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Starting healthy habits early

Children’s self-esteem and confidence can be badly affected by problems associated with continence, writes Janine Armocida.

Continence issues in schools continue to be an ongoing concern. Many health professionals recognise that children who experience the problem, particularly if they do not have a defined disability, are poorly understood.

Support for these children can vary greatly from state to state, region to region, and even at an individual school level. Every now and again, continence issues in schools hits the media, often demonstrating a lack of understanding about schoolchildren’s toileting needs, which can also lead to public outcry.

So how common are continence issues in schools? There are a wide range of causes of incontinence in children and it is not limited to children with cognitive and physiological disabilities. A Sydney-based survey in 2001 found that up to 19.2 per cent of primary school children suffered daytime urinary incontinence, ranging from mild to severe.

Constipation has been found to be even more common, with research showing constipation affects up to 30 per cent of children. Faecal soiling has been found to be less prevalent, but is still experienced by up to 5 per cent of school children.

The psychological and social impact of incontinence on children and young people cannot be underestimated. A 2006 Swedish study found that children affected with incontinence had significantly lower quality-of-life scores compared with an age-matched control group and reported “adversely affected self-esteem and confidence”.

School-aged children with faecal incontinence have been found to have higher rates of absenteeism and experience peer relationship problems. Not surprisingly, children with continence issues are more likely to be victims or perpetrators of overt bullying behavior.

The Toilet Tactics kit

This research highlights the need for better understanding and support for these children in our schools. One way the Continence Foundation of Australia is trying to help address these issues is through the development of an information resource for schools called the Toilet Tactics kit, based on Britain’s Bog Standard campaign (http://www.bog-standard.org) run by Education and Resources for Improving Childhood Continence (ERIC).

The kit aims to raise awareness of healthy bladder and bowel habits in schools, and to also help improve or maintain the standard of school toilets across the country, a significant consideration given research has shown school toilets can be a contributing factor regarding childhood continence issues.

Given the time spent at school makes up the bulk of a child’s day; how often they drink, how often they go to the toilet and the standard of the toilets are all important health and continence considerations.

Toilet Tactics was recently piloted in four Victorian and three South Australian primary schools. The results are being collated in preparation for the project’s national launch during World Continence Week, June 24-30, but feedback from participating schools has been positive and the children have been enjoying learning about their bladder and bowel health – after some initial giggling.

CFA has also received the support of the Victorian and South Australian education departments, and is talking to other state and territory governments regarding a national program. The foundation has also been liaising and developing partnerships with key organisations such as Life Education and Kids Matter to better understand how we can work together to help promote healthy bladder and bowel habits to school children, teachers and parents.

The information kit is designed to involve the entire school community and includes information for teachers, students and parents, and can be incorporated into the curriculum if desired.

By presenting the topic in a fun and positive manner and empowering students through education and knowledge, the initiative aims to motivate children to adopt lifelong healthy bladder and bowel habits and attitudes, and negate continence problems later in life.

Upon completion of the kit, it is hoped schools will develop a school toilet charter that the entire school community – students, teachers, parents and non-teaching staff has agreed on and committed to support.

As part of the Healthy Bladder and Bowel Habits in Schools project, the CFA has also developed a basic nursing care plan for children with continence issues at school.

While it is not designed for children with complex continence needs or to replace state or territory education department care plans, it is a useful resource for parents and health professionals, such as practice and school nurses, to ensure children with daytime continence issues are supported in the school environment.

Janine Armocida is the Continence Foundation of Australia project officer. She is a maternal and child health nurse and a continence nurse adviser. CFA is the national peak body for continence promotion, management and advocacy. References are available on request.

To view Toilet Tactics or download a care plan, go to www.continence.org.au. The CFA’s national continence helpline, 1800 330 066, is also staffed by continence nurses who can provide further advice and referral information.

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