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Managing bowel and bladder issues in early years education settings, schools and colleges
A guide for parents/carers and professionals to support children and young people across early years settings, school and college.
Read our advice sheets Advice for children with constipation, Advice for children with daytime bladder problems, Advice for children with night time wetting, Advice about children’s bladders and bowels – from birth, to potty training, to school and Advice about bladders, bowels and toileting for children with additional needs for more information, including downloadable PDFs of the advice sheets.
Early Years
1. Continence development in children
In previous generations most children were toilet trained by the time they were two years old.
Over the years this has changed due to social, environmental and cultural changes and now most are not toilet trained until they are 3 – 4 years old, with an increasing number of children starting school not toilet trained.
This, coupled with the fact that children are now in nursery for longer hours, means that it is essential that education staff are educated and informed on how to promote good bowel and bladder health in young children and support toilet training.
Young children have small bladders: they hold about 120mls of urine at age three years and this increases by about 30mls a year.
However, their kidneys produce urine at the same rate as older children’s kidneys (about 60mls an hour).
Also, they normally become aware of the message that they need to pee at a later stage.
Therefore, young children will need to use the toilet frequently and at short notice.
As children get older, if their bladder is working well, they become aware of the need to pass urine before the bladder is full, giving them the time and notice to use the toilet at convenient intervals, such as at break time.
If children are drinking adequately, their urine should be pale in colour, they should be passing urine 5 – 7 times a day and the bladder should be empty when they have finished passing urine.
By the age of three years old, children should be opening their bowels three times a day to three times a week.
If they do not go when they feel the need to go, they are at increased risk of developing constipation.
It is normal to have the urge to open the bowels after a meal or warm drink.
2. Why some children have difficulty toilet training
Not all children become toilet trained at the same age.
Most children are ready to master potty independence and lead in many parts of the process from around 18 months. The majority of children will be capable of doing most things including wiping by themselves when they start school.
Current research shows it is best for a child’s bladder and bowel health to stop using nappies between 18 and 30 months.
Before they can start training, children need to be given lots of opportunities for learning. Babies are born ready to learn new skills with our help and the best way for them to do so is through practice and repetition.
That's why it's important to think about potty or toilet training in the same way we support children to develop other skills such as brushing their teeth or using a spoon. This gives them all the time and practice they need to succeed with being independent from nappies when the time comes.
However, if a child has a bladder or bowel health problem, toilet training may be delayed.
Or, if a child has a disability or chronic illness, toilet training may have been delayed in favour of other treatments, or because assumptions may have been made about the child’s abilities in this area.
Children with additional needs or disabilities may experience the same bladder and/or bowel issues as their typically developing peers. However, they are more likely to develop lower urinary tract symptoms and/or constipation.
Furthermore, they may face additional obstacles to achieving and maintaining continence:
- Restricted mobility may make getting to the toilet more challenging
- Communication difficulties can hamper requests for help
- Reduced social awareness may impact on their desire to learn to use the toilet
- Sensory issues may make them unwilling to use school toilets
- Some children with disabilities will require adaptations to promote toileting
3. Role of early years education staff
Early years education staff spend a significant amount of time with young children during a crucial time in their development of toileting skills.
Therefore, it is essential that they are well informed in how best to support children in early years education settings to achieve these skills, whilst also promoting optimal bowel and bladder health.
Read the principles of good bowel and bladder health on our main school webpage for further information on the key recommendations:
- Access to drinks
- Toilet access
For further information on toilet training visit our potty training page Potty training: how to start & best age to potty train.
For more information on how to help children with additional needs achieve maximum continence visit Potty training children with additional needs
Have you heard about our Let’s Go Potty online learning course for early years practitioners?
This eLearning course is to teach early years practitioners about the 3-step approach to potty training that has been adopted by ERIC - Let’s Go Potty.
Learn the approach through videos by our specialist nurse, then answer questions to gain a certificate. For more information, click the button below.
