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Anyone else's NT child still been in nappies in reception?

(41 Posts)
Cadelaide Tue 18-May-10 17:14:30

I just don't see DS2 getting out of nappies before he starts school in September. His pre-school keyworker has said someone will be assigned to change his nappy at school but my Mum is appalled. I think she thinks he'll be teased for still being in nappies.

We've tried everything, everything to toilet train him but he just won't have it. If he doesn't have a nappy he holds on for hours and hours and hours, to the point where he was getting pains in his abdomen. This is for wees as well as poos, btw. So we've left it for the time being, but I feel the clock ticking.

I just don't know what I think and I don't know what to do.

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Cadelaide Tue 18-May-10 17:15:33

aaagh, chickens escaped, back later...

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Sidge Tue 18-May-10 17:22:10

You need to speak to your HV about implementing a toileting routine, possibly with the support of your GP if he is prone to constipation.

Most schools are IME not happy with children being in nappies in reception (I was a school nurse and spent a lot of time working with schools and parents to implement toileting routines).

Let me know if you want some more info.

Cadelaide Tue 18-May-10 18:45:38

Thanks Sidge.

So what is a "toileting routine"

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Goblinchild Tue 18-May-10 19:16:00

I've not come across a child without special needs wearing nappies in reception. I've been in primary over 22 years.
I'd get advice and support from GP, I think you need more professional help if you've tried everything you can think of.
I'd also check with the school if they would have someone able to change nappies, and the facilities to do so. I'm assuming you mean he's heading to reception and not nursery?

Cadelaide Tue 18-May-10 19:23:48

yes, he's starting in reception in september, he's in nursery 2 days a week atm.

We tried just dropping nappies altogether a couple of months ago, but after 6 weeks of wetting himself he just started to hold on for longer and longer, until he wasn't going until the end of the day either in the bath or when he had his night-time nappy on.

he's my third, I know a fair few tricks but I'm really stuck on this one.

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Cadelaide Tue 18-May-10 19:26:00

He goes to the pre-school associated with the infant school he will be attending, it was the manager there who said it wouldn't be a problem and someone would "be assigned to change him".

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AccidenToryOnPurpose Tue 18-May-10 19:35:58

it would need to be a health care professional that set up the plan for school, i think (most schools will be familiar with toileting procedures for sn students as necessary)

if it helps, dd1 wasn't dry until the summer in between yr r and yr 1 (but not in pull-ups - just lots of changes of clothes <sigh>) and ds1 still isn't reliably dry in yr 3.

both were referred to the paed and enuresis clinic for daytime wetting at school age - so ask for a referral now.

it's just luck and different genetics i think. dd2 has cerebral palsy and has been dry day and night since 2. how i ended up with two nt kids who were so late to train i can't work out for the life of me.

setting up a care plan for school will be fine, if necessay, but get a referral now.

make sure he drinks plenty, the first thing we had to do was measure output to work out bladder capacity. can he pee to order, or does he have no control at all?

ds1 does have encopresis, so for the past year or so we have been dealing with soiling as well as wet. ho hum. toileting routine / laxative/ diet and exercise all make life a bit easier...

RockinSockBunnies Tue 18-May-10 19:36:50

A friend of mine's DS was in nappies in Reception without special needs. He was changed at school.

What really got him out of nappies was a quite firm approach by his father when he was staying with him for the weekend. He was told in no uncertain terms that he had to use the loo and that was that. Nappies were no longer an option.

No idea if that would work with your DS but hope you get some success soon!

Sidge Tue 18-May-10 19:58:13

OK apologies in advance if any of this seems patronising or is teaching you to suck eggs - it's not meant to be! It's difficult explaining this as flat advice as usually I would spend about an hour doing an assessment with the parent(s) and child.

Most children that won't use the toilet do so because they have created a bad association, either through having done a painful poo or a sore wee, or because they are just far too busy to sit and use the loo. They then started to hold on to wee or poo, which means that the bladder has probably got overstretched and flabby and so can't hold much wee before emptying, leading to wetting. Continued wetting means that the poor despairing parent resorts back to nappies/pull ups. This means the child feels that the pressure is off, so no need to try sitting on the loo, and then wearing a nappy means they just wee whenever they want to so still aren't developing the means to tone and strengthen the bladder. It's a vicious circle.

