RECEPTION CHILD (4 and half years) and toileting problems - what would you expect school to do/think?

[looneytune]

I can't believe I just wrote a really big post, hit submit and my internet went and I lost it all!

I haven't got the time to put all the detail in again but can fill in later if needed. Basically, ds2 has been off school this week due to a very sore bottom due to never making it to the toilet and wetting/soiling himself all day long. He was perfect on the toilet for a year than started having problems which is being worked on as we don't know the cause. The main thing is that when he wets/poos himself at school, he doesn't tell anyone so sometimes it's not dealt with and he comes home in dried up poo which has made his bottom sore and/or they do notice and so take him to the toilet, provide my wipes but he does a terrible job of cleaning himself as doesn't really want to touch it when sore, therefore getting sorer.

School agreed that at the moment it's best he's off as so sore and was screaming when touched in that area (can't expect school to deal with that and it's not fair on ds2 as so sore). Once he's clear of the soreness, I'm not sure what to do about sending him back to school whilst having so many accidents (this has been happening on and off for about 6 months but he'd got so much better and not sure why it's started again). School mentioned possibly putting him in pull ups but I don't think that would help plus I think would make it worse in terms of embarrassment as kids would see it poking out of his trousers at times/when changing for PE etc. But I'm also concerned that as he doesn't get cleaned up properly, he's just getting sore all over again (this isn't the typical child goes to the toilet and doesn't clean up well enough, this is a wider part of his bottom as he sits in the poo once he's done it!)

I've phoned his Paediatrician asking for an emergency appointment (on Monday) to review this due to it getting worse again. In the meantime is there anyone out there who's had similar problems? Any advice on how to handle this once he's better sore wise?

Hi OP don't put him in pull ups. Can't believe that the school even suggested that!! He could still be sore in them and it just teaches him it's ok to be wet. are you or another relative close by so that if he did poo you could come and change him.

How do they go to the toilet at the moment?

I am a teacher and taught a seven year old with toilet problems. We were lucky enough to have an office lady who was prepared to help clean the child when accidents occurred with written parental permission. It may be worth asking if anyone could do this but be prepared for the answer to be no. Schools are notoriously worried/reluctant about stepping into this role and we are just lucky to have a lovely motherly staff member who will. Good luck sorting it out and hoping your little man feels better soon. Poor thing x

When I worked in nursery and reception we would remind the odd ome that needed it, we also had set times for toileting. Whilst in the toiletnI would just have a quick glance at a child's pants to see if wet or not.

Theoretically staff should not change a child on their own but have to have another adult present.

That's true christmas. We were concerned about humiliating the child so had another adult present by leaving toilet door slightly ajar but in such a way the child couldn't be seen

If he doesn't make it can they send him to try and go at certain times?

As a mum with an 8 yo DS who's had issues around toilets since nursery I send you all the best wishes and hugs. It's really not easy. The ERIC charity is very good. They have a website and a helpline you can email and phone and they make lots of practical suggestions. They really do seem to care [smile) If he's like my DS, he may be withholding and therefore not getting to the toilet on time?

My ds1 is nearly 6 (year 1). He started school last year at 4 1/2 having never been dry for more than a day at a time. We had tried everything, within a week or 2 of him having several accidents a day it was agreed with school to put him in pull ups, as we decided that it was less embarrassing than havin to be changed several times a day (we were lucky that all the staff were happy to help change and clean him up) we progressed from pull ups to dry like me pads which go inside the pants, and then to just pants and a wobble watch which you set to vibrate at certain times to remind tempo go to toilet, staff also reminded him to go. This year the watch strap has broken so can't use it but bar a couple of weeks around half term where he had several accidents he has been mostly dry at school. Still has the occasional accident at home and at night ( peadratrician says not to put him in pull ups at night as ds1 has asked not to) we have had tests and ultrasounds done but nothing has shown up so for us it's just hoping he will eventually grow out of it.

Also, I would expect the school to be familiar and supportive in this situation. It's quite common. I would also try the school nurse service. The school should be able to put in place a plan for your DS.

Soiling is almost invariably the result of constipation and a common trigger time is around starting school.
If he was clean before starting school and the problem has started since September then it's most commonly due to either being reluctant to poo at school (and therefore withholding leading to constipation) or drinking less during the school day or a mixture of both. The paediatrician will check for an underlying medical cause but to find a cause is very very unusual.
The key here will be finding out what's happening at school- are toilets nice and clean (check out the "bog standard" campaign for school toilets), does he have to ask to go, is he drinking plenty at school.
When soiling is happening, there is usually faecal loading of the large bowel with constipated poo which needs to be cleared out. You paediatrician may well prescribe movicol for this. I usually recommend trying to have a clear out during a weekend or school holiday as soiling often increases in this clear out phase. The key after that is maintenance of a clear bowel, which means going back to scratch a bit with toilet training. He should be encouraged to sit on the toilet after meals. Exercises like blowing bubbles or whistles can help here. It should be possible to get school engaged with encouraging him to sit on the toilet at each break time. Make sure he knows not to hang on when he does need to go.
Most schools will be familiar with this as it is very common but sometimes a letter from the paediatrician helps to explain the situation.
I would suggest applying a barrier cream to his bottom to help to protect the skin and prevent it getting sore and discuss with the school how they would handle soiling accidents, if they are happy to help him clean up etc.
Constipation and soiling is hard work unfortunately but the key to success is getting a toilet routine established, drinking plenty of water and not stopping laxative medications to quickly.
There is good advice and support on soiling and wetting available through ERIC www.eric.org.uk

