Fecal smearing, also known as scatolia, is one of the most distressing behaviors parents of autistic children may encounter. While it can feel overwhelming and isolating, it is more common than many families realize, and there are effective strategies to address it. Understanding the underlying causes is the first step.

Why Fecal Smearing Occurs

Fecal smearing is not done to be defiant or manipulative. In autistic children, this behavior typically serves one or more underlying functions:

• Sensory seeking: The texture, temperature, and consistency of feces can provide intense sensory input that some children find regulating or stimulating. Children with sensory processing differences may be drawn to this tactile experience.
• Communication: A child who cannot effectively communicate discomfort, such as a full diaper, constipation, or skin irritation, may engage in smearing as a way to express that something is wrong.
• Gastrointestinal discomfort: GI issues are significantly more common in autistic children. Constipation, food sensitivities, or abdominal pain can lead to behaviors related to bowel movements, including smearing.
• Anxiety or stress: Changes in routine, new environments, or overwhelming situations can trigger the behavior as a coping mechanism.
• Attention: If previous incidents resulted in significant reactions from caregivers, the child may have learned that smearing produces predictable, immediate attention.
• Toileting difficulties: Children who are not yet toilet trained or who have inconsistent toileting skills may have more opportunities for this behavior to occur.

Medical Considerations

Before addressing fecal smearing as a behavioral issue, rule out medical causes:

• Chronic constipation (which is very common in autistic children)
• Food allergies or sensitivities
• Gastrointestinal disorders
• Skin conditions that cause itching in the diaper area
• Urinary tract infections

A pediatrician or pediatric gastroenterologist can evaluate and treat any underlying medical issues.

Strategies That Help

Once medical causes have been addressed, behavioral strategies can be very effective:

• Provide sensory alternatives. Offer similar tactile experiences through play dough, kinetic sand, finger paints, shaving cream, or slime. If the behavior is sensory-driven, providing appropriate alternatives can satisfy the need.
• Address communication. Teach your child to communicate discomfort or toileting needs through words, signs, pictures, or a communication device.
• Make access difficult. Use adaptive clothing like onesies, backward zippers, or overalls that make it harder for the child to access their diaper. This is a management strategy, not a solution, but it can reduce incidents while other interventions take effect.
• Increase toileting routine. Regular, scheduled bathroom trips can reduce the occurrence of full diapers or accidents that lead to smearing opportunities.
• Respond calmly. Keep your reaction neutral when incidents occur. A big reaction, even a negative one, can reinforce the behavior.
• Reinforce appropriate behavior. Praise and reward successful toilet use and clean play activities.

How ABA Therapy Helps

A Board Certified Behavior Analyst (BCBA) can conduct a functional behavior assessment to determine the specific function of the smearing behavior for your child. Based on this assessment, they will create an individualized intervention plan that may include:

• Teaching alternative behaviors that serve the same function
• Building toileting skills through structured, evidence-based protocols
• Training parents and caregivers to implement strategies consistently
• Gradually reducing the behavior while building replacement skills

You Are Not Alone

If your family is dealing with fecal smearing, know that you are not alone and that effective help is available. This behavior does not reflect poor parenting, and with the right support, it can be significantly reduced or eliminated.

Contact Treetop ABA Therapy to connect with experienced BCBAs who can help. We serve families across 11 states, and most insurance plans are accepted.