Holding onto poo is also quite common (especially in boys apparently) and again causes the rectum to stretch meaning that it holds more poo before emptying, causing huge poos which can be quite painful to pass. Also as they have been held in the rectum for a while they are drier and again more painful. Usually giving a gentle laxative-type medicine such as Movicol Paediatric gets things moving so that they can't hold on and as the pooing is more comfortable the fear is eased.

A toileting routine is a good way to help tone the bladder - the bladder is a muscley bag and like any muscle gets stronger the more it's used. A strong toned bladder holds more wee and empties more efficiently, as well as sending a stronger 'go for a wee now' message to the brain, making it harder to hold on. The child should be drinking about 6-8 drinks a day (of about 150ml ideally). If a child is reluctant to drink (as many preschoolers are) let them drink pretty much what they like within reason; gallons of milk or milkshake will reduce the appetite and also milk is a food so takes longer to convert to wee.

Start planning a toileting routine that will fit around your lifestyle, eg ok when we get up in the morning you are going to sit on the loo for 1/2/3 minutes (use a timer if necessary), then again before we go to school/preschool, then again at preschool at say 1100, then again after lunch at say 1300, then again at say 1500 and so on up until bedtime. Sitting on the loo is non-negotiable - it's REALLY hard I know but try and enforce it. Use bribery, books, DVDs, whatever it takes to stay there for the allotted time. Maybe start off with 1 minute then work up to 2 and then 3. When the time is up you reward the action ie sitting on the loo, and NOT the outcome ie whether he weed or not. Sooner or later some wee will come out when he is sitting there (thanks to all those fluids!) and you do the hurray yippee doo dah routine and give an extra sticker or whatever. Have a pre-agreed reward such as if you have 6 stickers by bedtime you can have an extra story or 10 minutes of a DVD or whatever works for your child.

It can take some weeks but if you are really consistent IME most children are reliably using the loo and are out of nappies (excluding SNs or a physical reason) within a month. Also remember that peer pressure is a wonderful thing and seeing all the other boys and girls using the toilets at school can be quite powerful.

Also if he is starting Reception in September he should be having some previsits to the class this term. Have a chat with the teacher; I would be surprised if they assign someone to change him but I am sure they will work with you to continue the routine you have been doing at home. It's always worth giving his teacher a heads up as to the difficulties you have been having so s/he can be alert to reminding him to use the loo, drink his water bottle etc.

Sorry that's so long, hope it's of some use for you.

DilysPrice Tue 18-May-10 20:02:21

I'd disagree with your MIL, because I don't think most 4 year olds are old enough to tease in quite that way, and modern schools impress upon them strongly the need to respect other kids' differences. Bear in mind that there's likely to be children in the school with very serious special needs.

That said, nappies in school is very unusual - my kids were both catastrophically untrained when they went into reception (after 18 months of trying) and nappies were never suggested as an option.

MojoLost Tue 18-May-10 20:11:24

Wow, it's amazing that the school doesn't mind him being in nappies. My ds has special needs, going to mainstream and the school wouldnt accept him until he was out of nappies. It took 10 long months of stress and poo cleaning but in the end we managed.
I think you need to go cold turkey on this one, throw away all the nappies, give him plenty of fruit and fiber and give him a HUGE reward when he finally goes to the toilet.
It will be tough and you will have to clean, sorry, but if you keep going back to nappies it will never happen.

Cadelaide Tue 18-May-10 22:33:25

Thanks Sidge, that took some typing! smile

The thing is, he will not sit on the toilet,(we have a special small seat) a potty (we have two different kinds), or wee standing up. He won't even sit on it in his nappy with his trousers on despite multiple bribes/approaches.

I don't mind cleaning up, I had weeks and weeks of it the last time we tried until gradually he just stopped going at all. He just held on literally all day.

The problem isn't that he lacks control, he has awesome control.

The problem is that he won't go anywhere but in a nappy or in the bath. Short of pinning him on the toilet/potty (which of course would be pointless and ridiculous) I have run out of ideas.

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Cadelaide Tue 18-May-10 22:36:16

I think once he takes that first step it'll be plain sailing tbh

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Lionstar Tue 18-May-10 22:40:45

Have you tried one of those targets (like floating ping pong balls) in the loo to pee on - making it a game to start with. Sounds grim-a-rama, but if it gets him going? I remember my brother was late to start toilet training, but what really got him going was peeing in tandem with his Dad. Try appealing to his competitive instinct!

Cadelaide Tue 18-May-10 22:47:14

I have tried that Lionstar, both the target and competing with his Dad/brother, but thankyou for the suggestion.

