to face reality and admit there is a problem.  Their oldest son was like that to. I had him from infant on up and he would do things like stuff food in his mouth and not swallow it for a few hours, he did not walk until he was almost two, he scooted around on his hiney with his legs in a "V" shape.  Every time I would try to stand him on his legs, he would quiver all over and then fall down.  He never tried to pull himself into a standing position or try to stand or crawl on his own.  He is now 8 and is in a private school so he can get extra help.  He is very smart mentally, but has some issues with physical aspects.  Both of these children are very small in weight and height.  There issues just confound me.  The mom always says that the pediatrician never says that anything is wrong.  I think it is because she really doesn't ask or push to know.  Thank you all for your advice.  I will try to keep you posted.  If you have any more ideas, please let me know.

Thank you.

[Christie04_returns]

I'm wondering if it would merit contacting Social Services with your concerns that the child needs to be evaluated for diagnosis or intervention, and that the parents are not doing so?

Just sort of thinking out loud.  I'd hate to think the child is being neglected by parents who are in denial.  Maybe this would be the impetus they need to get going.

[xmsrlong]

This child is autistic.  Plain and simple.

[Kevin Kennedy, Ph.D.]

The additonal information does indicate a pretty serious emotional or neurointegrative disorder. It invites immediate evaluation. The most suitable type of evaluation would be a comprehesive developmental evaluation conducted by a developmental pediatrician, developmental and/or clinical psychologist, speech/language therapist and clinical social worker. Naturally you cannot insist that the parents respond to this, but you can offer your guidance and suggestion.

[fetter4]

Thank you for the information.  The child is very slow to speak.  It is as if he has his own language, which is gibberish.  He can say a few words plainly, and a couple of sentences.  However, he does not regularly speak.  He also does not play with the kids, but along side.  It is usually by himself.  If you ask him a question he will not make eye contact with you and he clenches his fists.  Many times he just lays on the floor and zones out.  As for the potty situation, I do put him on the toilet for almost 5 minutes before his nap time and at various times throughout the day.  He will never go on the potty.  His parents are very passive and have not taken me seriously.  They keep telling me that I am looking for problems where there are none. I have done daycare for 20 years and this is the first child I have had that plays with this BMs.  I asked his mom to have a talk with him about the seriousness of what he is doing, and she refuses.  She says that he won't understand what she is talking about.  However, I think he is brilliantly smart, which makes this all the more troubling.  He will not speak his alphabet or colors or anything like that, but when you ask him, he will point to the answer.  So I know that he is smart.  Is there anything that could be causing this behavior?  I am so desparate to find a solution.  Not only because it is unhealthy, but it is a mess to have to clean up.  Thank you for your advice.  I do so appreciate it.

[Kevin Kennedy, Ph.D.]

In and of itself the behavior is not symptomatic of an autism spectrum disorder. However, something is indicating to you that he may display some neurointegrative condition. You did the responsible thing by conveying your concern to his parents. From a behavior management point of view, you might employ one of two alternatives. Have him sit on the potty just prior to nap time, since that is the time of day he seems to reliably move his bowels. Or, on the other hand, due to your concerns about hygiene and health in the daycare, insist that he wera pull-ups to the daycare. By the way, does he play with the other children? Is he able to speak? Does he regularly communicate with you and the other children? What is he like in the presence of his parents?