Oh, that's poopy. The facts behind fecal smearing.

Toilet problems are not uncommon in households with an autistic child. It could be that they refuse to go potty, holding it in until it becomes an issue, which is worrisome enough. But it could also be that the child participates in fecal smearing, one of the most upsetting behaviors reported by parents of autistic children.

Brandy, a kindergarten school teacher and mommy to six-year-old Michael, says that the first time she discovered her son’s smearing, she wasn’t wholly surprised, but still troubled.

“I’ve been teaching for a few years and have had three autistic students in my classroom over those years,” says Brandy, “and yeah… as a teacher, of course the first time it happens, or even the third time it happens, it’s not the most enjoyable thing. But I always had the parents in mind, knowing they go through this way more than I would.

“There must have been reason I was so compassionate,” she adds with a laugh. “Because when Michael starting smearing, I wasn’t unprepared, let’s say that. But it definitely changed a lot of things for us, for our family.”

Fecal smearing is a category of behaviors. The child may roll feces in their hands. They may pick up their feces and hide it somewhere in the house. They may take their feces out of the toilet and play with it, smearing it along the walls or floor. They might do #2 in the bathtub.

In some cases, the behavior isn’t limited to the home. They may undress in the bathroom at school, smear feces on themselves or the wall, get dressed and head back to the classroom.

Such behavior causes a lot of parents distress. Many don’t talk about it. Others refuse to go out to places, like dinner outside or parties, because they’re so fearful it will happen “out there.”

“We definitely isolated for a bit,” says Brandy. “We used to go to my sister’s every Sunday morning for brunch, and that came to a fast stop right away, because it was so embarrassing. So there’s that too – you feel awful that your child is doing this, because you feel bad for them, and then you feel guilty over your embarrassment and shame because it’s not like your kid is bad or doing this on purpose because they want to be naughty.

“It’s a lot to deal with, physically, mentally and emotionally.”

Like Brandy and her family, many parents seek to understand the causes of fecal smearing. Sometimes there’s more than one, which professionals say is the reason it can be such a difficult behavior to resolve.

Kids may have medical issues like gastrointestinal problems, constipation, or persistent diarrhea. They may be dealing with psychiatric or psychological issues, like anxiety or OCD. It might be caused by sensory issues or problems, difficulty around proper toileting, or may just be a response to emotions, like anger or boredom.

The good news is that smearing can be managed, not just on the part of the child but the caregivers too. When parents or caregivers seek the advice of professionals who can help them determine the best route of toilet skill development, it’s a great first time toward reducing or eliminating smearing altogether. Smearing can most certainly be minimized, but everyone – caregivers, family members, and school staff – need to work in collaboration.

Some tips to help manage smearing include cleaning up without much fuss or words – simply clean up quietly without evident emotion. This is part of what experts call a low-arousal response – don’t show your child a positive or negative reaction to what they’ve just done. If you know you’re an emotional person, clean up when your child is in another space so they can’t see or hear you. If you’re cleaning up your child, keep calm around them.

Some parents have been advised to offer substitutions for the feces, if the reason for the smearing is merely sensory. You can provide them play dough, lotions, or even finger paints. These items are best placed where the smearing typically occurs, and used consistently and constantly until they’re routine and the fecal smearing is not.