There must be something that'll motivate him.

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pinkmagic1 Tue 18-May-10 23:00:19

I really think you should speak to your GP or HV if you have tried everything. I don't think you should send him to school in nappies if hes not special needs. I hope you it soon.

Cadelaide Tue 18-May-10 23:01:54

Thanks pinkmagic1, I agree it's time to seek help. smile

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AccidenToryOnPurpose Wed 19-May-10 02:04:48

ah. ds1 is also the king of stubborn smile so with him we need to make him make any decisions...

in your case i might be temnpted to try a hefty dose of immense bribery along with the laxative. wink

motivation is a bitch, to be honest. ds1 would cut off his nose to spite his face if it kept him in control. <sigh>

have you tried (not woo at all, but after 2 years of paediatric monitoring we gave it a go) hypnosis? last time we had a one-off session and it worked for three days - we didn't even have to ask him if he needed the loo, he just went... we were awestruck.

our gp has suggested a course of hypnosis this time (he thinks ds is an ideal candidate as it is likely to be behavioural - all physical/ developmental causes have been ruled out)

i have to say, i only mention this as a last resort actually (although we are not woo at all, our gp definitely is), and only after all the suggestions by sidge have been implemented. apparently it's 'parts therapy'...

along the way we have found malem do a cool wristwatch alarm that can be programmed to remind children that it is time to wee at school (subtley lol), and that their enuresis alarms for night time can be extremely effective (we used one when dd1 was 8 - she was completely dry within two weeks). but all kids are very different and you do need the help of a pead or enuresis clinic to talk you through strategies - stuff that worked with dd1 hasn't been successful with ds1...

but i've got two dry, and only one to go now grin, and like someone once asked me, how many 25 year olds with encopresis do you know? it does usually resolve one way or another...

first session for hypnosis for ds1 is 31st May grin <fingers crossed emoticon>

Cadelaide Wed 19-May-10 10:34:28

I suppose there might be lots and lots of 25yos going about their everyday lives, in the office, school run, catching aeroplanes, jumping off buses, all secretly wearing pampers pull-ups? grin

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soremummy Wed 19-May-10 10:49:08

Cadelaide my dd is just like your ds, although she was only 3 last week. She has a total meltdown if you remove her nappy will just get changing mat and lie on the floor holding herself and crying. If you find a magic cure for convincing him to use the loo or potty please please let me know. She is dur to go to nursery in september and i dont think they will let her go in nappie..

DaisymooSteiner Wed 19-May-10 11:01:12

Probably really obvious, but will he sit on the toilet/potty with his nappy still on?

schroeder Wed 19-May-10 11:24:38

It does sound like he has control if he can wait all day.
My ds was in nappies until after his 4th birthday and I really thought he might go to school in them. We struggled to make any progress with him especially after dd was born (when he was 3 1/2). But he finally did it by himself when I had almost given up and within a few weeks was even dry at night.
I know this isn't much help, I just wanted to reassure you that even though he's still in nappies now doesn't mean he still will be in September.
It always seemed to me that with my ds it was an attention seeking thing and when I took a step back he took control.

Cadelaide Wed 19-May-10 12:04:46

Thanks schroeder. I may be looking ahead too much, he's not 4 until July. It's just the school thing looming.

Daisy I have tried getting him to sit with his nappy on, but thanks for the suggestion anyway, I do feel as tho' the answer may be staring me in the face and if I keep bumping this thread someone will come up with the magic answer smile

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wigglybeezer Wed 19-May-10 12:05:23

I would second the hypnosis idea. DH had a similar problem (as an adult, its called paruresis, google it). The fight or flight mechanism when you are anxious (about using a public toilet for instance) basically clamps your bladder spincter shut so that you cannot physically "let go" of the wee.

In the end he could only go at the end of the day, in the bath (incidentally MIL says that she was worried that he would not be out of nappies in time to start school, I suspect he was like your son).

It was affecting his ability to travel and work so he got referred to a psychologist
who tried desentization techniques (which didn't work well for DH, but, a type of hypnosis called something like Rapid Eye Movement Therapy (sorry can't remember its actual name) worked very well and he is now almost cured. However he has never been able to pee on command (ie. peeing before a car journey) and he cannot pee in front of anyone (even me!).

I feel your son's problem is definitely an anxiety issue.

Unusually DH could always pee outdoors even at the height of his phobia about peeing in bathrooms.

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