Smearing, A Therapist's Guide

Smearing- A Therapist's Guide
 

With non verbal autistic children who smear faeces the main rule is not to reinforce the behaviour through big reactions. 

Any attention, whether praise or scolding, can strengthen it. 

Smearing almost always has a reason behind it, such as constipation, sensory seeking, curiosity, or communication frustration.

If a child has faeces in their hand and seems about to smear, give a calm and neutral redirection before it happens.

 Instead of shouting or snatching their hand away, provide a clear physical alternative that meets the same need safely. 

This could be a washable textured object, a playdough type material, or a soft item they can manipulate.

 The goal is to meet the sensory need without creating drama or attention.

For example, if the child often smears during nappy changes, have a small object ready for their hands as a “toilet time” item. It can be a stress ball, silicone brush, fidget spinner, or anything with a texture that satisfies their sensory urge. 

The key is to swap the activity calmly rather than distract with a noisy or overly stimulating toy.

 Give them something functional to hold that replaces the urge to smear.



What not to do



Do not shout, punish, or show disgust.

Do not give a dramatic distraction like flashing toys or loud music, as this makes toileting unpredictable and can confuse the child about what you want.

Do not overtalk or give long explanations.

What to do instead

When you see them about to smear, calmly hand them the substitute and say “hands on toy” or “hold this.”

Keep tone flat and predictable.

Guide them to wash hands immediately after any contact with faeces.

Then proceed with toileting or cleaning routine as normal.

NHS and UK charity sources agree that predictable, neutral responses prevent reinforcement. 

The NHS constipation guidance emphasises calm reassurance so the toilet is not linked with stress. 

The National Autistic Society toileting guide notes that sensory needs should be addressed directly, for example providing safe textures to explore rather than punishing sensory behaviour. 

ERIC, the bowel and bladder charity, also recommends giving a suitable hand activity during toileting to reduce smearing and make routines more positive.

Example script

“Hands on toy. Poo goes in toilet. Let’s wash hands.”

Summary

Never reward or punish the act. 

If the child begins to reach or hold faeces, calmly replace it with a safe sensory alternative and continue the routine without emotional reaction.

With practice and patience are required.

 Treat medical causes first, keep routines identical each time, and use minimal speech. Calm repetition and meeting the sensory need safely are what eventually stop the smearing.

Liz Lucy Robillard