Fecal smearing is a distressing and often misunderstood behavior that many families encounter when raising a child with autism. Despite its prevalence, it’s rarely discussed openly, leaving parents feeling isolated and overwhelmed. This behavior can stem from a combination of medical, sensory, and behavioral factors.
Children may be seeking sensory input, expressing discomfort from gastrointestinal issues, or responding to stress and communication challenges. Understanding these underlying causes is essential for developing effective strategies to manage and reduce fecal smearing in autism.
What is fecal smearing?
Imagine walking into your children’s room late at night to check on them sleeping, only to find them smearing poop all over themselves or their room! Some children who play with poop also do so in front of other people.
It raises concerns about psychological well-being and health risks, such as becoming ill or spreading illness, and creates a mess for others to clean. It can affect social relationships and limit a child’s ability to participate in typical daily activities.
It can also be deeply embarrassing for parents, especially if others witness the behavior or find out about it. Fecal smearing is often a highly distressing and socially isolating experience for families, particularly when support and guidance are limited.
While toilet training is a common challenge among parents of children with autism, few people discuss the smearing of feces.
Parents may encounter various types of inappropriate or risky poop behaviors, including:
- pica (eating the feces),
- anal poking,
- sexualized behavior with feces,
- fecal smearing (playing with or spreading around).
This has been reported as one of the most common bowel-related problem behaviors in autism, yet very little research exists around how often it happens, what causes it, and what to do.
Why does fecal smearing happen?
Several factors can contribute to fecal smearing in autistic children. Understanding the underlying cause is the first step toward effectively addressing the behavior.
Fecal smearing may be linked to a combination of medical issues, sensory processing difficulties, and behavioral challenges. All of these are commonly reported by parents and caregivers in autism communities.
Based on parent observations and expert insights, the most common reasons for fecal smearing in autism include:
- Medical problems (such as constipation or gastrointestinal discomfort)
- Sensory challenges (seeking tactile input or relief from irritation)
- Behavioral factors (communication difficulties, anxiety, or attention-seeking)
In addition, some studies suggest that factors such as gender, intellectual disability, gastrointestinal symptoms, and comorbid mental health conditions may increase the likelihood of toileting difficulties.
While it’s not yet clear whether these factors specifically predict fecal smearing, ongoing research continues to shed light on this complex issue.
Medical issues
Some medical problems that may occur in autism or for a child in general, and that may contribute to the problem, may include:
- constipation or diarrhea,
- gastrointestinal issues,
- abdominal or systemic pain.
Sensory challenges
Sensory challenges that may contribute to autism fecal smearing include:
- Over-responsivity (SOR), such as tactile defensiveness (touch sensitivity) or oral defensiveness (smell sensitivity)
- Under-responsivity (SUR), i.e., the child needs more input in order to feel or smell certain things, and
- Poor interoception (difficulty being able to feel internal sensations, like when it’s time to go to the bathroom).
Sensory sensitivities may play a significant role in fecal smearing, especially for children with autism.
A child may be hypersensitive to certain sensations, such as the sound of a flushing toilet or ceiling fan, the feel of toilet paper, or the brightness of bathroom lights. Because of this, they may avoid using the toilet altogether to escape the overwhelming stimuli.
On the other hand, some children are under-sensitive and seek out extra sensory input, including touch or smell, as a form of self-regulation. They may be drawn to the texture of feces or the strong scent as a way to fulfill these sensory needs.
With around 86% of autistic children experiencing sensory processing differences, it’s likely that these sensory challenges contribute to fecal smearing in many cases.
Behavioral factors
Fecal smearing is considered a behavior, and all behavior has meaning. A child who is smearing is using that behavior to meet a need and/or to communicate. Very often, behaviors are unintentionally reinforced.
A child may get a reaction from parents or a sibling. They may get more attention, or they may get the benefit of delaying or avoiding something they don’t want, such as bedtime or school.
A child may use the behavior to seek attention due to anxiety, a desire for connection, or because they cannot communicate that something hurts. Behavioral factors are often one of the main reasons behind fecal smearing.
How to stop fecal smearing in autism
Fecal smearing can be a complex and overwhelming behavior to manage, but with the right tools and support, progress is possible.
While there’s no one-size-fits-all solution, a combination of strategies tailored to your child’s specific needs can help reduce or stop the behavior over time.
Below are practical tips that address common causes of fecal smearing and offer supportive steps parents and caregivers can take to manage this challenging behavior.
Keep track
Temple Grandin says, “We can’t manage what we don’t measure.” First, keep a written log of when and where the smearing happens. Make sure to include what was happening before, during, and after each incident.
This information helps to identify patterns or certain triggers of the behavior or the need that it fills. This is one way to take the first step toward resolving the issue.
Talk to a specialist
Communicate with the pediatrician and other specialists working with your child, including a nutritionist. They may be able to first identify or rule out medical reasons for the behavior. They may also help to develop solutions or offer information and resources.
Sometimes the consistency of a child’s stool will determine if they can have a bowel movement, where or when it happens, and thus the potential for poop to even be available for play.
Some parents have found that improving stool consistency helps their child use the toilet during the day instead of soiling their bed at night.
