Professional Documents
Culture Documents
Toilet Training For Children
Toilet Training For Children
Project Report
Results
Of the 28 children that were identified to participate.
Childrens parents felt their child was too young or not yet ready. (Number
6 on chart)
Results
12
11
10
8
4
Number of Children
3
2
1
0
0
1
For the three children who have achieved continence, a total of 6,400 per
year will be saved by the NHS in continence pads that are no longer required.
Case Study
Luke (pseudonym used to maintain confidentiality)
When original assessments were performed with Luke and his Mother in
summer 2013 it became apparent that Luke was very fearful of the toilet
environment and would not even enter the toilet in his home. He wore pads
supplied by the continence team and would not use the toilet. He had had a
previous frightening experience where he had locked himself in the toilet and
then was unable to unlock the door. Luke was displaying many signs of
readiness, such as staying dry for up to 2 hours and indicating when he was
wet. A specific toileting plan was created for Luke that included:
Removal of the bathroom door at home to alleviate fear of becoming
trapped again
Mum to change Lukes pad initially just inside the bathroom, and
gradually take him closer to the toilet each time.
Once Luke felt comfortable enough, Mum encouraged Luke to sit on
the toilet at regular intervals; after snack and meal times. She would
stand in the doorway encouraging and praising him when he urinated
or opened his bowels in the toilet.
Whilst toilet training Luke would wear trainer pants so that he had the
sensation of being wet if he had an accident.
School staff also took Luke to the toilet at regular intervals and created
a reward chart for him in school. He was able to use a favourite toy
whilst he sat on the toilet and was rewarded each time he used the
toilet to urinate or open his bowels.
Lukes Mother said that she identified a big change once Luke felt secure
in the bathroom environment. It took approximately 8 months for Luke to
become continent during the daytime and required both school and his
Mum to provide lots of encouragement, use social stories and reward
charts. Mum says he now goes by himself and sometimes will inform her
that he is going by using the word toilet Mum commented that it is brilliant
that he can now go independently and she is very happy.
7
8
9
10 - Very relvant
10
1 - to little
5 - just right
10
10 - too much
1 - No
10
10 - Yes
10
1 - No
10
2 - Yes
1 - No
10
10 - Yes
1
1 or 2 children 47%
3 or more children 53%
0
1 or 2
3 or more
11
No
Not Sure
Yes
Yes 86%
N0 7%
Not Sure - 7%
Yes 27%
No 40%
Not Sure 33%
Yes
No
Not Sure
Yes 73%
No 0%
Not Sure 27%
Yes
No
Not Sure
12
Yes 50%
No 25%
Not Sure - 25%
Yes
No
Not Sure
Limitations
There were numerous factors that limited the ability of children to develop
continence and toileting skills. These include:
Not enough time for the School Nurse, SLT and OT to perform joint
home visits for all children
Some follow up phone calls for parents were not performed due to
parents missing calls and calling back when School Nurse was
unavailable
School holidays disrupted routines causing some children delays in
their progress.
There were differing levels of parent motivation. Some parents were
enthusiastically implementing plans and following recommendations
whereas some parents struggled to implement plans as they felt that
their child was unable to achieve continence or develop skills in this
area.
Differing levels of teachers motivation. Some teachers placed high
importance on developing toileting skills, especially if it was one of the
childs targets. Some teachers did not see this as a priority.
Some family circumstances meant that it was not appropriate to begin
toilet training at that time, for example a new baby or a brereavement.
Staff shortages affected ability to implement plan in school setting.
Teachers who did not attend training did not feel as confident to
implement plans.
Recommendations
To provide adequate training for both staff and parents regarding toilet
training for children with special needs. If there is a paediatric continence
13
advisor in the borough then they could provide this. If not, then funding
should be allocated for this to be delivered by an external company such
as ERIC.
To perform initial assessments jointly ideally with parents, School Nurse,
OT, SLT and Teacher.
To create a toileting plan that everybody working with the child is aware of
and can be delivered both at home, school and at respite/play centres.
To provide regular telephone follow up, support and advice.
All recommendations fit within the proposed model of care that has been
developed and is displayed below.
Proposed Model of care for use in Special Needs Schools London wide
14
Future Plans
The proposed model will continue to be used within the current setting. It can
be developed as services develop and include new assessments as these are
continually updated by the Bladder and Bowel care team.
The model will be used locally in the Special Needs Schools, especially when
new starters begin in September each year
15
Conclusion
This project was originally embarked upon as there was no integrated
approach to toilet training within four Special Needs Schools in London. The
aims were to ultimately increase childrens independence with toileting,
empower parents and staff to implement plans and save money by reducing
use of continence products. A grant of 3,500 from the Florence Nightingale
Foundation was used in order to meet the project aims. 28 children
participated and were assessed using adapted resources from the local
16
References
ERIC, 1999. Bowel and Bladder Management in Children with Special
Physical Needs, A Guide for Parents. Bristol: ERIC.
Fleming, E. and MacAlistair, L., 2013, Learning to wee and poo in the right
place Continence problems in children with autism, PowerPoint
presentation, National Autistic Society, London.
