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Practice comment

Landmark guidance puts childhood continence firmly in the spotlight

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New NICE guidelines will help nurses to be proactive about improving the lives of children and families who are affected by childhood continence issues, says Jenny Perez

2010 has been a landmark year for health professionals working in the field of childhood continence, and for the charity Education and Resources for Improving Childhood Continence (ERIC).

The much-anticipated NICE Guidelines on Idiopathic Constipation in Children (National Institute for Health and Clinical Excellence, 2010a) and Young People and Nocturnal Enuresis in Children (NICE, 2010b) were launched earlier this year, bringing comprehensive  recommendations for assessing, treating and managing these issues.

This guidance offers parents a clear indication of the care they should expect for their children. Continence problems cause a great deal of distress for both children and their families and can even lead to the child becoming socially isolated. Time and again, parents who ring the ERIC helpline blame themselves for their child’s problem and express frustration at their inability to resolve it. These new guidelines will help inform parents about what they can expect from health professionals and to be aware of their own role in the process of resolving and managing their child’s continence problems.

This week, the ERIC conference will introduce both guidelines, which will be presented by the chairs of the guideline development groups. The one day conference will also look at the main guideline recommendations, and the potential impact on continence services at both a local and national level.

Along with many great opportunities, the NICE guidelines will present some challenges. A review of the current service provision for PCTs will be necessary in order to meet the recommendations. It is therefore essential healthcare professionals, including nurses, have a full understanding of the guidance in order to provide the best possible services.

ERIC was pleased to receive a grant from the Department of Health to help disseminate the NICE guidelines. By using our helpline, website, information leaflets and fact sheets we will ensure the important messages are communicated to those who need to access this information. Our organisation has also developed a new training day, focusing on the NICE guidelines, for healthcare professionals who were unable to attend the ERIC conference.

We need to work hard to improve the lives of children and families affected by continence problems. A proactive approach is required and it is vital that people do not shy away from issues such as bedwetting, soiling and constipation, because they are embarrassed. Significant steps are being made to raise awareness however, and ERIC has received coverage on national television, radio, in print and online leading to a rise in visitors to our website and contacts to our helpline and information team.

This year, ERIC diversified and now provides information on toilet training. This enables us to reach parents early, so if they continue to need our services they know where to access help.

The organisation has also launched a national School Toilet Award. This award is needed now more than ever to help tackle problems such as constipation. This year, the Global Handwashing Day survey conducted by the London School of Hygiene and Tropical Medicine, showed that 40% of children will not use school toilets. And a 2010 survey of nurses and continence specialists commissioned by the Bog Standard campaign and including the opinions of Nursing Times readers,also found that all believed school toilets are a contributing factor to continence problems in children and young people.

A lot of these problems could be avoided, alleviated or eradicated with improved school toilet facilities and by allowing children to use the toilet when they need to. School toilets are often neglected due to lack of funding, inadequate regulations and simply because other priorities get in the way. This issue continues to be pushed down the list of priorities by the government. But school toilets are vital. They affect pupils - their education and their health. And it is ERIC’s main aim to make sure this issue, and the impact of childhood continence as a whole, is not neglected.

Jenny Perez is director, at Education and Resources for Improving Childhood Continence, Bristol


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