Thanks for all the replies :)

Christmas - that was my instant thought about pull ups and no, I won't be going down that route. Plus as you quite rightly say, it will just make ds2 be GUARANTEED to not use the toilet! This was mentioned by the TA in his class, she's lovely and has been dealing with him but I'm not sure if they've had problems as bad as this before? As for how they go to the toilet, do you mean how it works at school? If in the classroom they can just go I believe and there are toilets almost within, just to the side, but if they are in the hall or something like that, they just need to tell someone they are going to the toilet (but ds2 would never do that). From the playground they can just go in and get a drink/go to the toilet so no problem there. NOt sure about set times or anything although they have prompted him more because of the problems. I'd be more than happy to be called to sort him when he has accidents however with the number he has, I'd be better off staying for the day! (not sure they'd want that with all the little ones I look after with me) Oh and yes, I totally understand the thing with another adult present which I guess is where problems arise as they probably can't always do that.

teaguzzler - that would be great to have someone who would be willing to clean him up properly, hoping that he wouldn't react in the way he can with me at home (as doesn't like being wiped so much but it has to be done!). I totally understand how school feel awkward about all this. I'm a childminder and work alone so worry about false allegations etc. but I also always do what parents ask if it's in the child's best interest but having said that, I'd feel more comfortable cleaning an older child up if it was one who'd been with me for many years (i.e. several been with me since babies, some since 8 weeks old so would feel more natural than with someone who started with me since they were school age IYSWIM).

Wolfiefan - I guess they can but I know that doesn't work for me at home, unfortunately

Peanutbutter - thanks so much, I'll check that site out. And yes, I do believe he's withholding so just bits of poo come out and when that happens, I get him on the toilet but often the moment has gone and he spends ages on the loo but nothing comes out. I then clean him up and it all happens again later. For example, earlier I just guessed he was holding it so picked him up and rushed him to the loo (thank god I have a loo downstairs as I'm pregnant and couldn't be doing with carrying him upstairs all the time!), managed to not get it in his pants as was just in time, encouraged him to get the poo out in the loo (said he couldn't but I sat there with him, put the tap on making him wee then he relaxed), he did a little one, promised he was done, I wiped him and washed his hands with lots of praise for getting that bit out. A parent arrived to collect their child whilst I was wiping/washing hands so then went through and were gone within about 5 mins. Once I shut the front door I could smell poo and yep, he'd done some in his pants again that soon! Anyway, will speak to school again and talk about the school nurse. His bottom is clearing up very well now but I'm just not sure what to do about sending him in tomorrow? :(

jojane - that must have been really hard for you, pleased they worked with you to help the problem. As my ds2 goes through phases, it's hard to know what's best to sort the problem, a couple of weeks ago he was fine with no accidents, now this again.

Abby - when I saw the GP about it in the summer, he didn't think he was constipated but referred him to the Paediatrician as felt it was psychological. Paediatrician agreed and said she didn't feel it was medicial and referred him to CAMHS (as had other behavioural issues). I strongly believe that it started due to him being anxious about starting school and not being with one of my mindees as we chose to put them in different reception classes. This mindee started with me at 8 weeks old and has been with me full time apart from my ML. So ds2 has grown up with her around since he was 10 weeks old. He had bad speech and language difficulties which caused him to be mute in preschool, he found it so hard to communicate with people he wasn't familiar with (as other people didn't understand him). When he started nursery and was with this mindee, he was a totally different child and would be more himself in that environment (plus attached to the school he's always known). But they became each other's security blankets (more him) and their relationship was a bit too intense and he wouldn't make new friends so we decided to split them. I think once he knew about this, he got really worried about school and this could have started it off (was the right decision though as he's done amazingly well socially since starting!). Before he started school he was having up to 9 accidents a day :( Once he started school it soon became a lot better (like he realised he didn't need to worry about school afterall, he settled MUCH quicker than was expected!). But every now and then it starts again and we get locked into this cycle IYKWIM. I'm not saying he's never constipated but it doesn't appear to be the issue. I do think sometimes he's holding it in for some reasons although other times I'm sure he just doesn't feel it. Thanks for the tip about letter from Paediatrician, as we've got an appointment on Monday I'll ask for something to be sent! :) And yes, using Bepanthem now which has been amazing at clearing it up, will continue to apply as a protective layer too.

Anyway thanks again for taking the time to respond to my OP. I've now got to decide on whether to take him in tomorrow or leave it and arrange a proper meeting with them to discuss the situation now it's got to this level.