5th August 2024
Juliette Rayner, CEO of ERIC, The Children’s Bowel and Bladder Charity, outlines the issues around school readiness and the support available for parents, carers and healthcare professionals.
Juliette Rayner, CEO of ERIC, The Children’s Bowel and Bladder Charity
It isn’t long until millions of children across the UK will start school for the first time – but are they ready?
Here at ERIC, The Children’s Bowel and Bladder Charity, we run a helpline for families experiencing bowel and bladder issues (in addition to many other resources, including a webpage for professionals and information based on NICE guidelines).
For the past few years, we’ve seen an increase in calls, particularly from July onwards, from parents whose children are due to start school but aren’t ready. Some are still in nappies or require a nappy to poo. Many discover, through speaking to an advisor, that their child may be constipated. This needs to be diagnosed by a GP and treated before they can successfully begin toilet training in preparation for school.
A school readiness survey by early years charity Kindred² found that 1 in 4 children in England and Wales starting reception class are not toilet trained. In fact, 90% of school staff reported at least 1 child in a 2023 reception class who is not toilet trained.
The report found that school staff are diverting 2.5 hours a day, on average, away from teaching and towards supporting children who are not school-ready.
The impact of later toilet training
Later toilet training can have a serious effect on children’s and families’ lives. It can hide continence issues, such as constipation, which can cause pain and discomfort, and practical issues like missing out on socialising and school days.
We know from the thousands of families we’ve worked with over 30 years that continence issues can have a devastating effect on families – yet most of them can be solved with correct, timely intervention.
In recent years, there has been a move towards waiting for signs of readiness before potty training, but this misses the key point that many children, and particularly those with additional needs, may never give any signs that they are ready to potty or toilet train.
Before children can start training, they need to be given lots of opportunities for ‘potty learning’, for example:
- Getting used to the idea that the bathroom is where we ‘wee and poo’
- Taking them to the bathroom to change their nappies
- And sitting them on the potty. This process can start from when children can sit independently, usually between six and nine months old.
Most children – including those with additional needs – are ready to master potty independence and lead in many parts of the process from around 18 months. With support and encouragement, the majority of children will be capable of doing most things, including wiping by themselves, when they start school.
Research shows it is better for children’s bladder and bowel health to stop using nappies between 18 and 30 months. The longer this is left , the harder it can be for children to learn this new skill and accept not having a nappy on anymore.
A long-term issue
There are many contributing factors that can impact a child’s ability to be toilet trained before school, though there is sadly often a great deal of stigma and shame associated with it.
The long-term impact of the pandemic, the economic downturn, and cuts to essential children’s services in recent years have resulted in a lot more pressure on families and the professionals who support them.
Indeed, recent statistics from the Institute of Health Visiting revealed that poverty was the cause of greatest concern to health visitors, with 93% reporting an increase in the number of families affected by poverty in the last 12 months.
The Public Health Grant that funds the health visiting service has been cut by £1 billion in real terms1. As a result, there is an estimated workforce shortage of about 5,0002 health visitors in England. Despite health visitors working tirelessly, they have less time and capacity to provide help and guidance to families in need of support. This contributes to the wider lack of support services and advice for families who are experiencing problems. The recent iHV State of Health Visiting Report highlighted that only 45% of health visitors said they were “confident” or “very confident” that their service was able to meet the needs of vulnerable babies and children when a need is identified.
All of this is affecting outcomes for children and contributes to this issue of school readiness.
Support is available
ERIC is the UK’s leading charity supporting all children and teenagers with a bowel or bladder problem. 1 in 12 children in the UK are affected by a bowel or bladder condition including constipation, soiling and wetting accidents, and bedwetting.
We offer the following support:
- Online training courses for early years professionals and health visitors
- Online advice sheets
- Resources to share with parents and carers (including advice sheets in languages other than English)
- Our Let’s Go Potty guide, with key advice on toilet training, including for children with additional needs
- Free helpline for families who are struggling
For health visitors who wish to update their professional skills, we’re hosting the ERIC Paediatric Continence Care Conference 2024 on 14 October in Birmingham. The event includes a broad programme of talks from some of the world’s leading practitioners and researchers, cutting-edge interactive workshops and practical demonstrations. Tickets are available now from eric.org.uk.
Juliette Rayner, CEO of ERIC, The Children’s Bowel and Bladder Charity
References
- The Health Foundation (2019) Urgent call for £1bn a year to reverse cuts to public health funding. Joint press release from the Health Foundation and The King’s Fund. https://bit.ly/47TvDSv
- Conti G & Dow A (2021) Rebuilding the health visiting workforce: costing policy. https://bit.ly/3XdvWlw
