As a primary school teacher, Ethan Tate* is accustomed to the occasional daytime "accident". But when one of his Year 4 pupils wet herself for the fifth time in a month, he knew that something was seriously wrong.
"The few times that the school tried to speak to the child's mother about the issue, she was incredibly hard to deal with," he says. "The senior leadership tried in vain to address the issue, and when I tried to speak to the headteacher about it, he told me not to 'make a fuss'."
Daytime wetting affects about one in 75 children over the age of five, according to a 2005 study. When it happens to a nine-year-old, it is certainly cause for alarm, says Eileen Jacques, helpline manager at ERIC, a charity that helps education professionals to deal with childhood incontinence.
"It is very unlikely that this child is just being lazy," she says. "There are many reasons that she could be wetting herself, and the teacher needs to explore this."
First, has the mother taken her child to a doctor to rule out any underlying medical condition? According to Mrs Jacques, the child could be suffering from an overactive bladder - where the bladder contracts urgently with little warning. Alternatively, the problem could be a urinary tract infection or small bladder capacity.
"In all situations, an assessment by a health professional is required for any child who wets during the day over the age of four," says Mrs Jacques.
Marina Angadi, education director at the Twist Partnership, a consultancy that works with schools, says teachers should familiarise themselves with school procedures for changing clothes and sending notes home. Ideally, the school would be able to provide several sets of spare clothes for this child, she says.
"The mother may not have the facilities to wash the uniform on a daily basis," she adds. "She could agree to wash and return clothes to the school on a weekly basis, for example, which might take some of the pressure off."
One of the main reasons for daytime wetting is anxiety or emotional upset, so there may also be a child-protection issue here. Are there any signs that suggest the school should follow the requisite procedures? If so, the teacher must act immediately by speaking to the school's child protection officer, says Mrs Angadi.
Speak to the child quietly about the wetting and try to find out whether there is something in the class that is upsetting her, and try to get the child to agree that she will tell the teacher when she has wet herself so that she can have a change of clothes. This should be done in a way that does not embarrass the child - for example, by using a special card that signals permission to leave the room, says Mrs Angadi.
"When the child does wet, the incident must be dealt with as privately as possible," she says. "The child must never be humiliated or told off for the wetting."
You could also develop a system of rewards for the child when she is dry.
"The teacher could start with stickers for just the morning sessions or afternoon sessions, and move on to whole days and then whole weeks, but she should be careful not to let the other children know the reason for the rewards," says Mrs Angadi.
You should also recognise that it can be embarrassing, upsetting and frustrating for the parent when an older child wets during the daytime. Often, the parent will feel as though they have already tried every remedy and that ultimately it is their fault; indeed, this might go some way to explain the mother's defensive attitude. With this in mind, the teacher should speak to the mother.
Everyone involved with the child should be patient and consistent. This problem will take time to solve, but the child will stop wetting eventually.
*Name has been changed.
Next week class contracts
- Explore the reasons the child could be wetting themselves - is there a medical or psychological problem?
- Speak to the child quietly about the wetting and try to find out if something is upsetting the child.
- Follow the school procedure for changing clothes and sending notes home.
- Develop a system of rewards for the child when they are dry.
- Recognise that it can be embarrassing, upsetting and frustrating for the parent when an older child wets during the day.
- Tell the child off for wetting.
- Reveal the child's problem to their peers.