School Age Children’s Continence

Parent Seminar

School Nursing

WelcomeAim of today’s session is:• To look at daytime and night time wetting

and constipation/soiling.• To provide information and awareness to

help you support your child.

Information on the Kidneys and

Bladder

Kidneys

Ureters

BladderUrethra

How the kidneys and bladder work

General Information about the bladder• Between 2 – 3 years bladders mature and

child can become dry• Usually pass urine 6 – 8 times a day• Urine usually pale yellow in colour• How much the bladder holds depends on

age• 83.6% of children are dry at night by the age

of 7 years

How the Bladder works

How much a bladder can hold

Age Bladder Capacity

5 180mls

6 210mls

7 240mls

8 270mls

9 300mls

10 330mls

11 360mls

12 390mls

Daytime Wetting

1 in 75 children have day time wetting

What can cause day time wetting

• Fluids – not drinking enough or types of fluids

• Urinary Tract Infection• Constipation

• Delay in emptying bladder• Overactive bladder – twitchy bladder• Small bladder size• Physical or learning needs

What can be done

• Gradually increase fluids – water based & take a drink to school

• Reduce dark coloured fluids and fizzy drinks

• Regular toileting throughout the day • Counting • Use a reminder to go to the loo

What can be done

• See your doctor• Reward charts• Avoid constipation• Easily removable clothing• Stay calm and relaxed• Opportunity and access to toilet

Drinking

Night time Wetting

1 in 10 age 5 - 6 years bed wet, decreases with age

What can cause night time wetting

• Fluids – not drinking enough or types of fluids

• Arousability – not waking to signal of needing the toilet

• Lack of vasopressin• Constipation• Overactive bladder –

twitchy bladder• Genetic

What can be done

• Treat day time and constipation first• Fluids – encourage to drink and look at types• Praise• Toilet prior to bedtime and return 5-10 mins • Easy access to toilet & Night light• Advisable not to lift

What can be done

Alarm

Medication

Reward charts

Child’s responsibility

Constipation

Affects 30% of children

How the bowel works

Liver

Large Intestine

Stomach

Small Intestine

RectumAppendix

Information about constipation can cause• Many parents/carers don’t recognise the

signs and symptoms of constipation

• Signs: small hard stools; less than three times a week; painful; night time soiling

Bristol Stool Chart

Which one is the ideal poo?

What happens when constipated

What can be done

• Exercise• Diet• Fluids• Toilet routine• Toilet comfortable• Position on toilet & foot stool• Praise & rewards• Medication

• Restricting fluids• Telling your child off• Having too high expectations• Thinking you’ve failed• Taking all the responsibility yourself

Traffic Lights

• Family/Environmental History

• Your child as an individual• Fluid intake• Frequency of toileting• Bedtime routine• Your own reaction

• To your child• To yourself• The support offered • To others experiences

Stop

Look At

Listen

Baseline Charts

• Input & Output - 4 days for wetting

• Baseline - 14 days for wetting

• Soiling & toileting charts - soiling

Remember …. For all continence issues:• You and your child are not alone• Don’t tell off – they are not doing it to

annoy you• Listen to advice• Work with your child• Increase fluids• Praise! Praise! Praise!

Further Information and help• Enuresis Resource website – www.eric.org.uk

• School Nurse website – www.healthforkids.co.uk/illness

• School Nurse• GP