Child information library
Here you can find advice about bladder and bowel issues in children, and general bladder and bowel health. The information library is designed for you, for your family, as well as for the healthcare professionals who support you.
Bladder and bowel problems are common in childhood and adolescence. Most can be successfully treated, including in children with additional needs or disabilities. Children and young people who have problems with day or night time wetting, having to go to the toilet suddenly, urgently and/or frequently, constipation, soiling (pooing in their underwear), or who are struggling with potty or toilet training should have an assessment of both their bladder and bowel. This will help to make sure that their bladder and bowel are healthy, will help work out what is causing any problems and suggest actions that may help.
Your healthcare professional will support you in understanding the assessment and in developing an individual treatment plan that will help your child to become clean and dry.
Identifying an underlying bowel or bladder problem
Many people find it difficult or embarrassing to talk about bladder and bowel issues and some people wrongly assume that they will just get better in time. For families any problems may be difficult to understand and may be stressful to deal with.
Up to a third of children and young people can have a bladder or bowel problem. When children have additional needs or disabilities, health care professionals and families may assume that the additional need or disability will cause bladder or bowel problem, or delay toilet training. However, this is not usually the case. Every child with a bladder or bowel issues should be offered an assessment and then treatment to help them.
Your child’s health visitor, school nurse or a specialist children’s bladder and bowel nurse, should be able to use an assessment to help to work out what is causing the bladder or bowel issues. They can then talk to you (and your child) about treatment options, so that your child gains as much control as is possible for them.
Common causes of bladder and bowel problems include:
- Soiling – which is often caused by constipation and usually happens outside your child’s control
- The bladder not working as well as it should. This can cause wetting during the day and/or at night. It can also cause a sudden and urgent need to use the toilet, which may look as if your child is leaving it to the last minute to go, or make them have to go do the toilet more often than is usual to empty their bladder
- Urinary tract infections
Although these happen more frequently in children and young people with additional needs or disabilities, the issues may affect any child or young person and at any stage of their lives. They can usually be successfully treated if they are identified, but may not get better without specific support. There is more information about these issues on the Bladder & Bowel UK website.
What will an assessment for bladder and bowel issues or delayed toilet training include?
- General questions: You will be asked questions about your child’s general health, their development and about any medication they are taking. You may be asked about when you first noticed the problems and whether your child has had any treatments in the past and, if so, how effective they were.
- Diet and fluids: You may be asked what your child usually eats, whether they have fruit and vegetables every day, and a wide variety of foods. You may also be asked what your child drinks, how much and how many times through the day.
- Bowels: You may be asked to keep some record charts about your child’s bowels for seven to fourteen days. This will include information about when they open their bowels, what their poos are like and whether there are any symptoms associated with bowel actions, such as pain, withholding, straining etc. You will be asked where your child opens their bowels (e.g. potty, toilet, nappy, underwear) and whether there is any particular behaviour associated with them opening their bowels (e.g. hiding to do a poo, or hiding soiled underwear)
- Bladder: You may also be asked to keep a bladder diary for about two or three days. This will include information about when, what and how much your child is drinking, how often they pass urine (pee or wee) and, for toilet trained children, you may be asked to note when they are wet and to measure how much urine they pass when they go to the toilet. All this information provides clues as to how their bladder is working
- If your child is toilet trained in the day, but is wet at night, you may also be asked to keep a diary of their bedwetting for seven to fourteen days. You may be asked to fill in a chart that includes what time they go to bed and get up, whether they are wet or dry and, if they wear nappies or pull ups at night you may be asked how heavy these are, whether they leak and if you know what time of night the wetting is happening.
The assessment should include questions about any other bladder or bowel symptoms you or your child have noticed. There are also likely to be questions about your child’s general health and development and about any treatments / medications they may be taking or have had in the past.
For younger children and those with additional needs or disabilities: You may be asked for more information about your child’s additional need or disability and how this affects them. You may be asked if your child can sit on the potty or toilet on their own, whether they need any specialist equipment or alterations to allow them to sit safely and comfortably on the toilet.
You may be asked if you have noticed whether your child is frightened or upset by the bathroom or any part of toileting and how much your child is able to do on their own, such as managing their own clothing, or washing their hands. You may be asked how your child communicates to you (do they use words, signs, gestures, picture cards or another device to let you know what they want or need) and you may be asked if your child will follow simple instructions.
