There are lots of aspects of school readiness, including getting dressed, putting shoes on, and eating independently. An oft-forgotten part of the routine is using the toilet. Even if your child has been toilet trained for many years, big changes can cause children to regress and experience incontinence (having accidents). This can be a one-off or spiral into an ongoing issue.
To meet this challenge head-on and make sure your child has the best chance at starting school without toileting mishaps, we spoke to Jessie Smith, a school nurse at a specialist school that caters for children aged 5 -18 years with additional needs.
“It is important for your child to know where the toilet is at their new school, the rules around when they can go to the toilet, and who they should ask to go to the toilet,” says Jessie. “If your child is experiencing incontinence already, it is important to raise this at your four-year-old health check at the doctor. This is a really good opportunity to rule out any medical issues that could be causing or contributing to your child's continence issues.”
Communicating with your child about toileting
As toddlers grow and mature into preschoolers their increasingly broad vocabulary and confidence in speaking and asking questions can mislead you to think they are grasping life skills without being explicitly taught. So perhaps what you perceive as incontinence could just be your child not understanding what is expected of them. If you are worried about your child’s toilet habits, the first thing to rule out is misunderstandings with the process. Four- and five-year-olds will still need basic life skills such as visiting the toilet explained to them, and the communication process that will work for one child might not work for another. Ways to learn about and discuss toilet routines could be:
- Visuals such as a worksheet, infographic poster or book show them what to do (step-by-step process)
- Verbal communication and reminders about expectations (“Have you washed your hands?”)
- Watch short educational videos online and discuss them with your child (learning about how your body tells you it is time for the toilet)
Once you have ruled out miscommunication around toilet expectations with your child, it is important to see a medical professional for advice.
Questions you might get asked at a doctors’ appointment
For most parents, the first port of call is their child’s GP. Some questions they might ask you at an initial doctor’s appointment could include:
- Has your child ever been continent or has this been a persistent issue?
- Frequency/how often do accidents happen?
- Does it happen daytime or nighttime?
- Are accidents poo and/or wee?
- What is currently happening in your child’s life, are there any external stressors?
- Medical history – physical and mental
- Social – any big life changes or challenges at home?
Once the doctor has an understanding of the background of your child’s toilet troubles, they can either offer advice and treatment options or refer you for testing and specialist opinion/treatment.
Make sure to update your childcare, preschool or school if you agree on a treatment plan with the doctor as this will help them offer consistency for your child outside of the home environment.
Starting school
Before starting school your child will likely visit their classroom a few times for orientation. This is a great opportunity to show them where the toilets are and make sure they can use the facilities independently. Once they get their uniform, practice going to the toilet at home to make sure they can get their new clothes on and off without help. At the start of the term, help them develop good toilet habits such as going to the toilet when they arrive in the playground before the bell rings so they are ready for morning lessons.
To help your child’s confidence consider discussing these points with them during orientation:
- Safe people to talk to if they need to use the toilet or have had an accident
- Where the toilet is
- How to find their change of clothes if they have an accident
- Toilet card/visual (for children who struggle with communication)
- Communicate with school to create a toileting plan
Working with school on a toileting plan
Toileting plans should be family-led and follow what you already do at home to keep it consistent and empower and educate families. Toileting plans should try to find a bridge between NDIS, families and school funding to get the equipment or staff put in place to support your child. Most of all, toileting plans should put the child and their emotional well-being first.
"School-age children experiencing incontinence need to have their privacy respected and be spoken to using respectful language,” Jessie says. “We don’t say, let's change your nappy, nappies are for babies. We say, let's go to the toilet. And we don’t ever announce publicly that a child has had an accident”.
Get support
If you are worried about your child’s toileting and are not sure where to go for information and advice, call the Free National Continence Helpline 1800 33 00 66 (8am-8pm AEST Mon-Fri) to ask a continence specialist any questions you have relating to your child’s toileting.
Download the One Step at a Time - The Expert Toilet Training Guide
Read more from Bridge: https://issuu.com/continence.org.au