17
Appendices
1. Paediatric Assessment
Parents Name:
Child's position in the Family:
18
DOB:
GP Contact details:
NHS No:
M/F:
Address:
School Nurse:
Assessment date:
Postcode:
Phone:
Mobile:
Ethnicity:
Allergies:
Fluid intake
How many drinks in 24 hours?
Diet
Any special diet eaten?
Vegetables?
Beaker
bottle
Cereals?
bottle
sports
Enteral Feeding
Feed:
Quantity in 24 hours:
Water:
Flushes:
Bowel Habit
Daily:
Alternate Days:
Less Often:
Food Allergies?
Laxatives: Yes
No
19
Diarrhoea:
Soiling:
Hides
Suppositories: Yes
Enemas: Yes
No
No
Yes
No
Yes
No
No
pull ups
underwear
Communication
How does your child communicate?
Normal speech
Yes
No
Limited Speech
Yes
No
Sign language
Yes
No
No Communication
Yes
No
Other form
Yes
No
Behaviour
Does your child have any behavioural problems related to incontinence? Yes
How does your child manage his/her incontinence at school?
No
20
9
2
9
2
9
10
3
10
3
10
No
Yes
No
Able to transfer
unaided
Yes
No
Dexterity
Does your child need help pulling
down clothes?
Yes
No
Yes
No
Yes
No
21
At Home:
At School:
No
2. Toileting Chart
Please follow the individual toilet training plan and complete the chart below so that we can see what your child is d
both at home and school. Record in the 'Nappy column whether the pad/pamts were wet (W) or dry (D), or if the ch
opened their bowels (B). Record in the 'Toilet' column whether the child did a wee (W) or opened their bowels (B) o
the toilet. Each time your child has a drink, record it by putting a tick in the 'Drink' column.
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day
Date:
10am
11am
12am
1pm
22
Nappy
9am
Toilet
8am
Drink
7am
Nappy
6am
Toilet
Drink
Nappy
Toilet
Drink
Nappy
Toilet
Drink
Nappy
Toilet
Drink
Nappy
Toilet
Drink
Nappy
Toilet
Time
5am
Date
1
2
3
1
2
3
1
2
3
1
2
3
Independence
(e) Sitting on the toilet
1 Afraid or refuses to sit toilet/potty (Shade in area 1)
23
Date
2
3
4
1
2
3
4
other components
(h) Bladder control
1 Never or rarely passes urine on toilet/potty (Shade in area 1)
2 Passes urine on toilet sometimes (Shade in areas 1 & 2)
3 Passes urine on toilet every time (Shade in areas 1, 2 &3)
4 Can initiate a void on request (Shade in areas 1, 2, 3 & 4)
1
2
3
4
1
2
3
(j) Behaviour problem that interferes with toileting process (e.g. screams
when toileted)
1 Occurs frequently once a day or more (Shade in area 1)
2 Occurs occasionally less than once per day (Shade in areas 1 & 2)
3 Never occurs (Shade in areas 1, 2 & 3)
2
3
1
2
(l ) Toilet If
1 Requires toileting aids or adaptations (Shade in area 1)
2 Uses normal toilet/potty (Shade in areas 1 & 2)
1
2
1
2
24
1
(Shade in
2
(Shade
3
2 Drinks 50ml/kg per day 4 5 drinks per day (Shade in areas 1 & 2)
3 Drinks 80ml/kg per day 6+ drinks per day (Shade in areas 1, 2 & 3)
2
3
4. Reassessment Checklist
25
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decompressor
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QuickTime and a
decompressor
are needed to see this picture.
26
27
6. Parents Questionnaire
Was
this
session
1 2
3
Not very relevant
relevant
2)
and
your
child?
10
Very
4
5
6
7
Just the right amount
9
10
Too much
10
Yes a
Did you find the questions and answer session with the continence
nurse
useful?
1 2
Not really
lot
5)
you
1 2
Not really
lot
4)
to
Did the presentation have the right amount of information for you?
1 2
3
To little information
information
3)
relevant
Would
1
10
Yes a
you
3
recommend
4
this
6
session
7
to
8
other
9
parents?
10
28
Yes
FEEDBACK ANALYSIS
Out of the 40 delegates who attended this seminar 38 completed and returned their
feedback questionnaires. All the percentages below have been calculated against the 38
responses.
Q.1
The sessions were rated as follows: Session A Healthy bladders & bowels
No.
30
6
2
0
%
79
16
5
0
Option
Very useful
Useful
Quite useful
Not at all useful
26
10
2
0
%
68
26
5
0
Option
Very useful
Useful
Quite useful
Not at all useful
19
17
2
0
%
50
45
5
0
Option
Very useful
Useful
Quite useful
Not at all useful
20
16
%
53
42
Option
Very useful
Useful
29
5
0
Quite useful
Not at all useful
16
21
1
0
%
42
55
3
0
Option
Very useful
Useful
Quite useful
Not at all useful
Comments included:
Q.2
Really useful. Answered all questions very well everyone excited to put ideas
into practice
Very interesting
Very informative but a times felt bombarded with information, probably good
idea to have had a 15 min break not 5 for a chance to refresh
Excellent for our students! Fantastic presentation and info to use straight away
26
10
2
%
68
26
5
Option
Yes
No
Neither box ticked
30
2
17
19
%
5
45
50
Option
Yes
No but all said they would do from now on
No comments
Comments included:
31
32
33
34
35