Making the most appropriate changes
There are a range of products available to support children who have issues with bladder and bowel control. These include special potties, toilet seats, steps to ensure your child is correctly positioned on the toilet or potty to help with complete bladder and bowel emptying.
The assessment will help to identify if there are any products that may be appropriate to support your child’s needs. It may also indicate for some children, that referral to an occupational therapist for provision of equipment may be needed.
Adaptations to your child’s routine and the right support for them to learn the skills for potty or toilet training can be very helpful for children who have additional needs or disabilities that have or are likely to delay potty or toilet training. There is more information about potty and toilet training on the Bladder & Bowel UK website
Medication may be suggested for some children. Constipation in children should be treated with laxatives (medicines that either help the bowel to empty or that soften the poos). There is more information about this on the Bladder & Bowel UK website
Some bladder issues such as frequency (passing urine more often than is usual), urgency (a sudden desperate need to pass urine) and day time wetting may also be helped by medications. Your healthcare professional will discuss these options with you if, following the assessment, they think that medicine is an option for your child.
Bedwetting may be helped by making changes to your child’s bedtime routine and daytime drinking. It can also be helped by treating constipation if that is a problem. Other options include medication or an alarm. The assessment will help to indicate which treatment is most likely to work well for your child. There is more information about daytime wetting and bedwetting on the Bladder & Bowel UK website.
Outcome of the assessment
The assessment should provide the information your child’s healthcare professional needs to be able to work with you to create a treatment plan. The aim of the treatment plan is to help your child to have the healthiest bladder and bowel possible for them, as well as the most control that they can manage. Your healthcare professional should then offer reassessment and review as often as it is needed.
If it is felt by the healthcare professional that your child is not able to learn the skills they will need for potty or toilet training, this should be explained to you. There should then be a discussion about whether they are able to provide continence containment products to your child.
Disposable nappies, or pads should only be provided to children or young people who have been assessed as unable to become clean and dry with a supported toilet training programme. In line with national guidance, products should not be provided to children under the age of five years old, or to children who are assessed as likely to be able to develop the skills to be able to use the potty or toilet. These children should be provided with an individual programme to help them learn the necessary skills. There is more information about learning the skills for potty or toilet training on the Bladder & Bowel UK website.
When is it a bladder ‘problem’?
Most children become reliably dry in the day by the time they are 2-4 years old. However, some continue to have wetting accidents in the day. The cause may not always be clear, but some underlying problems, such as constipation, can make the problem worse. Therefore, any child who has bladder problems once they are aged 5 years or more, or who has developed wetting after they have toilet trained should be seen by either their doctor or nurse for assessment and treatment or advice.
It is important to remember that daytime wetting is not caused by your child being lazy or naughty, or by anything you or your child has done, or has not done in the past. The problem can be helped, although treatments often take some time to work and relapses can happen.
Try to always praise your child for any efforts they make to become dry.
Why does the body make urine?
Urine (wee) is one of the ways in which the body gets rid of waste.
Urine is continuously made in the kidneys and stored in the bladder. The bladder is a bit like a soft, stretchy balloon. When it is starts to get full the bladder sends a message to the brain that it needs to empty.
Your brain should start to get messages from the bladder before it is full to allow time get to the toilet, before the need to go is urgent.
Why does my child wet themselves in the daytime?
Day time wetting can happen for different reasons including:
- Your child’s bladder may be smaller than it should be for their age
- The muscles in the wall of your child’s bladder may tighten and ‘twitch’ suddenly at any point during filling. This will cause a sudden, unexpected message that your child needs the toilet. If they cannot get there quickly enough they may get damp underwear or wet clothes.
- Some children ‘dance about’, hold themselves, or crouch when the bladder wall tightens unexpectedly. Many children do not associate this with knowing they need the toilet. If this happens they may say they do not want the toilet if asked to go, but then realise they do need it a minute or two later, but then wet on the way.
- Sometimes children are very busy or have sensory differences and so do not notice their bladder telling them it needs to empty. The bladder may then get too full and is unable to hold on, so they get wet.
