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Lack of bowel control in a child who has previously been toilet-trained and does not have diarrhea or constipation. A child cannot be expected to have complete bowel control until at least 2-1/2 years of age.

Affects children of both sexes over age 2-1/2.

• Passing stools in underwear.
• Mass in left lower abdomen (sometimes).

• Physical or emotional crisis in the child's life, such as birth of a sibling or recent illness with diarrhea.
• Resistance to using the toilet because of too much pressure to do so.
• If the problem is long-term, the original cause may be forgotten, and the behavior may persist as a habit.

• Stress.
• Recent illness that brought the child increased attention.

• Don't lavish attention on a child for being ill.
• Avoid undue emphasis on toilet training. Approach it calmly with realistic expectations. Don't embarrass or blame the child for accidents.

We have seen enough mothers getting neurotic with a delay in child’s toilet training

• Be sensitive to stressful situations your child faces. Talk together about the child's feelings.
• Expect and accept if your child is sent for Psychotherapy or counseling.

• Observation of symptoms.
• Medical history and physical exam by a doctor, if necessary.

None expected. The symptoms frequently trigger more emotional difficulties than the initial cause.

TREATMENT

• Let your child decide when it is time to go to the bathroom. Don't remind him or make him sit on the toilet against his will. This fosters a negative attitude.
• Praise your child for having bowel movements in the toilet--he deserves positive reinforcement for success. Other family members may also praise the child.
• Provide a prearranged reward if the child stays clean all day. The favorite reward of many children is 30 minutes of free time with either parent, doing whatever the child chooses. Incentives builds motivation to succeed.
• Respond gently to accidents. When the child is soiled, he should clean himself and change into clean underwear. For younger children (under age 5), you will probably have to do this.
• Don't blame, criticize, restrict or punish the child for accidents. This may cause him to give up, as well as lead to secondary emotional problems.
• Don't allow siblings or others to tease the child.
• Never put the child back in diapers.
• Ask for the school's cooperation. The child needs quick access to the bathroom at school, especially if he is shy or new at school. Remind him that there should be nothing embarrassing about leaving the classroom to go to the bathroom.

DO NOT use any medications as:

• Laxatives and stool softeners. These will probably cause diarrhea in addition to the original problem.
• Enemas and suppositories. These may make the child resistant and uncooperative. 

Your child has encopresis, and despite your efforts it persists longer than 2 months.