Know your loo role
Toilet issues can be a sensitive matter for schools to deal with. This guidance from continence charity ERIC offers some tips
Continence problems can have a significant emotional impact and can increase the risk of bullying and of behavioural problems in children. This guidance, taken from the publication The Right to Go, produced by charity Education and Resources for Improving Childhood Continence (ERIC), offers some practical advice for education staff to help deal with the issue.
If a child is starting school without having achieved continence, it is essential they have an assessment by a school nurse or health visitor to identify the cause and what support the child and family need.
For children whose continence or toileting problem first presents itself at school, it is important that staff discuss the issues with parents and do not make presumptions regarding the cause.
Parents of children who have continence issues should be made aware of the school continence policy and sign any parental consent forms regarding the child being changed. Wherever possible, this should happen at entry meetings or prior to the child starting at the school.
Although teachers' contracts do not include continence care, they do act in loco parentis. Continence management is normally included in the job description for care staff, teaching assistants and midday assistants.
To help support a child, the school can:
- agree a procedure with the parents to change the child should they soil/wet themselves
- agree how the school will inform parents of any wetting or soiling accidents — possibly via a home/school book
- agree how often the child should be routinely changed and who will be changing them
- agree to report to the headteacher or SENCO if the child is distressed or if marks or rashes are seen
- agree to review arrangements, in discussion with parents/carers, should this be necessary
- agree to encourage the child's participation in toileting procedures wherever possible to promote independence
- discuss and take appropriate action to respect the cultural practices of the family.
Any adult should inform the teacher when they are going to change the child or carry out a procedure. There is no requirement that two adults are present and staff will need to make their own judgement based on their knowledge of the child and family.
Consideration should be given to a suitable place for changing children and ensuring privacy and dignity are maintained at all times, such as by having a 'do not enter' sign on a toilet door.
Schools' health and safety policies should include the following requirements:
- staff should wear disposable gloves and aprons while dealing with incidents
- soiled nappies should be double wrapped
- the changing area should be cleaned after use according to guidelines
- hot water and liquid soap should be available to wash hands
- a hot air dryer or paper towels should be available for drying hands.
It is likely that most of the personal care will be undertaken by one or more of the support staff. It is recommended that job descriptions include statements such as 'a duty of personal care to support and promote independent toileting and other self-care skills may be necessary at times'.
Teachers are responsible for facilitating, supporting and releasing teaching assistants to fulfil this role.
Other issues to consider in managing a child's continence are the following:
Independence: what is required of the support staff to ensure that the child can be as independent as possible?
Toileting times: does the child need to be prompted at regular intervals, or does the child initiate toileting?
Communication: how does the child let you know they need the toilet? Some children are extremely embarrassed so a discreet method will aid the child to have more confidence to use the toilet when they need to.
Facilities: the environment, facilities, privacy and the distance to an appropriate toilet need to be taken into account to allow adequate time for toileting to be undertaken; children will often have valid reasons for not wanting to use a certain toilet, for example if it has no lock.
Manual handling and lifting: does the child need to be hoisted when toileted or for nappy changing, is this manageable by one person, and is any training needed?
If a child has a wetting or soiling accident it should be dealt with swiftly and in a sympathetic manner. Parents need to provide spare clothes, wipes and plastic bags, which are kept in school, in an easily accessible, discreet location. There must be a private area, such as disabled toilet, where the child is able to get cleaned and changed with the support of a member of school staff if necessary.
To read the full guide, see the personal care page.