Hi Elaine – this is an incredibly challenging situation for all involved. Firstly, my sympathies to you and your family for the loss of your grandchild. You do not mention in your question whether your grandson died suddenly or whether his death was the result of an illness. I raise this as a concern as it is not unusual for siblings of terminally ill children to experience significant stress which may be a contributing factor to his incontinence (which would explain why this behaviour began even before his brothers death). Faecal incontinence can also be the result of a medical condition such as chronic constipation. If left untreated, constipation can result in leaking of faceal matter that can very smelly and dark in colour. The signs and symptoms of constipation include: poor appetite, lack of energy, irregular bowel movements, excessive and foul smelling flatulence, irregular stool texture, withholding of stools, daytime soiling or overflow, nighttime incontinence, abdominal pain or discomfort, and irritability. In order to help him improve his bowel habits, you need to encourage him to go to the toilet. Rewards work best when children are involved in deciding how they want to be rewarded and for what type of behaviour. The more he feels included in the process the better he will feel about the situation. Rewards may be given for a range of behaviours (not just when he has a bowel movement) including sitting on the toilet for 10 to 15 minutes after each meal, eating healthy food, or drinking regularly throughout the day. This is a time when he will need lost of reassurance and praise. With respect to dealing with the death of his sibling, it is important that you try and keep his routine as familiar as possible during this time – children at times of stress take great comfort from the familiar. Understandably his parents will be experiencing significant grief so it will be important that you are there for him so that he knows that he has someone to talk to. Check his understanding of the situation as children can be incredibly self-referential about death and it is not uncommon for them to feel they are somehow responsible, which can lead to feelings of guilt. If you feel that he is experiencing difficulties coping with the loss of his brother you can ask to be referred to either a grief counselling service or support group for young children.

Regards,
Dr Cathrine

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