SUMMARY Simple, incentive based behaviour modification, with or without a modest programme of psychotherapy involving outpatient visits every four to six weeks, seems to be associated with a useful cure rate in children with lower bowel function disorders.Appreciable social disadvantage seems to be the most important factor mitigating against a successful outcome, associated with non-compliance with treatment. Failure to respond to treatment was associated with important psychological problems. These were more common in the socially disadvantaged groups.Children from satisfactory social backgrounds who have lower bowl disturbances can be effectively treated by fairly simple programmes. More elaborate and expensive strategies should be reserved for those whose psychosocial circumstances make it possible to predict a less satisfactory outcome.Faecal soiling with or without faecal retention is a common cause of referral to general paediatric outpatient services and accounts for some 25% of the gastroenterological workload. Primary or secondary referral to child psychiatry services is also considerable. Methods of treatment include pharmacological, 2 behavioural,3 behavioural and medical,4 dietary,6 psychological,7 and surgical.8 The diversity of treatment is a reflection both of the multifactorial nature of the problem and the difficulty encountered in applying recommended management programmes in clinical practice because of the considerable demands they make on valuable outpatient time.The published results of treatment show cure rates of between 45% and 70% and failure rates of between 25% and 35%o, depending on selection of cases, criteria of assessment of outcome, and (possibly) intensity of treatment. In view of the non-fatal and self limiting nature of the problem the issue of cost effectiveness is a major one. A regimen with a high success rate that overwhelms available resources or diverts attention from more serious matters would clearly be unsatisfactory. This study was devised not to find a regimen with an optimal cure rate but to test the effectiveness of fairly modest programmes of behaviour therapy or psychotherapy, or both, that would not seriously tax the resources of busy district paediatric or child psychiatry services. For example, one British study involved weekly or biweekly visits in comparison with the monthly or six weekly visits employed here.We report our experience with 47 children who presented with faecal soiling, with or without constipation, who were treated by incentive based behavioural modification, plus or minus psychotherapy, and consider factors that might predict the outcome for a non-intensive approach. In particular, we wish to draw attention to social background as a prognostic indicator, a factor not previously reported. Material and methods

No abstract

No abstract