Pediatrics/soiling

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Question
hello,
my son is 6 and he has had problems with soiling all his life.  He finally got diagnosed with encopresis but I haven't been able to do the first step of the prescribed treatment yet.  He has sensory problems, prefers to drink than chew, very picky eater, we have not been able to give him medicine properly since he was a baby, he spits everything out.  I've tried the different powders, syrups etc. his doctor has prescribed to clear out his bowels and then give him daily to establish the right stool consistency and retrain his bowels, but he won't keep anything down.  Tried hiding it in food, drinks, but since his a picky eater and tastes everything very easily, I haven't had any luck yet.  Is an enema an option?  do I need to take him to a pediatric gastroenterologist?  Should I try to put the prepared syrup in a freezy?  Would a pharmacy mix something that is completely tasteless and mixes well?  I'm very concerned because his condition is not helping him socially as he has behavior problems and very lonely.

Answer
Hi, gabi,

Enemas are an option, but they really are pretty invasive and need to be done daily, just like the cleanout and maintain program needs to be done daily for at least a few months. I send about 1 in 20 kids with encopresis to a peds gastro, and really they have no great techniques to help with this.

My treatment is to do a clean out for a couple days with Miralax powder mixed in whatever liquid he desires.  I would use a one cap in 4 oz dose twice a day for a couple days as a cleanout and then would do a daily one cap for at least 3-4 months, with somewhat frequent, encouraging checks in the office and telling him to engage the gastrocolic reflex, the one that tells us when we eat, we need to poop.  He should try sitting for 5 min after every meal, regardless of the need to go, and sit anytime he needs to go.

If your pediatrician is not skilled at this treatment, or if he really has been stooling all his life, from birth this way, then a peds gastro may help.  Lifetime symptoms raise the possibility of Hirschsprungs disease, a rare problem that needs special techniques to diagnose.

Good luck, Dr. Olson

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David Olson, MD

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I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

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