One in four children start school still wearing nappies – but it’s not the parents’ fault

It’s been widely reported that a quarter of children are starting school not toilet trained, with teachers having to divert 2.5 hours a day away from teaching to support children who are not school-ready.   

When this news was first reported, there was a deluge of coverage shaming parents for not adequately preparing their children, but these knee-jerk reactions miss a crucial point; when things go wrong, there are far fewer opportunities now for parents to get help.  

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Toilet training can be more difficult now than in previous generations, due to many social and economic factors affecting families.  A change in focus for health visiting and dwindling numbers means the profession has less capacity to provide help and guidance, contributing to the lack of support services and advice to help people who are experiencing problems.  

The knock-on effects of the pandemic and cuts to essential children’s services in recent years have contributed to this issue and, if not addressed soon, it could have serious implications for children’s health and education.  

Feeling the pinch

Across the country, children’s services are struggling. In December 2023, the Local Government Association warned of a £4bn overall funding gap over the next two years, with £4 in every £5 of additional spending going on late intervention services.  

Many children struggling with potty training do so because of an underlying bladder or bowel condition such as constipation, soiling or day-time wetting.  Later potty training means these conditions go undetected and can lead to long term conditions needing specialist treatment. Bladder and bowel services are also feeling the pinch and there are many NHS trusts areas across the UK that do not have a service for children and young people.  Covid-19 further impacted it, with many services either being restricted or closed altogether.   

For people who can’t afford to seek private support, this means they may struggle to find adequate provision in their area – a postcode lottery, essentially.    

ERIC: The Children’s Bowel & Bladder Charity runs a helpline for families experiencing bladder and bowel issues. For the past few years we have seen an increase in calls to the helpline, particularly from July onwards, from parents whose children are due to start school but aren’t ready. Some are still in nappies or require a nappy to poo. That’s why we’ve launched a campaign this summer, to support more families in getting on board the Toilet Train, with support and advice to put them on the right track.  

A long-term problem

It’s well documented that issues like constipation, soiling or day-time wetting can impact on the development of the child in many ways. Untreated, they can cause wider physical problems including chronic changes in the kidneys, bowel or bladder over time.   

Continence difficulties may be detrimental to mental health, with evidence available to show that affected children from a UK cohort are more likely to have anxiety disorders, depression and self-harm thoughts. Children are also more likely to underachieve at school.  

Bladder and bowel issues may have wider implications for the family, being a source of stress affecting relationships and finances.  

Children affected by bowel and bladder issues need to be treated quickly, while the problems are still at an early stage, and before they become a lifelong burden.  

A complete and integrated service

The Paediatric Continence Forum Children’s Continence Commissioning Guide (PCF CCCG) recommends that all children from birth to 18 with bladder and/or bowel issues and/or delayed toilet training, should have access to a fully integrated children’s community bladder and bowel service.  

An integrated service is one that provides assessment and treatment for all functional bladder and bowel issues as well as interventions for delayed toilet training and provision of containment products to children who are clinically assessed as unable to achieve bladder or bowel control.  

It shouldn’t be left to charities like ours to pick up the pieces once the problem has become unmanageable. It would save the health service a lot of money – and families a lot of heartache – if children’s services and bladder and bowel provision was properly funded so that issues like these could be addressed sooner.    

We welcome the commitment in the Labour Party manifesto that children will be at the core of their mission to improve the nation’s health.   

It’s time to stop blaming parents,  ensure that local services have adequate resources to support toilet training, and a bladder and bowel provision in place to help those who experience problems – before it’s too late.   

Juliette Rayner is CEO of ERIC: The Children’s Bowel & Bladder Charity.

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