The treatment and management of soiling children

Buchanan, Ann (1989) The treatment and management of soiling children. University of Southampton, Doctoral Thesis.

Abstract

This is a study of 66 soiling children: A retrospective study of 18 children treated by Paediatricians (Hospital Group), a retrospective study of 18 children treated by the Child Guidance Clinic (Clinic Group) and finally a prospective study of 30 children treated by an experimental `whole child' approach (Experimental Group), which sought to incorporate treatment of the psychological, physical and social aspects of the problem. A behaviourally trained social worker working under medical supervision, was the key therapist. The Thesis is in Three Parts. Part I is a comprehensive review of multi-professional literature. Part II shows that the findings from the Study Groups indicate few significant differences in the number or presence of physical, behavioural or social problems between the Hospital and Clinic Group. Constipation was a factor in two thirds of all the soiling children; associated behavioural, educational and social problems which often improved on the alleviation of the symptom, were common in all groups. Soiling children as a whole suffered from more developmental and medical concerns than children in the general population. The possibility that some soiling children may have been sexually abused was considered, but no cases were confirmed. The danger of mis-diagnosing sexual abuse in a soiling child because of the lack of specificity in criteria was illustrated. All treatment groups were successful in alleviating the symptom, but the Experimental approach was more successful than either the Hospital or Clinical groups in achieving longer symptom-free periods. It was also more successful in reducing associated behavioural, educational and social problems. In all groups, soiling relapses throughout middle childhood were common even after extended `clean' periods. In a five year follow up study of the total group, some soiling children were shown to have moved from treatment agency to agency. In Part III, the study recommends the setting up of a single local treatment centre which is able to focus on the needs of the `whole child'. Physical treatments may be necessary for some children; behavioural programmes focussed on regular defecation are indicated for most soiling children; therapy which focuses on management of the associated problems, as well as alleviation of symptom is recommended for all soiling children.

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