Toilet training: what schools need to know

Given that parents are now potty training later, should schools introduce ‘must be toilet trained’ policies? Absolutely not, researchers tell Chris Parr. School staff, they say, should be trained in the issues around toilet training so they can help and work with families
10th January 2020, 12:04am
Toilet Training: Everything You Need To Know
Chris Parr


Toilet training: what schools need to know

First, it's sleeping through the night. Then it's crawling, followed swiftly by walking. Talking makes an appearance soon enough. And then you finally hit the biggie: toilet training.

Of all the topics that become awkward conversations between parents, toilet training can be the worst. Mostly, this is because other milestones up to this point have been largely out of parents' control: the child reaches them when they are ready. But the decision to toilet train a child - to dump the nappies and embrace the potty - is usually down to the parent. And to complicate matters, that decision is usually made in the crucible of public opinion that states that earlier is better.

Schools have a big role to play in that pressure. EYFS settings are, of course, used to dealing with children still in nappies, but as the children in these settings get older - and certainly as they approach Reception - there is often an assumption that not needing a nappy should be the overwhelming norm. But is that fair?

According to the children's bowel and bladder charity Eric, children are being toilet trained later than in previous generations and, as a result, more and more are starting school wearing nappies or pull-ups (a conclusion that comes from two studies it carried out in the past three years - one in 2016 with the Association of Teachers and Lecturers, now part of the NEU teaching union, and one in 2018 with the National Day Nurseries Association).

This is not just a UK issue. Alexandra Vermandel, a senior lecturer in the medicine and health science department at the University of Antwerp, Belgium, who has published extensively on childhood continence, says that it is common across the EU. "The research literature shows that people in European countries are delaying toilet training," she explains.

"In the 1940s and 1950s, parents started toilet training their children when they were younger than 18 months old, but now it is more like 21 to 36 months."

Part of the reason is that parents now have less time to toilet train.

"More often now, both parents are working," she explains. "And also, the research literature describes how modern parents are no longer proud to teach children the process."

In the past, Vermandel says, parents reported feeling greater pride in successfully toilet training their children.

"It's also harder these days, because diapers [nappies] make children feel very comfortable, and it is often unclear when the child is urinating, so it is more difficult to give feedback," she adds.

Should EYFS settings push back against this later toilet training? Is a strict "must be toilet trained" policy or advising a parent of the need to toilet train advisable or even legal? What teachers definitely should not do, say the experts, is judge parents or deny entry to those not toilet trained.

According to the American Academy of Pediatrics, setbacks during the toilet-learning process (including children withholding stools or insisting on wearing nappies after learning to use the toilet) "tend to escalate if a child is pushed too hard, or too fast, or if a significant, stressful family event (such as a new sibling, new home or new childcare provider) transpires".

Moreover, according to the charity Eric, introducing a strict "must be toilet trained" policy would be contrary to the Equality Act. Its website states: "The Equality Act 2010 states that schools must not discriminate against or disadvantage disabled children or those with special educational needs. A delay in achieving continence - or not being toilet trained - is considered a disability. It is therefore not acceptable for a school to refuse or delay admission to children who are not yet continent."

Meanwhile, Vermandel says that judging parents if their child is not toilet trained is completely unfair. "I don't want to point to the parents and say that they are deliberately doing something wrong, because the fact is they don't know any better because they lack information," she says. "We did a study, and the parents, they just don't know about it. They don't know when to start - they are really confused."

Support rather than admonishment is clearly the path to follow, but shouldn't it be the health services who are stepping in? Ideally, yes, but the experts feel that school does have a role, too.

That should begin with better training for staff around toilet-training issues, say the experts. For example, knowing the age range toilet training should ideally happen within.

The research is not conclusive on that, but Eric suggests 18 months to age 3 is the most common age range when toilet training should be happening. This would mean that expecting all children to be toilet trained at the start of nursery would be unreasonable.

However, expecting the vast majority of children to be toilet trained by the age of 4 is, according to Vermandel, entirely reasonable.

"If a child is not toilet trained at 4, then you might have to go to a doctor to see if there are problems," she says.

Parents and teachers have to realise, though, that night toilet habits are very different to day habits.

"You can train a child during the day, but it is completely normal for bedwetting to occur until they are 6 years old," explains Vermandel. "After 6 years, if a child is not dry during the night, then you can treat it, but we don't treat a child before that."

It is also useful for all involved in a child's care to fully understand that when toilet issues become persistent, it can have very negative health repercussions, says Tinne Van Aggelpoel, a PhD student in the same department as Vermandel at Antwerp, who is researching the consequences of later potty training. "Children who refuse to use the toilet, or who keep on asking for a diaper when they want to pass a stool, can end up retaining their stool, which will make it more difficult and sometimes painful when they do finally go. They can end up in a vicious circle, meaning they don't want to go at all," explains Van Aggelpoel.

Unfortunately, the potential problems of resisting the toilet extend beyond simple discomfort. It can lead to bladder problems and longer-term incontinence issues.

Understanding and sharing all this information with parents would ideally be the job of health services, but most experts agree that schools will likely be the only option for most. It is also likely that schools may be the first line of support in identifying and supporting parents and children.

Spotting an issue, though, can be tough: teachers can only see what is happening at school, and communication with home is often not at a point when a good insight into out-of-school toilet habits is possible. That may mean toilet accidents are confused with longer-term problems.

"A lot of children have accidents, and that doesn't mean they are not toilet trained," explains Van Aggelpoel. "But sometimes the communication between all the interested people is not great. Everyone who is part of the toilet-training process - so not only the parents, but the teachers, the grandparents - they need to communicate and work together."

This is particularly important as many children will experience regression when toilet training and that can be triggered by starting school.

According to guidance from the American Academy of Pediatrics, regression is a normal part of the toilet-training process, does not constitute failure, and should be viewed as a temporary step back to a more comfortable place. "Often regression confuses and upsets parents, who, in turn, may express anxiety toward and exert pressure on the child," the guidance states. "Instead, the parents need to be accepting of the setback and reinforce toileting behaviour."

Where there is a persistent issue, though, the message is simple: consistency, empathy and support are crucial.

"I think in a school setting there are possibilities," says Van Aggelpoel. "Children can imitate their peers, for example, so when their friends go to the toilet, they can go, too. If a child does have a problem, then having fixed, scheduled moments when the whole class needs to go to the toilet can help to educate them about the need to go."

Whatever happens at school needs to be communicated with parents, she says, so consistent approaches can be found.

"If a child doesn't wear a diaper in the classroom, then why should he wear one again when he goes in the home? You need to be consistent in your training methods," Van Aggelpoel explains.

Toilet habits are awkward enough for adults to talk about, so the open approach that the experts have advocated here may make some teachers and parents uncomfortable. However, it seems that such conversations are increasingly likely to become a necessity as toilet training shifts to later age ranges. Judgement clearly has no place in those discussions, and nor do zero-tolerance approaches. Instead, the message is clear: remember PEE - partnership, empathy, elucidation.

Chris Parr is a freelance journalist

This article originally appeared in the 10 January 2020 issue under the headline "Tes focus on... toilet training and EYFS"

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