What causes daytime wetting?
There are other reasons why a child might have an issue with daytime wetting:
Overactive bladder sometimes used to be called ‘detrusor instability’ or ‘unstable bladder’. This is one of the commonest causes of daytime bladder problems, including wetting.
Most of the time the muscles in the bladder wall are relaxed, soft and stretchy. They only tighten and squeeze when the person is at the toilet and passing urine and relax again once the bladder is empty.
When the bladder is overactive the muscles in the bladder wall tighten suddenly at any stage of bladder filling, usually before the bladder is full. This sudden tightening of the bladder wall muscles sends an unexpected signal to the brain saying that it wants to empty immediately. This sensation is called urgency: because of the need to use the toilet is urgent.
As well as having urgency, people with an overactive bladder may also have frequency, which means they pass urine more often than most people do. Most children aged over four years old should be passing urine about five to seven times a day. If they are passing urine eight or more times a day they are described as having frequency.
Overactive bladder is the most common cause of daytime bladder problems. Adults often mistakenly believe that children with this problem are being lazy or naughty and putting off going to the toilet until it is too late. They do not always understand that children will often dance or hold themselves as an automatic response to the messages from the bladder, without realising this is what is happening.
Constipation can be difficult to diagnose in children. If your child is not opening their bowels more than three times a week, or is not fully emptying when they do open their bowels, then the stools will collect in the rectum (the bit of bowel near the bottom). These stools will then press against your child’s bladder, giving it less space and making it less able to hold on to the urine. Therefore, constipation may cause frequency, urgency or day or night time wetting. There is more information about constipation in the information library on the Bladder & Bowel UK website.
Many children reduce their fluid intake if they have bladder problems. However, if your child drinks less, the bladder has less opportunity to expand and can respond by becoming smaller and therefore less able to hold urine.
If your child is not drinking enough their urine will be very strong and concentrated (dark yellow in colour). Strong urine can irritate the lining of the bladder and make the twitching of the bladder wall worse. Fizzy drinks and drinks with caffeine in them also irritate the lining of the bladder. Tea, coffee, cola, hot chocolate and energy drinks all contain caffeine.
If the bladder lining is irritated, then the bladder twitching will get worse. This means that the urgency, frequency and wetting may all happen more often.
Not getting to the toilet in time
If your child puts off going to the toilet for too long, instead of going when they feel they need to, they may be more likely to get wet.
Urinary tract infection (UTI) can cause frequency and urgency. This means your child might want to go to the toilet more often than usual and have to get there quickly. Urinary tract infections also increase the likelihood of wetting. Infections can cause pain when passing urine.
If your child does not change their underwear when they are wet, their skin could become sore, and make them more prone to urinary tract infection.
How can I support my child to have a healthier bladder?
Your child’s healthcare professional should undertake an assessment of your child’s bladder and bowel to find out the possible causes of the problems.
The assessment usually involves you and your child completing some charts together at home. They may also do a bladder scan and they will ask questions about the symptoms and your child’s development and medical history.
Completing bladder and bowel charts
Keeping a record of your child’s drinks and their toilet visits to empty their bladder for two or three days can help you and your doctor or nurse find out how their bladder is working. You may also be asked to write down information about their bowel motions for a few days.
You may be asked to:
- Record on a chart when they have a drink, what they drink and how much. This will help you, your child and your nurse or doctor know if they are drinking the right amount for their age and if they are drinking things that might irritate their bladder.
- You may be asked to measure their urine every time you go to the toilet and record this on a chart for two to three days. Your child’s nurse or doctor will then work out if their bladder is holding the right amount of urine for their age. You can also work this out with the equation: your child’s age in years + 1 x 30. This gives the average bladder capacity for age in millilitres.
- You may be asked to write down when your child gets damp or wet.
- You may be asked to keep a record of all your child’s bowel motions for a few days to make sure they are not constipated.
What is bladder training and can it help?
Bladder training can help your child’s bladder to work better through making sure they drink well and go to the toilet regularly.
What does bladder training involve?
