Incontinence at School: are Schools well equipped?

Incontinence at School: are Schools well equipped?

  • On September 26, 2017

It is estimated that approximately 11% of children and young people in the UK who are aged 5-19 years old have a continence problem. An increasing number of children with complex bladder and bowel care needs are attending mainstream school.


The charity organisations Education and Resources for Improving Childhood Continence and PromoCon regularly receive feedback from health professionals, children and families suggesting that schools struggle to cope with childhood continence problems. The NICE organisation claims, “we know that 80% of these admissions could be avoided through improved care and support in Primary care”. The problem is not only that incontinence can be an annoyance and barrier for children in completing daily tasks, but that continence problems can have a profound effect on children’s physical, emotional and psychological health and wellbeing. Dr Carol Joinson asserts, “Childhood bladder and bowel conditions that are poorly managed can have a profound effect on children’s physical, emotional and psychological health and wellbeing, as well as having a negative impact on their learning”.



The lack of understanding that teachers have of bowel and bladder problems has caused a number of disputes and campaigns in the recent years. One dispute around pupil’s access to toilets received widespread coverage in the national press recently. Pupils at Bedale High School, North Yorkshire, claimed that they weren’t being allowed free access to the toilet during lessons and at other times. A protest at the school by up to 40 students even resulted in police being called but they advised staff it wasn’t a police matter.


A number of Equality Acts, however, are still attempting to improve the way incontinent children are dealt with. Under the new Children and Families Bill 2013, schools are legally required to provide appropriate support for children with medical conditions. Children with continence problems should always be dealt with sympathetically and in a neon-punitive way. The Bill was lobbied for by the Schools Alliance, a coalition of charities representing children with a wide range of long-term medical conditions. The supporting guidance for Schools will highlight the role of the school nurses in making sure that education establishments meet their responsibilities, for example, by helping them to identify training needs. School nurses are also now encouraged to play a key role in ensuring children who have medical conditions, such as bladder and bowel problems, also have an individual healthcare plan in place.


Recent academic studies and incontinence organisations have concluded that Schools should comply with the following policies:



> Prioritise respect and privacy


ERIC emphasises the importance of staff respecting the privacy and dignity of children with incontinence. The staff assert that staff who help with intimate care should make sure another member of staff is aware they are going to change a child and is in the vicinity and visible or audible. The ERIC organisation also states that “intimate or personal care procedures should not involve more than one member of staff unless the pupil’s care plan specifies the reason for this”. Not only is there no need for two members of staff to be present, it is in fact discouraged unless the child needs two members of staff.


> No tolerance of discrimination


In line with the Equality Act 2010, schools can not discriminate against or disadvantage disabled children or those with special educational needs. It is vital for schools to remember that a person has a disability if they have a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out day to day activities. A delay in achieving continence or not being toilet trained can, therefore, be considered a disability. Schools are not legally able to turn away children who haven’t learned to control their bladders or bowels, however, must work to support those children in the school environment so they can play an active role in school life, remain healthy and achieve their academic potential. The Children and Families Act 2014 places a statutory duty on schools to support pupils with medical conditions, including bladder and bowel problems. If a child has an identified continence issue which won’t be resolved before they start school (whether related to toilet training or not), the school cannot refuse entry. It is the role of the School Governing Bodies to ensure that school leaders consult health and social care professionals, pupils and parents to ensure the needs of children that aren’t toilet trained are effectively supported.


Unnecessary exposure should be avoided, and incidents such as other children observing the management of an accident should be prevented. Calling up a parent and waiting for them to come and change them I also discouraged. It is tantamount to abuse and bullying to force a child to sit in wet or soiled underwear until their parent or guardian can come in to change them.



> Easy and immediate access to the bathroom


There is no legislation that asserts Schools are not allowed to prevent children from accessing toilets. A large number of Schools have policies in place preventing lesson-time toilet breaks on the grounds that pupils go to the toilet to meet up with friends or misbehave. It is clear therefore that the fear of children socialising or misbehaving overrides their basic health and safety needs.


Parents of pupils at Westlands School in Kent were reportedly left outraged recently after being told their children could only go to the toilet during lessons if they had a note from their doctor. One father claimed that his 12-year-old son, a pupil at SCC, came home last week and told him about the ban. The father recalls how his son claimed one pupil asked to go, claiming they were desperate and they were told they could only go during break time. He continues, “The simple fact is that children are embarrassed to ask in front of their friends, so the school will end up dealing with a lot of wee on the floor if they don’t change the policy.” A spokeswoman for children’s charity ERIC, which campaigns on the slogan ‘Every Child Has The Right To Go’, said the policy was “totally wrong”. It is vital to remember that some children will have bladder conditions which mean they need to wee urgently and frequently. Others may have bowel conditions which require immediate attention. For small children, this may even negatively affect their ability to learn to use the toilet. Preventing children from accessing a toilet may cause problems such as dehydration which can affect their concentration and energy levels, impacting on their ability to achieve academically. Preventing urination can also result in children being distracted and unable to focus on their studies. This can ultimately have a negative impact on the success of both the pupil and the School.



If a pupil has an incontinence problem that the school is aware of, many organisations and campaigns from parents have put forward the idea that they should be given a “toilet card” that allows them to go to the toilet when they need to. In schools where the toilets are locked, these pupils have to get a key before they can use the facilities. However, for a child with urgency problems, this is not always a feasible solution. This policy also signals out pupils with bowel and bladder conditions when they may want to keep their condition private, as they are the only pupils allowed to use the toilet during lessons.



If you are a parent of a child who has incontinence and feel they are treated unfairly in the School’s policy for bathroom access, you should feel able to contact the Headteacher of the School and urge for a more feasible method. Do not hesitate to report an incident with your local newspaper or council to make others aware of the problem.

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You can visit the ERIC’s Right to Go campaign page for more information and free resources about best practice in education settings in relation to continence management, toileting and school toilets.