Initial Promise and Acceptability of a Virtual Group-Based Caregiver Intervention for Pediatric Fecal Incontinence

Objective: Fecal incontinence affects up to 7.8% of youth and can impact psychological and physiological well-being, including increased risk for loss of rectal nerve functioning, high family stress, and mental health disorders. Behavioral approaches can be combined with medical management, but have limited research support. This article describes the development, acceptability, and feasibility of a group-based, telehealth, caregiver-only behavioral intervention for pediatric fecal incontinence. Methods: Caregivers of children with fecal incontinence were referred by gastroenterology providers. Participants completed four virtual group sessions focused on psychoeducation and implementing strategies for shaping child behaviors related to medication adherence, toileting, and clean-up. Feasibility was assessed via recruitment and uptake, participant retention, and implementation within routine clinical operations. Acceptability was assessed via caregiver satisfaction. Caregivers stress, frequency of accidents, clean-up behaviors, and intervention satisfaction were assessed. Results: Mean child age was 5.80 ( SD = 1.80) with 51.4% male. Of the 72 caregivers who began the intervention, 88.9% ( n = 64) completed all 4 sessions. Most (98%; n = 52) respondents completing post-program questionnaires would recommend it. The majority thought the number (60%; n = 32) and length of sessions (79%; n = 42) were “just right.” Child responsibility for cleaning increased ( X 2 (1, N = 131) = 3.90, p = .04 ) and there were significant reductions in caregiver stress levels on all subscales of the POOP-C ( p < .05– p < .01). Conclusion: Results support the initial acceptability and feasibility of a caregiver-only group behavioral intervention for pediatric fecal incontinence. Future research includes evaluation of program adjustments and clinical efficacy.