Name of Child: __________________________________________

Date: ____________________

This child occasionally has a problem with leakage of bowel movements (BMs) into the underwear. The main cause of the problem is constipation. With a medicine and diet program, bowel control is now greatly improved. You can help this youngster in your school setting in the following ways:

• Prevention

  Please give the child permission to leave and use the restroom at any time without seeking approval from the teacher, playground supervisor, or lunchroom supervisor. (Note: Encopresis commonly occurs during sports, gym, or other physical activities.) Sometimes this child has very urgent bowel movements and must go to the restroom without delay. Please let this child come in from recess if necessary.

• Detection of soiling

  If a member of the school staff feels that this youngster has soiled himself (because of odor, etc.), please act rather than ignoring the situation. Speak with the child in a private setting and request him to change. Also ask him if he needs any help. It is better to act on your observations than to allow other children to detect the soiling and possibly ridicule the child.

• Changing when soiled

  The child's parents will bring you one set of clean underwear and some wet wipes to keep at school in case of soiling. Please give the child access to a bathroom where he can clean up without being interrupted by other students. It is possible that he may need some assistance with this. Remind the child that before cleaning up, he should always sit on the toilet and try to pass a BM. (Reason: Soiling always means there is a larger BM inside that has caused the leakage. Unless it is released, leakage with soon recur).

Thanks for helping this child through this difficult time. Please feel free to call our office if you have any questions.

Physician's name: ______________________________________

Physician's signature: _________________________________

Phone: _________________