Your child’s healthcare professional will explain bladder training to you. It includes:
- Making sure your child is having a water-based drink about every two hours from waking up until an hour before bedtime. Water is the healthiest drink. If they will not drink water you could try diluted sugar-free fruit squash instead
- Your child should try to pass urine after every drink and before bed
- Make sure your child sits on the toilet with their bottom well supported and their feet flat on a step (for girls). Boys might be asked to sit down to pass urine once or twice a day
- Make sure your child does not rush when using the toilet. They should take time to make sure they empty their bladder completely.
- Your child might be asked to double void. This means that when they have finished passing urine they should wait for 20-30 seconds and then try to pass urine again. Your child might be asked to stand up or both boys and girls might be asked to move a bit before trying to pass urine again.
What else can I do to help?
- Make sure your child is drinking 6-8 water based drinks every day, including three at school. Make sure that their school knows that they need to have their drinks as part of their treatment. Your child’s school nurse may be able to help you speak to school if needed.
- Most primary school-aged children need about 1.5litres of water-based drinks spread out evenly through the day. Older children and those who are very active need more.
- Make sure that school allows your child to use the toilet at school whenever they need to. Many secondary schools will provide a medical card to allow children out of lessons.
- Make sure your child has spare clothes, wipes to clean themselves and plastic bags for wet clothes, at school with them. Make sure any wet clothes are taken home for washing.
- Remind girls to wipe their bottoms from front to back. This helps to stop ‘germs’ from the bottom getting into the bladder and causing infections.
- Try to prevent your child from becoming constipated by encouraging them to eat lots of fruit and vegetables. Tell their healthcare professional if you think they may be constipated
If the bladder training does not help, or if the wetting is happening frequently and causing problems with school or home life, your child’s healthcare professional may suggest medication.
Always follow your healthcare professionals advice when giving medication. Speak to them if you have any concerns or questions.
Anticholinergics are medicines that help the bladder to stay soft and stretchy while it is filling. The medicines sometimes start to work within a few days, but they can sometimes take several weeks to start to be effective. Some children may need the dose increasing to get the best effect from the medication. The anticholinergics often work better if your child is doing bladder training while taking it.
Your child’s healthcare professional will explain how the medication works, how much your child should take and will arrange to see your child again. If the medication is not being fully effective, they may discuss increasing the dose with you at the review appointment.
Although medicines can be very helpful, sometimes they can affect other parts of the body and cause things you may not want to happen. These are called ‘side effects’. Talk to your child’s nurse, doctor or pharmacist if you think your child may be having side effects from the medication. Most people start a low dose of medicine to help the bladder get better without the medicine causing problems
If your child has had a urinary tract infection they may have to take antibiotics. Some children need to stay on antibiotics after the infection is better to help stop the infection coming back. Your doctor or nurse will explain this to you, if antibiotics are needed.
It can sometimes take time for treatments to work. If you are worried then talk to your doctor or nurse who will be able to explain what they think is causing the problem for you and what the options are.
Bedwetting, sometimes called nocturnal enuresis, or simply enuresis, affects approximately 20% of 5 year olds and 10% of 7 year olds. It is considered to be a medical problem once children have passed their fifth birthday.
It used to be thought that bedwetting was caused by stress or psychological problems. While these can be contributing factors, the opposite is true for many children and young people, with bedwetting causing stress and psychological problems. It was also thought that children would grow out of the problem. However, without treatment many children will continue to wet the bed into late childhood or their teens. It can sometimes last into adulthood. Children who are wet every or most nights are the ones who are least likely to just get better with time.
Why do children wet the bed?
The main reasons why children wet the bed are:
- They make too much urine (wee) at night. The brain produces a special chemical messenger, called vasopressin, during sleep. This tells the kidneys to make less urine. Some children are not able to produce enough vasopressin at night, so their kidneys carry on making as much urine at night as they do during the day. If the child sleeps through, then their bladder will empty, because it is not able to hold the large volume of urine produced.
- Their bladder is not able to hold onto urine well enough overnight. If the child’s bladder is smaller than it should be, it will not be able to hold all the urine, even if the child is making enough vasopressin. If the child’s bladder wall gets twitchy during filling, it may empty some or all the urine at any time. Many, children with this problem also have some bladder issues in the day. They may have to run to the toilet (urgency), they may go to the toilet more often than others (frequency), or they may get damp or wet underwear during the day.
