Health services for children and young people

Continence is control over your bladder and bowel.

Every child is different; they learn to walk and talk at different times and they learn how to use the toilet at different times too. Children are often ready to be toilet trained between 18 months and 3 years. However, this is a complex skill and can develop later in children with special educational needs and disabilities.

There is a very broad range of ages that children are toilet trained and it can depend on where you live. For example, living in a hot or cold climate and depending on when you want to start toilet training your child.

Some children and young people will always need some support in this area due to their disabilities. The following services and advice are available to help you and your child to master this key area of development to the best of their ability.

Continence Children Services

The majority of children develop day and night continence skills with help from you, and by establishing a routine of when they want to go to the toilet. The rate at which they learn is affected by their own interest and motivation in being clean and dry. It is also affected by how much they want to copy what their friends or adults are doing.

You can find out more about how to help them by looking at the Eric website (Children’s bladder and bowel charity).

Who can offer help

All the health visitors, school nurses, and GPs in Waltham Forest have been trained to support the development of children’s toileting skills.

Sometimes toileting, and staying dry at night, can be a real challenge for children. This may be for several reasons, including;

• They don’t have the words to tell you what they are feeling as yet
• It is difficult to establish a routine
• They have not learned the muscle control they need as yet
• They have a selective diet and may become constipated as a result, affecting their ability to establish a toileting routine.

All of the above may be affected by the food they eat, exercise, and making time for toileting are all important too.

You can discuss this with your Health Visitor and School Nurse

If your child has special education needs, mastering toileting may take longer. Your child might also need structured teaching and support to help them learn.

Your health visitor or school nurse may suggest you visit your GP to rule out any physical needs for your child taking longer to learn the above skills. Your GP may check your child’s growth, and urine, and also look at their back to rule out any physical reasons for a delay.

Occasionally the GP, school nurse, or health visitor may refer you to a specialist service for further advice.

This might be a dietician if they think your child’s diet and eating patterns contribute to their difficulties. For example, issues such as constipation, or a specialist continence nurse if your child’s needs are particularly complex.

 If your child is known to Wood Street Specialist Health Services or attends a Special School you can also contact the Specialist Nurses

No, it is not a problem. Many children are still learning to be fully toilet trained when they start school. Schools should make arrangements from within their own staff to help support your child, and also help them learn to be independent.

You can ask to speak to the school SENCO if you have any concerns that your child will still need some support.

You should contact your school SENCO to discuss their needs and ask what support can be provided.

The Department of Educations’ policy on medical needs in school states that:

• Pupils at school with medical conditions (including bladder and bowel) should be properly supported so that they have full access to education, including school trips and physical education.
• Governing bodies must ensure that arrangements are in place in schools to support pupils at school with medical conditions.
• Governing bodies should ensure that school leaders consult health and social care professionals, pupils and parents to ensure that the needs of children with medical conditions are effectively supported.

In addition, the law on school admissions states that children cannot be refused entry on any matters related to their SEN needs (attached) which would include toileting.

If you need any help or advice about getting support for toileting in school you can also contact your school nurse or health visitor.

Advice for schools from the children’s bladder and bowel charity on toileting might be helpful.

Equipment to support toileting

If your child has physical needs, your SENCO with the school‘s health and safety advisor should be asked to do an assessment. This will assess the toileting areas, and if they meet your child’s needs. They may make some recommendations about adjustments to the area to support your child’s toileting

NELFT Occupational Therapists (OT) will assess your child’s seating and toileting equipment needs at school.

The Social Services OT’s will assess your child’s seating and toileting equipment needs at home.

If your child is late to develop toileting skills due to their physical and special educational needs, you will be entitled to support with continence products such as nappies. Your child’s needs will be assessed, with children most commonly prescribed 4 continence products each day. You can ask your school nurse or health visitor about a referral for continence products.

If you have products for your child but wish to ‘top up' the supply you can contact suppliers Attends Lifestyle

Continence products for adults

If you are over 18 years old and continue to need continence support, you will be referred to the adult continence team. They work with young people aged 18 years and over. The service is available to people registered with a Waltham Forest GP.

The Service provides skilled nursing assessment, treatment, and advice to people with complex continence needs, including urinary and/or faecal problems with or without incontinence.

The Continence Advisory Service also manages the continence pad provision and recommends suitable containment products where necessary in complex cases.

The Continence Advisory Service offers education and training to Health and Care Professionals.

Continence Advisory Service
Chingford Health Centre
York Road
Chingford
E4 8LF

Tel: 0208 430 8246
Fax: 0208 430 8259
Contact the Continence Advisory Service by email

Opening times are Monday to Friday 9am to 5pm (excluding bank holidays).

Referrals

Referrals are accepted from GPs or Health Care Professionals through electronic booking, e-mail, fax, or post.

Continence products

People over 18 years requiring basic continence assessments and pads should be directed to the local District Nursing Service.

The onset of their child’s puberty can be a concern for any parent. When the child has additional needs especially learning difficulties and/or social and communication, difficulties this phase can be particularly problematic.

Common issues for young people are understanding the physical changes in their body including:

• Personal hygiene and the need to wash more carefully and use deodorant
• Learning about privacy and respecting others’ privacy
• Public and private places 
• For girls, periods and coping with sanitary protection, including becoming more independent with personal care
• For boys, understanding their body changes including erections.

Family Lives has advice on puberty and disabled teens

There are also resources for schools produced by Leeds NHS trust on puberty and sexuality for people with learning disabilities

Managing Periods for Girls with Learning Disabilities

Some easy-read guides may help you have a discussion about periods and how to manage them