Develop a behavior plan
Search for and work with a medical provider (Psychologist, Behavioral Therapist, or Occupational Therapist) to complete a Functional Behavior Assessment. This way, you’ll be able to accurately identify the variables contributing to the fecal behavior.
Use that data to develop an individualized plan for how to target those specific variables that are contributing to the maintenance of the behavior. Reinforce positive behaviors you want to see, such as going to bed without smearing or using the toilet for a bowel movement.
Remain neutral when an incident occurs by having minimal interaction with your child and by showing no emotional reaction at the time. This keeps the reinforcement of the behavior to a minimum.
Use social stories and visual reminders
Read books and create social stories with pictures of your child using the toilet in desirable ways. Search for pictures that will reinforce and encourage your child to use the bathroom.
The use of YouTube videos and favorite characters, toys, and even other family members can be motivating, and when hung in obvious places around the house, it is a constant reminder of what is expected and “normal” in your home.
Address challenges
Make the bedroom sensory-friendly. Items like a white noise machine, a light projector (for calming visual stimulation), and soft/tactile/squishy toys are all inputs that are more acceptable and tolerable, and supportive of child development.
Ensure opportunities for tactile messy play outside of sleep times and bathroom use. Examples are:
- sensory bins,
- Play-Doh,
- finger paint,
- water beads,
- play with shaving cream, whipped cream, pudding, slime, or Cloud Doh.
Adaptive clothing
Special pajamas designed to limit access to diapers or pull-ups can be an effective way to reduce or eliminate fecal smearing.
These garments fasten in a way that prevents children from reaching into their clothing and are also available as regular adaptive clothing for daytime wear, helping normalize routines for both children and parents.
Is playing with poop a sign of autism?
Playing with poop, or fecal smearing, can be alarming for parents. While this behavior is sometimes seen in autistic children, it isn’t a guaranteed sign of autism.
Many young children explore through touch, and this can include poop, often out of curiosity, boredom, or sensory seeking.
In autistic children, fecal smearing may be linked to sensory processing differences, communication struggles, or discomfort during bowel movements.
If your child shows other signs of autism, such as delayed speech, repetitive behaviors, or social challenges, it may be helpful to consult a pediatrician or developmental specialist. No matter the cause, support and understanding can make a big difference.
Finding support and practical solutions for fecal smearing
For parents who struggle with their child’s fecal smearing, it can be scary and overwhelming, frustrating, and confusing. There are few resources available, and research has not yet shown a consistent one-size-fits-all approach that will help every child.
Research has shown that if you find out and address the reasons that the behavior is happening in the first place, it will help. Working with specialists such as a doctor, a psychologist, an occupational therapist, or a behavior therapist can be a great support.
Finally, there are practical tools such as adaptive clothing that might make bedtime or school a tidier experience for everyone involved. If your child struggles with this problem, please share with others so you can get support and don’t have to manage this problem alone!
FAQs
Q: Is toddler playing with poop a sign of autism?
A: Playing with poop can occur in toddlers with or without autism, but when combined with other signs like communication delays or repetitive behaviors, it may warrant further evaluation. It’s important to consider the overall developmental context rather than one behavior alone.
Q: What is smearing feces a sign of?
A: Fecal smearing can be a sign of sensory processing issues, emotional distress, developmental delays, or neurodevelopmental conditions like autism. It may also be a form of communication or a response to stress in nonverbal children.
Q: What is the psychological reason for smearing feces?
A: Psychologically, smearing feces may serve as a coping mechanism for anxiety, a way to seek sensory stimulation, or an attempt to express unmet needs. It can also reflect a lack of awareness or understanding of social norms.
Q: Is fecal smearing the same as incontinence?
A: No, fecal smearing is an intentional act of spreading stool, often linked to behavioral or sensory factors. Incontinence is the unintentional loss of bowel control and typically involves medical or developmental issues.
References
Citation: MacAlister L (2014) Toileting problems in children with autism. Nursing Times; 110: 43, 18-20.
Case, J. & Konstantareas, M. Interventions for inappropriate handling of feces in adults with Autism Spectrum Disorders. Journal on Developmental Disabilities 17(2), 73-78 (2011). https://oadd.org/wp-content/uploads/2011/01/41010_JoDD_17-2_73-78_Case__Konstantareas.pdf
Dalrymple, N.J., Ruble, L.A. Toilet training and behaviors of people with autism: Parent views. J Autism Dev Disord 22, 265â275 (1992). https://doi.org/10.1007/BF01058155
Leader, G., Francis, K., Mannion, A. et al. Toileting Problems in Children and Adolescents with Parent-Reported Diagnoses of Autism Spectrum Disorder. J Dev Phys Disabil 30, 307â327 (2018). https://doi.org/10.1007/s10882-018-9587-z
Interventions to decrease the occurrence of scatolia in children with developmental disabilities https://search.proquest.com/openview/f8cd58a989ec94f5c96bae50a6367889/1?pq-origsite=gscholar&cbl=18750&diss=y
Al-Beltagi, M., Saeed, N. K., Bediwy, A. S., Elbeltagi, R., & Alhawamdeh, R. (2023). Role of gastrointestinal health in managing children with autism spectrum disorder. World journal of clinical pediatrics, 12(4), 171. https://pmc.ncbi.nlm.nih.gov/articles/PMC10518744/