All children who wet the bed are unable to wake up when the bladder needs to empty. If they did not have the problem with waking, they would get up and go to the toilet
Other things that may cause bedwetting, or make it worse include:
- Constipation. The full bowel puts pressure on the bladder, making it more difficult for the child to hold onto the urine made overnight
- Drinking too much before they go to bed. If children drink large amounts before bed, they are more likely to fill their bladder before morning. If they are unable to wake up to the full bladder, their bed will get wet
- Not drinking enough during the day. Not drinking enough during the day means that less urine is produced. If this happens regularly the bladder will get smaller, as it does not have to hold much urine. This may result in bedwetting
- Drinking the wrong things. Fizzy drinks and ones that contain caffeine (tea, coffee, cola, chocolate and many energy drinks) can irritate the bladder lining and make wetting worse
- Urinary tract infection. A urinary tract infection irritates the lining of the bladder, causing the bladder to empty more often. This can result in bedwetting.
- Very rarely children wet the bed because of a different underlying medical cause. For this reason, if the child is unwell, or if bedwetting starts suddenly after a child or young person has been dry at night for some weeks or months, then they should see their GP.
- Bedwetting can run in families. If a parent or close relative wet the bed, then it is more likely that the child or young person will also have bedwetting.
It is important to understand that children and young people do not wet the bed because they are lazy or being naughty. Punishment is likely to make the problem worse.
All children and young people with bedwetting should be offered an assessment of their bladder and bowel health and treatment options should then be discussed. This should happen when the wetting is worrying or upsetting for the child and/or their family.
What does an assessment involve?
The assessment is usually done by a nurse. You and your child may be asked to keep records of the bedwetting, of their bowel actions (poos) and you may be asked to help them keep a bladder diary. The bladder diary is a record of what and how much they drink over two to three days and how much urine they pass each time they go to the toilet. This will allow the nurse to see how well their bowel and bladder are working.
It is likely that you will be asked questions about how long the bedwetting has been happening, about your child’s general health, toilet training and medical history. Let the nurse or doctor know if you have any concerns about their use of the toilet during the day, including damp, wet or soiled underwear.
What does treatment involve?
Sometimes lifestyle approaches are suggested to help with the bedwetting. These may be tried on their own or in addition to other treatments. Lifestyle approaches include:
- Having a water-based drink every two hours. Primary school age children should be drinking about 1.5litres a day. Older children should have more (1.5 – 2litres for teenage girls and 2 – 2.5 litres for teenage boys). Children should drink extra if they are very active, or the weather is hot.
- Ask school to allow open access to their drinks and provide them with a sports-style bottle to use at school
- Encourage your child to drink water. You may offer them sugar-free fruit squash if your they will not drink water, but avoid fizzy and caffeinated drinks
- Encourage your child to try to pass urine after each drink (about every two hours)
- Avoid all drinks and food for an hour before bed. Drinks and some foods, particularly those that are high in protein or salt, encourage the kidneys to make more urine
- Good bedtime routines. These include a regular time for going to sleep, avoiding electronic screens in the hour before sleep, emptying their bladder just before going to sleep and turning off the lights in the bedroom.
Is there medication for bedwetting?
Medication is suggested for some children. Desmopressin is a medication that works by helping to reduce the amount of urine produced at night. It comes as a melt or tablet and is taken at bedtime. The melt is placed under the tongue and dissolves quickly, without the need for a drink. Because the desmopressin works by reducing the amount of urine produced in the kidneys, it must only be taken in the hour before going to bed and the child or young person must not drink for an hour before taking it and for the eight hours afterwards.
Your child’s doctor or nurse will discuss this with you and help you to decide if this is an appropriate treatment for your child. There is more information on desmopressin in the information library.
An enuresis alarm is appropriate for some children, but they are not suitable for everyone. The alarm works by waking the child as they are wetting the bed. Alarms are suitable for children who are bothered by the wetting and can be used from about seven years old, although some younger children and children with disabilities do manage them well.
The alarm makes a noise as soon as the wetting starts. Many children need their parent or carer to wake them the first few nights, but usually then learn to wake to the alarm themselves.
