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'It is imperative that all children have an appropriate continence assessment'

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Many children are not given the opportunity to become toilet trained

The process of both continence assessments and provision of containment products is well recognised to be both ‘ad hoc’ and arbitrary across many areas of the UK, depending on where the individual lives and who carries out the initial assessment.

This arbitrary provision of products is of particular concern among children and young people under the age of 16 years, when the ‘assessment’ process may be no more than a filling in of a form and ticking the appropriate boxes.The success of the ‘one step at a time’ toilet training programme as well as clinical experience has highlighted the fact that many of the so called ‘children with special needs’ have both the ability and potential to be toilet trained.

However Desai et al (2008) reported that 59% of continence services provided products to children below the recommended age of 4 years. As the average age that normally developing children are toilet trained is 3+ years, this may well not only be an inappropriate use of resources, particularly at a time when many services now have to ‘ration’ products because of imposed cost cutting, but may also deny children the opportunity to become toilet trained. The Children’s nsf (2003) stated that in many continence services for children there existed ‘… a waste of money in providing products instead of expertise’

There is clear emerging evidence that the longer a child remains in disposable products, the longer it may take them to acquire bladder and bowel control, risking ongoing bladder problems. Therefore it is imperative that all children have an appropriate continence assessment that not only identifies any underlying problems that require treatment, such as constipation, but also toilet training readiness.

The need for validated assessment tools is an important step towards both standardising practice and improving outcomes. To this aim PromoCon has developed a number of paediatric continence assessment tools which are now available on the PromoCon website These tools are designed to complement existing continence assessment documentation and the ‘one step at a time’ toilet training programme. All the tools have been extensively peer reviewed but like all documentation they will require ongoing review and updating as necessary and are not designed to replace clinical expertise or judgement.

For  further information visit the promocon website or contact us via phone, 0161 834 2001, or email

PromoCon is running a series of free toilet training workshops at the Disabled Living Kidzs events – next event is in Coventry 10th March – for further information follow this link.


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