The nurse is assisting the family of a child with a history of encopresis. Which should be included in the nurse's discussion with this family?

A) Instruct the parents to sit the child on the toilet at twice-daily routine intervals.
B) Instruct the parents that the child will probably need to have daily enemas.
C) Suggest the use of stimulant cathartics weekly.
D) Reassure the family that most problems are resolved successfully, with some relapses during periods of stress.

Children may be unaware of a prior sensation and unable to control the urge once it begins. They may be so accustomed to bowel accidents that they are unable to smell or feel it. Family counseling is directed toward reassurance that most problems resolve successfully, although relapses during periods of stress are possible. Sitting the child on the toilet is not recommended because it may intensify the parent-child conflict. Enemas may be needed for impactions, but long-term use prevents the child from assuming responsibility for defecation. Stimulant cathartics may cause cramping that can frighten the child.