Signs that the alarm is likely to work include the child being able to hold onto some of the wee, so they can finish in the toilet after the alarm has woken them. They may also stay dry for longer into the night and gradually learn to sleep through the night without needing to go to the toilet.
Both desmopressin and the alarm have a success rate of around 50-70%. The choice of which treatment is most suitable should be based on the outcome of the assessment but also on the preference of the child or young person and their family. If the first choice of treatment does not work, there may be the option of using both the alarm and desmopressin together. Some children may also need treatment for constipation or for daytime bladder issues before starting treatment for bedwetting. This may include medication to treat these and that medication may need to continue alongside the desmopressin and/or alarm.
Getting further help
Your child’s GP, school nurse should be able to provide initial support for bedwetting. They may, after discussion with you, be able to refer to a local specialist children’s continence service or enuresis service for further assessment and support.
You can find more information about bedwetting at www.stopbedwetting.org
- Download this information as a document (PDF)
- Bedwetting information for children
- Bedwetting information for children ( picture story)
- Picture cards about bedwetting
- Using alarms as a treatment for bedwetting – for parents and carers
- Understanding desmopressin – for parents and carers
How much should my child drink for a healthy bladder?
Children need to drink the right amount of fluid to stay healthy and to keep the urine (wee) in their bladder dilute. Dilute urine is pale, straw colour. If urine becomes too concentrated (dark yellow coloured) it can irritate the lining of the bladder, making it less able to hold on to the urine. This means that your child may need to go to the toilet more often and may have to rush to get there in time.
The bladder is stretchy and learns to hold on to as much urine as it needs to. If your child only drinks small amounts the bladder learns to only hold on to small amounts of urine. Therefore, it is important that your child drinks the recommended amount for their age and size, as this will help their bladder work well and hold on to urine effectively.
Toddlers should be having about 1 litre a day, pre-school children should have about 1.25 litres a day, primary school age children should be having about 1.5 litres per day, teenage girls should have about 1.8 litres and teenage boys should have about 2.5 litres. These amounts are a guide. Children will need more than this if they are very active, larger than their peers, or if it is very hot.
Children should have their daily fluid intake divided into about six to eight drinks a day. Three of these (about half of their intake for primary age children) should be drunk during school hours.
How to keep a bladder healthy
Some drinks are better than others for bladder health. Water is the best drink. However, if your child is reluctant with water, then dilute fruit squashes, preferably sugar-free, may help them to drink the right amount. Ice cubes, jellies, reward charts, regular drinks times, novelty straws and cups or glasses can help some children who are reluctant with drinks.
Your child should avoid fizzy drinks as these can irritate the bladder, making your child feel the need to pass urine more frequently and more urgently.
Caffeine can also irritate the bladder. Tea, coffee, drinking chocolate, cola and some energy drinks contain caffeine. These should be avoided.
Other drinks can cause problems for some children. For example, some children have more urgency (needing to get to the toilet quickly) if they drink blackcurrant. If you think what your child is drinking may be causing bladder issues, then try avoiding that drink for a few days to see if the problem improves. However, do make sure they continue to drink the right amount for their age, size and activity levels.
Bladder health for babies and toddlers
Once fully weaned it is important that babies start to have their drinks in a regular pattern, throughout the day. Encourage them to have a water with or after every meal and another drink midway between meals. This regular fluid intake also helps with potty/toilet training.
For children over one year old, try to limit milk intake to not more than a pint per day, unless advised otherwise by a dietician or their health visitor.
What should I do if my child has a bladder problem?
If your child appears to leave it to the last minute to go to the toilet, dances, holds themselves, , or if they get damp underwear or are wetting, speak to their healthcare professional.
You may be asked to keep a record for two or three days, of about what and how much they are drinking and of when they use the toilet to pass urine and to empty their bowels. This is because constipation can cause problems for the bladder. The records will help you and their healthcare professional see how their bladder and bowel is working and may help indicate what is needed to make the bladder issues better.
If your child is not drinking as about the amount = expected for their age, you might be asked to help them adjust the number and amount of water-based drinks they have in the day. If they are having drinks that appear to be making the wetting worse, you should avoid these.
Your healthcare professional will be able to suggest other ways to help your child overcome any wetting or other bladder problems. These may include treatment for constipation if that is present and drinking and toileting routines, or medication to help the bladder problems.