Starting school: information for parents/carers
If your child isn’t quite toilet trained, or they have a medical condition such as constipation, or they are required to carry out a bowel or bladder procedure at school as part of their condition, it can be an additional source of worry when your child starts nursery/school. You might worry about who will help them at school or what will happen if they have an accident in class.
Ask yourself these questions as you start to think about your child starting school:
Is your child reliably clean and dry in the daytime?
If the answer to that is no, don't panic! Maybe you've been trying but things haven't been going well...
There can be reasons why children struggle to get their wees and poos in the potty or toilet. Help is at hand below.
If you haven't starting potty training yet, look at our information on how to potty train.
Children with additional needs may need extra time and effort with toilet training. We have information and support on tailoring toilet training to support your child’s individual needs and capabilities.
Could your child be constipated?
Up to a third of all children struggle with constipation (see NICE Guidelines). This can also cause wee problems because the bladder and bowels are closely related. If your child is constipated their tummy may be so full of poo that it makes their bladder misbehave!
Take a look at our Poo Checker to find your child’s poo type and what it means.
Read our factsheet Advice for children with constipation and check out the symptoms of constipation. Your child only needs two of those symptoms to be diagnosed with constipation.
Does your child drink enough?
Check your child has plenty of fluids - a minimum of 6-8 drinks every day.
Don't limit their drinks to help them stay dry - it doesn't work! The bladder needs to be properly filled and emptied to behave properly.
Let your child choose a water bottle for school, and get them to practice using it. Talk to their teacher to find out what the practice is for allowing children to refill during the day and to be able to keep on their desk.
Praise your child if when they come home with an empty water bottle or tell you they refilled it during the school day.
Take a look at our Wee checker to see what colour their urine should be and how much they should be drinking.
If your child is struggling to get dry in the daytime despite plenty of work on healthy bladder and bowels, look at our factsheet Advice for children with daytime bladder problems.
Video: The impact of delayed toilet training
An increasing number of children are starting school not toilet trained. The emotional and social impact on both child and family can be significant – this video can help to imagine what starting school in nappies might be like for the child and their parent.
If your child is not yet toilet trained, don’t worry, there is lots of help available. But do take action, don’t just wait for your child to work it out by themselves.
Tips to make starting school less stressful
Here are some tips for making your child’s transition into primary school easier:
- Relax and try not to panic! Look at our website, use our resources, or contact our Helpline. There is lots of help and support available and medical conditions such as constipation are very common and treatable. We run free parent webinars every month so keep checking our website page and socials for information.
- Speak to the school. Inform their new teacher and/or SENDCo about your child’s needs. Show them the School toilets information on our website. Complete an Individual Healthcare Plan like the one on our website and look at our Intimate Care Policy.
- Do some research. Have a look at the school's medical needs or uniform policy if your child will be wearing protective underwear and a reminder watch.
- Get local info. Ask your child’s school to send you information about the local school nursing team and parent, carer forum. They will be able to offer you lots of support and advice. You will quickly discover you’re not alone as bladder and bowel conditions in young children are very common.
- Practice using the toilets away from home with your child so they get to experience different types of flushes and hand dryers for example.
- Prepare. Consider the type of clothing your child will be wearing at school, make it as easy as possible for your child to undress. Buttons, zips and tights can be tricky for children so look for elasticated waist bands and long socks where possible. Look on the ERIC shop at our range of protective underwear, vibrating watches and items such as TomTags and other visual aids.
- Get into a routine. Treat any constipation and get your child into a positive toilet programme by ensuring they are drinking plenty and using the toilet 20/30 minutes after eating breakfast, lunch and dinner.
Video: getting ready for using school toilets
Watch our video with a parent who shares her experience of getting their child ready for using school toilets with school staff to help her son get the right support at school with his toileting challenges.
Sam, Helpline Advisor at ERIC, offers tips and strategies to help if your child is experiencing difficulties such as constipation, soiling, toilet avoidance and anxiety.
This is a 9-minute video.
