Starting school is a big milestone for families and as the first day looms, parents everywhere are busy preparing their kids to become independent during the school day. It’s usually expected that children will have developed good toileting skills by the time they start school, but increasingly teachers are reporting that this isn’t the case. And for parents whose children are not yet fully clean or dry, the prospect of starting school can be fraught with anxiety about how their child will cope.
Even if your child has been successfully toilet trained it would be unusual if there weren’t a few accidents in the first weeks of school. There’s so much to learn and so many new activities that it’s inevitable young children will become engrossed in what they are doing and get caught short. For many children having to disturb the teacher to ask to go to the toilet in front of everyone can be daunting. Others may be reluctant to use the school toilets if they are dark, noisy or smelly or even if they are used by older children.
[Related article: Parents put off asking for bedwetting help]
Everyone’s level of anxiety can increase if a teacher or assistant has an unsupportive or negative attitude to the problem. In some cases parents have been led to believe that schools have the right to refuse admission when there are continence problems or that they will be expected to come to school to change their child if they wet or soil.
If you anticipate that your child will have problems always let the school know so they can be aware and put measures in place to help your child. Many schools have supportive systems in place and will prompt a child during the day or allow access to the toilet without needing to ask for permission. Most schools have a school nurse available who can help families resolve on-going wetting or soiling problems and she can be an important link between the family and the school. It’s important to seek help from your GP, school nurse or health visitor as soon as you begin to have concerns about your child wetting or soiling.
Wetting in the day
The extent of wetting accidents can vary from a large puddle on the floor to damp patches on pants. When very young, the most common cause of wetting in the day is becoming engrossed in play or activities and ignoring the signal of a full bladder. But there are several reasons why a child may wet at school. Causes of daytime wetting include:
• An overactive bladder. This is a condition in which the bladder muscle contracts suddenly, before the bladder is full, causing a strong need to wee with little or no warning.
• A urinary tract infection (UTI)
If a child wets for one of these reasons they will have little ability to control the problem and if you have any concerns at all, always make an appointment with your GP to have the problem checked. The problems can almost always be managed or resolved.
Other reasons for wetting in the day include:
- Leaving it too late and not having enough time to reach the toilet
- Difficulty undoing or pulling clothes up and down without help
- Avoiding an unwelcoming or intimidating toilet environment (e.g. cold, smelly or with spiders!)
- Changes in routine, tiredness or a mild illness
- Being in too much of rush to completely empty the bladder
- Emotionally upset
Tips to help you manage if your child wets in the day
- Encourage your child to drink six to eight cups of water based drinks spread out over the whole day. Drinking more may seem counter intuitive but over time this helps increase how much the bladder can hold
- Ensure your child wears clothes that are easy to undo or pull up and down
- Establish a regular, prompted toilet routine every two to three hours in the day
- Introduce a fun way of prompting toilet visits such as “123 do I need a wee?” or use a vibrating reminder watch
- Try to encourage your child to fully empty their bladder by weeing in a steady continuous stream. At the end of the stream wait, change position and then try to do a bit more. This will ensure the bladder is fully empty
- Put a changing bag with clean pants, wet wipes and disposal bags in your child’s school bag in case there is an accident – and explain to your child what you would like them to do and practice how to do it
Soiling accidents are less common that wetting accidents but cause a lot more distress for families and schools. For most children who soil they have very little, if any, control over it happening. The problems can usually be managed but can take a little while. If your child is soiling it is always recommended that you visit your GP immediately to have the problem checked. Causes of soiling include:
- Constipation. If your child’s pooing pattern changes and they poo less frequently than normal it is usually an indication of constipation. Soiling happens when there is a build-up of hard poo in the bowel and either newer poo leaks out or pieces break away
- Sometimes children have a painful poo and try to avoid more pain by withholding poo
For both of these, medication, which can break up hardened poo and help soften poo so it is more comfortable to pass, is usually prescribed.
Other reasons for soiling include
- Dislike or fear of using unfamiliar toilets
- Poor diet or fluid intake
- Anxiety or emotional upset
- Mild illness
- A change of routine
- Not having a regular toilet routine
- The child doesn’t recognise the signals of the need to poo
Tips to help you manage if your child soils
- Ensure your child has a well-balanced diet and drinks six to eight cups of water based fluid every day
- Make the toilet a welcoming and fun place to be
- Put a daily toilet routine in place. Ask your child to sit on the toilet for a few minutes, 15-20 minutes or so after meals, following some gentle exercise. A reward system can help encourage this
- When boys stand to wee they have to make special time each day to sit on the toilet. If this routine isn’t in place it can lead to constipation
- Ensure your child’s feet are supported on a step and they sit on the toilet in a comfortable and secure position
- Use techniques such as blowing bubbles, a musical instrument or blowing raspberries on the back of the hand to help with pushing poo out or try a gentle rocking movement
- Use an appropriate prescribed laxatives as required
- Pack your child a changing bag as described above
Starting school is a big step for most children and toileting accidents are very common and totally normal. If you have any concerns about your child’s toileting don’t delay seeking help from your GP, school nurse or health visitor as problems that are dealt with early can usually be resolved more quickly.
ERIC (Education and Resources for Improving Childhood Continence) is a charity that offers information and support with all childhood wetting and soiling problems. The Helpline is available on 0845 370 8008, email firstname.lastname@example.org or visit the website for lots of information and free leaflets to download. The webshop has a good range of useful resources that can help you manage wetting and soiling problems www.ericshop.org.uk.