If your child suddenly starts to have a problem with wetting, or if their urine (wee) becomes smelly or painful to pass, then you must always seek advice from a healthcare professional.
Information to help complete the chart
Information collected on the baseline bladder and bowel chart can be useful to help plan a toileting programme. It can also be used to see how your child’s bladder and bowel are working and if there are any problems, such as constipation.
The chart should be completed for at least three full days, or more if you can manage that. These days do not need to be consecutive, but your child needs to be at home for most of the time on the days the chart is being done, as you will need to check their nappy every hour they are awake. Schools and nurseries do not usually have the resources to help. The more days that are completed the greater the likelihood that you will be able to see if there are any patterns to when your child opens their bowels or passes urine. These patterns can be helpful for knowing the best time to sit your child on the potty or toilet when you are toilet training them.
Modern disposable nappies have special highly absorbent granules inside them. This holds the urine within the nappy, so that the layer of the nappy that is next to your child’s skin, stays dry. This helps to stop their skin from getting red and sore, but it helps your child to feel dry, which makes them less aware of their bladder emptying than they would be if they felt wet. It also makes it more difficult for you to know when they have passed urine.
Therefore, to complete the chart, something is needed inside the nappy to make it easy to see if your child has passed any urine. The nappy may not look wet if they have only passed a small amount of urine. If you put a piece of folded kitchen roll (one that does not disintegrate when wet) inside the nappy, it will be easy to see if they have been wet.
At the first nappy change of the day put a piece of kitchen roll inside the nappy. Then check your child’s nappy every hour that they are awake. Record on the chart whether your child had passed any urine by marking W if they were wet, D if they were dry. If your child has had their bowels opened write B.
If the kitchen roll that you put inside the nappy is wet it should be changed, but the nappy can stay on until it cannot hold any more urine, or is soiled (i.e. when it would normally be changed). Continue like this until night time. Do not use the kitchen paper inside the nappy overnight.
If your child uses the toilet or potty, then write T in the pad column to show they sat on the toilet or potty. If they manage to pass urine on the toilet or potty write TU (for toilet urine). If they open their bowels on the toilet or potty write TB (for toilet bowels).
Every time your child has a drink then make a note in the drinks column. If possible, also write down what they had and how much. If your child has a tube feed, that should be recorded in the drinks column, with the volume. If your child has a meal, then make a note of that on the chart with the letter F (food).
Information to help complete the diary
Information collected on a bladder diary (frequency volume chart) can be useful to help understand how your child’s bladder and bowel are working. It will show how well your child’s bladder is storing urine and how much they wee they are passing when they go to the toilet.
The chart should be completed for at least two full days. Your child needs to be at home for most of the time on the days the chart is being done, as you will need to help them measure how much urine they pass. Schools and nurseries do not usually have the resources to help.
It is often best to plan to complete the charts for a full weekend, if you are doing them during term time, or for two consecutive days if you are doing them during the holidays. If your child is wearing nappies during the day, then have a look at the baseline bladder and bowel chart instead.
Every time your child has a drink then make a note in the drinks column of what they have had and how much. The easiest way to do this is to measure their cup, glass or drinks bottle, to see how much it holds and then use the same one the whole time you are completing the chart. You can then make a good estimate of how much they have had to drink.
When your child goes to the toilet, ask them to wee into a jug or other container. You can then measure how much they have passed. Write this down in the urine column.
If your child was wet then make a note of this. Use WS to indicate a small amount of wetting (just damp or wet underwear). WM for a medium amount of wetting (outer clothes and underwear wet) or WL to indicate a large amount of wetting (clothes wet and a puddle). Write B in one of the columns at the time they go to bed each night.
Write M in one of the columns at the time they wake up in the morning.
When your child opens their bowels, write what their poos looked like in the bowel column. You can use the Bristol stool chart picture to help you with this (you just need to write down the number that is closest to what your child has done.
What is considered a normal poo?
A normal poo is soft, easy to pass and its colour will be any shade of brown or dark green. Most children over the age of three open their bowels no more than three times a day and no less than three times per week.
