Flowchart – Children with Additional Needs

Every child must be fully assessed using the appropriate Continence Assessment Form.

Some children with complex additional needs may never achieve continence. However, even children with significant learning, mobility or communication difficulties can achieve a good level of continence. Every child has the right to be helped to achieve their best possible level and to maintain their dignity.

Even if a child is unable to achieve full continence, a healthy bladder and healthy bowels should be promoted at all times. Constipation is very common in children with additional needs, and is often overlooked as their bowel problems are incorrectly attributed to their learning disability. Constipation may result in frequent, loose bowel actions (overflow soiling) which can cause sore skin. The full rectum and colon also occupy the space required for the bladder to expand, resulting in frequent small voids, and placing the child at risk of Urinary Tract Infection (UTI) as bladder emptying is impaired.

NO child should ever be provided with nappies, pull-ups or pads without a full continence assessment to identify any bladder or bowel problems and to consider their toilet training potential. The small minority of children unable to achieve continence may be eligible for a supply of pads or nappies. As stated in NHS England’s Excellence in continence care guidance: “It must be the exception, rather than the rule, that children and young people are provided with containment products.”

The flowchart below should be followed to ensure the child receives the correct assessment, treatment and management. Continence care for children with additional needs is provided by the team who look after the child, which may include health visitors, special school nurses, learning disabilities nurses, children’s community nurses and others. It is provided in conjunction with the Children’s Continence Service.

Back to the Children's General Continence Flowchart