New guidance highlights role of health visitors in toilet training

The Institute of Health Visiting (iHV) has published new guidance on toilet training to help tackle ‘unnecessary delays’ in transitioning children from using nappies to a toilet.

Parents and carers should seek help from a health visitor if they are unsure how to start toilet training, how to progress or if babies and children have special educational needs and disabilities, the guidance states.

It also encourages parents to seek help if constipation or pain is making toilet training hard, or if a baby or child is afraid of the potty or children.

Developed in collaboration with ERIC, The Children’s Bowel and Bladder Charity, the iHV’s new parent tips on toilet training document highlights the benefits to children’s bladder and bowel health to stop using nappies between 18 and 30 months.

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The change in guidance moves away from previous advice to ‘wait until children are ready’ to use a toilet.

This advice is now outdated as modern nappies are designed to protect children from feeling wet and many will not show signs that it is the right time to stop using nappies, the iHV has said.

It also comes as two-thirds of teachers (65%) and 58% of parents agree that not being ready for school when starting reception could have long term impacts on a child’s success in later life.

The guidance includes practical tips to support toilet training, including speaking to a health visitor, school nurse or healthcare professional if a child isn’t dry at night by age five.

Lifelong consequences

Alison Morton, iHV chief executive, said: ‘Gaining mastery of your own bladder and bowel function is an important milestone in a child’s development.

‘However, toileting practices and advice have changed over the years, and are heavily impacted by marketing tactics to delay toileting and prolong the use of nappies under the guise of ‘waiting until children are ready’. This has a human, financial and environmental cost,’ she warned.

‘Unnecessary delays and low expectations are limiting children’s life chances and can have lifelong consequences. Getting this right is not really a choice, it is fundamental for children’s dignity, safety and quality of life Ms Morton added. .’

The guidance is intended to support the government’s target for 75% of children to achieve a Good Level of Development (GLD) by 2028 – including self-care skills like being able to use the toilet independently.

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A changing picture

Currently around 1 in 4 school aged children living in the UK are not toilet trained according to the charity Kindred, with the average child fully out of nappies at around three to four years of age.

In comparison, 83% of children were out of nappies by 18 months in the 1970s and 1980s, according to the iHV.

Overall, around 90% of teachers have at least one child in their class who is not fully toilet trained.

On average, 2.4 hours of teacher time is lost every day supporting children who are not toilet trained to catch-up on missed lesson-time.

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Health costs and concerns 

Hospital admissions for childhood constipation, which can be exacerbated by delayed toilet training, have increased by 60% over the past decade to over 44,000 children last year.

In total £168m was spent treating constipation in 2018/19, including £81m being spent on avoidable admissions to A&E for constipation £87m on prescription laxative costs.

This means the cost of treating constipation is equivalent to funding 7,304 newly qualified nurses for a year, according to Bladder and Bowel UK.