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.
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. http://www.kidzupnorth.co.uk/kidzinthemiddleseminars.shtml
- Bakker E, Wyndaele JJ. Changes in the toilet training of children during the last 60 years: the cause of an increase in lower urinary tract dysfunction? BJU Int. 2000; 86(3):248-52.
- Bayliss V, Cherry M, Locke R, Salter L. Pathways for continence care: the validation process. Br J Nurs. 2001;10(2):87-90.
- Desai N, Keane T, Wagg A, Wardle J. Provision of continence pads by the continence services in Great Britain: fair all round? J Wound Ostomy Continence Nurs. 2008; 35(5):510-4.
- Good Practice in Continence Services (2000).
- Good Practice in Paediatric Continence Services: Benchmarking in Action (2003) NHS Modernisation Agency
- Joinson C, Heron J, Von Gontard A, Butler U, Emond A, Golding J. A prospective study of age at initiation of toilet training and subsequent daytime bladder control in school-age children. J Dev Behav Pediatr 2009;30(5):385-93.
- Joseph A, Lantz J.A systematic tool to assess urinary incontinence parameters: a closer look at unfamiliar parameters. Urol Nurs (1996)16(3):93-8.
- National Service framework for Children and Young People. Continence 2004; 6:30.
- Nazarko L. Br J Community Nurs. 2008;13(5):219-20, 222, 224-6.
- A guide to continence assessment for community nurses.Br J Community Nurs. 2008; 13(5):219-20, 222, 224-6
- Simon J I, Thompson R H. The effect of undergarment type on the urinary continence of toddlers. Journal of Applied Behaviour Analysis. 2006; 39:363-368
- Tarbox R S. F., Williams W. L, Friman P C. Extended diaper wearing effects continence in and out of the diaper. Journal of Applied Behaviour Analysis. 2004; 37:1; 97-100
- Winder A. Devising an effective general nursing continence assessment tool. Br J Nurs. 2001; 8;10(14):935-47.