I was gratified to read the study of Levine and Bakow on childhood encopresis (Pediatrics 58:845, December 1976). Disorders of defecation cause great suffering to many children and their families. Pediatrics, as a clinical pursuit and scientific discipline, has too often side-stepped disorders of elimination.

The value of the authors' humane, caring attitude toward their patients cannot be overestimated. I would like to offer the following criticisms:

1. A pediatrician's ability to help a patient depends on his understanding of the symptom.

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