It’s not uncommon for children to regress even after being clean and dry for a while. A change in routine such as starting school can be a trigger.
Listen to our podcast Potty training problems for some useful hints and tips on how to get back on track.
Managing bowel and bladder issues in schools and colleges
For many children and young people their continence problem will be 'chronic' - meaning it could persist for many years or keep recurring. Other children may have an underlying condition that requires lifelong management.
Therefore, it is an issue that will commonly affect not just younger children, but also teenagers.
Research tells us that bowel and bladder issues affect peer relationships and cause social isolation and feelings of difference. They are also a cause of reduced self-esteem, a sense of social stigma, distress and are associated with behavioural disorders.
These may all impact experiences of education, highlighting the importance of managing these issues effectively and for young people in education settings.
ERIC and The University of Bristol carried out some joint research, looking at the link between bladder and bowel issues and school performance.
The findings are summarised in the following short film, which hears directly from young people who are living with these issues. It gives useful insight into how these conditions impact on their everyday lives and what they need from schools to support them.
The video is a must-watch for all school staff as it also contains helpful tips and key messages.
Managing bowel and bladder issues: information for education settings
ERIC have teamed up with Bladder and Bowel UK to produce comprehensive, practical guidance for education settings regarding bladder/bowel issues and toileting. This document, revised in Jan 2025, provides information on how to manage these continence issues in nurseries, schools and colleges.
Topics covered include:
- The development of continence
- How to promote good bladder and bowel health in schools
- Health and safety/infection control
- Hygiene standards/provision of school toilets
- Managing incontinence in schools
- Medication
- National legislation for the four countries of the UK
- Safeguarding
- Continence policy and care plans
Caring for children with medical conditions in school – relevant legislation
An explanation of the legal situation in each nation in the UK in supporting children with medical conditions in schools can be found here:
Legal-Situation-in-Schools.pdf
Guidance for supporting pupils in school with medical conditions:
England: Supporting pupils at school with medical conditions
Scotland: Supporting children and young people with healthcare needs in schools: guidance - gov.scot
Wales: WG31248
Northern Ireland: Supporting pupils with medication needs | Department of Education
Intimate Care
ERIC and BBUK have produced a sample toileting and intimate care policy for nurseries, schools and colleges.
This document aims to provide a clear framework for staff to ensure the safety and dignity of all learners when using the toilet and for those who need support with personal care, including toileting and continence management.
It also clarifies for learners and their families the support they can expect from school.
Find the document here: intimate-care-policy-for-nurseries-school-and-colleges/
Individual Health Care Plan for pupils with bowel and bladder conditions
It is advised that an Individual Health Care Plan (IHCP) is completed for all pupils who have bowel and bladder difficulties that affect their school day.
An IHCP is essential to ensure a child’s needs are sensitively and effectively met in education settings and that all people responsible for the child understand their needs. It should include a description of the condition and outline the management required.
School staff should agree the plan with the parents and the learner, where they are able to participate. All care plans should be reviewed at least annually or sooner if the needs change.
ERIC and BBUK have produced a template for an IHCP – Individual Health Care Plan – and also an example of how it might be completed.
Individual health care plan - ERIC
The following video has been compiled by one of our Family Services Advisors. It talks through how to fill out an Individual Health Care plan. The video has automatically generated captions and is 25 minutes long.
Transitioning to secondary school/college
Moving onto secondary school can be an anxious time for young people living with bowel and bladder issues. Visit our page Managing at school and college - ERIC for:
- Real life experience from teenagers and young people about how they manage their conditions at school and college
- Who to talk to
- How to get a toilet pass and other tips and hints
This page also contains lots of advice and information for teenagers and young people living with bowel and bladder conditions, including:
- Managing relationships and feelings
- Managing medical appointments
- Trips away from home
Resources
- All
- At school
- For Parents
- For staff
- For Teens
- Kid's stuff
- Videos
Last Reviewed: January 2025
Next Review: January 2028
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