Mother of A 2-year-old with Runny Stools After Stopping Laxatives — Free SCA Practice Case

Character Overview: You are Hayley, mother of Leo, who is 2. Leo was constipated and was prescribed a laxative (a sachet powder), but you stopped it a couple of weeks ago because he started having runny, leaky poos in his pants and you assumed the laxative was causing diarrhoea. In fact he still strains and seems to hold on, and only passes hard poos occasionally, with the leaking in between. You are in the middle of potty training and it is not going well. Leo is otherwise well, eating, drinking, growing, and happy. You are a caring, slightly frazzled first-time mum who wants to do the right thing and is puzzled about the laxative.

Opening Sentence: "Hi Doctor. My little boy Leo, he's two — he keeps having these runny, leaky poos in his pants, several times a day. He was on a laxative but I stopped it because I thought the laxative was giving him diarrhoea. That makes sense, doesn't it? But it hasn't got better."

History if Asked (Data Gathering Phase)

• ●The stools: "Runny, smeary, leaky poos in his pants during the day — not proper big soft poos. In between, when he does 'go', it's hard and he strains and cries."
• ●The laxative: "He was on a sachet powder for constipation. I stopped it about two weeks ago because of the runny stuff — I thought it was causing diarrhoea."
• ●Straining/holding: "He strains, goes red, sometimes seems to hold it in — clenches and hides. When it comes it's hard."
• ●Potty training: "We're trying to potty train and it's a nightmare. He gets upset about the toilet."
• ●General health: "He's well otherwise — eating, drinking, playing, growing fine. No tummy swelling or vomiting."

ICE — Ideas, Concerns, Expectations

The mother does not volunteer this information unprompted. These responses surface only when the candidate directly explores her perspective.

• ●Ideas: Hayley believes the laxative caused diarrhoea, so stopping it was sensible — she does not realise the leaking is overflow from constipation. "In my head the laxative gave him the runs, so stopping it made sense."
• ●Concerns: She is worried something is wrong with his tummy/bowels, and stressed that potty training is failing. "I'm worried there's something wrong with his tummy, and the potty training is doing my head in."
• ●Expectations: She wants the leaking sorted and advice on potty training. "I want the leaking to stop and some help with the potty training."

If Asked — Constipation and Red-Flag Screen

The mother answers these only when directly asked.

• ●If asked about hard, infrequent, painful stools / straining: "Yes — when he goes it's hard and painful, and he strains. He doesn't go often."
• ●If asked about withholding behaviour (clenching, hiding, refusing the toilet): "He does clench and hide, and he's scared of the toilet."
• ●If asked about the leaking pattern (smearing between hard stools): "It's smeary leaking in between the hard ones — not proper diarrhoea."
• ●If asked about diet and fluids: "He's a fussy eater, not much fruit or veg, and I don't think he drinks a lot of water."
• ●If asked about blood, tummy pain, vomiting, or a swollen tummy: "A little blood streak on a hard poo once, no vomiting, tummy's not swollen."
• ●If asked about growth/weight and general wellbeing: "He's growing well and is happy and active."
• ●If asked about red flags (from birth, delayed meconium, weight loss, developmental concerns): "He passed meconium normally as a newborn, he's developing normally, no weight loss." (Reassuring against organic causes.)

Responses to Management (The Negotiation Phase)

• ●If the Doctor explains this is overflow from constipation, not diarrhoea: "So the leaking is actually overflow because he's constipated — not diarrhoea? That's the opposite of what I thought." (The tested point is explaining overflow soiling and correcting her understanding.)
• ●If the Doctor advises restarting/optimising the laxative: "So I should put him back on the laxative — even though he's leaking? That feels wrong." (The tested point is explaining why laxatives are needed [disimpaction then maintenance], addressing her understandable concern.)
• ●If the Doctor advises on toilet training and behaviour: "How do I handle the potty training when he's so scared of the toilet?" (The tested point is positive, non-punitive toilet-training support.)
• ●If the Doctor advises on diet/fluids: "Would changing his diet help?"
• ●If the Doctor safety-nets: "What would mean I need to get him seen?"