The intestine is made up of the small and large bowel. The small bowel mixes the food with water and digestive juices and then absorbs the nutrients. The parts of the food that cannot be absorbed pass into the large bowel with the water. The parts of the food that cannot be absorbed are the waste products and are used to form the poo. Some of the water that passes from the small bowel into the large bowel is gradually reabsorbed back into the body, so that the poo is not too wet and loose. If the poo remains in the large bowel for too long it becomes harder, as more water is absorbed.
The last part of the large bowel before the bottom is called the rectum. The rectum stays empty until it is time for the bowels to open. Normally as the poo enters the rectum it triggers a message to the brain signalling that it is time to do a poo.
What is constipation and withholding?
Constipation can develop if the poo becomes hard and difficult to pass. This can happen quite slowly, so parents may be unaware of it, and they often never know how or when it first started. However, passing a large hard poo can be uncomfortable or painful. As a result, the child becomes frightened of pooing again and will start to ‘hold on’ when they feel the need to poo. Unfortunately, this makes the problem carry on. The longer the child holds on, the harder and bigger the poo gets and the more likely it is to hurt when they do eventually pass it. This is the reason why constipation should always be treated as soon as the family are aware it is present.
Children who are constipated are often reluctant to open their bowels on the toilet due to previous experience of passing a hard, painful poo. The child may become very distressed at the feeling of needing to do a poo and be seen to be ‘holding on’.
Typically, the child may stand on tip toes as they clench their bottom together to try and stop the poo coming, or they may run and hide. Therefore, it is important that constipation is always treated with enough laxatives to produce soft formed stools, both to overcome the fear of pooing and to prevent the development of faecal impaction.
What are the signs and symptoms of constipation?
Other signs and symptoms that might indicate constipation include:
- Pooing less than three times a week or more than three times a day
- Soiling (any amount of poo in the underwear)
- This may get better for a few days after doing a large poo
- A painful bottom, or pain when doing a poo
- A swollen or bloated tummy. Passing large hard poo which may block the toilet, or passing only small poos (soft or hard), or poos of different sizes and consistencies
- Appearing to strain to poo or to avoid pooing
- Poor appetite
- Angry or irritable mood
- Some children with constipation may have problems with wetting in the day and/or at night. This is because the normally empty rectum is full of poo that may press on the bladder. Constipation may also make children more prone to urinary tract infections. However, wetting and urinary tract infections can also happen in children who are not constipated.
What is faecal impaction?
A child is said to have faecal impaction when the constipation becomes so severe that they are unable to pass any formed poo. All the poo in their bottom clumps together to form a large mass, which the child is unable to pass. New poo will keep forming in the large bowel but cannot get past the blockage, so it just builds up.
Symptoms that may indicate faecal impaction include any of the symptoms of constipation as well as:
- Inability to pass a formed poo
- Passing only ‘rabbit dropping’ type poo (small hard bits, that have broken off the larger mass)
- Uncontrolled watery or loose poo, also known as overflow soiling
- Passing lots of wind so child seems to smell of poo even though they are clean
- Significant soiling (poo in the underwear)
- Swollen and painful abdomen
- Lack of appetite
What is the effect of faecal impaction and constipation?
When children become constipated and the poo stays in their rectum the message to the brain that they need to do a poo becomes weaker and weaker until eventually, they lose the feeling that they need to do a poo. If the constipation is not treated effectively the poo in the rectum will continue to gradually build up and faecal impaction may develop.
Although the child does not feel that they need to do a poo, peristalsis (the muscular movement that moves the poo along the bowel) is still taking place. This pushes the more liquid poo along. Because the rectum is full of poo the anus relaxes slightly, thinking that the child is about to open their bowels, which allows the liquid poo to leak out into the child’s underwear. Bits of the old, impacted poo may break off and be passed as well – this often results in the soiling being very smelly. This happens outside the child’s control and they are often unaware that the leakage has happened.
Any poo passed into the pants by a child with constipation/impaction is called overflow soiling. This can happen occasionally or many times during the day.
Both constipation and faecal impaction may cause stretching of the bowel, which takes time to return to normal. Therefore, if the problem has lasted for more than a four weeks it is usually described as chronic constipation. Chronic constipation usually needs treating with laxatives over a long period of time. Laxatives for chronic constipation should not be stopped suddenly but should be reduced gradually over many weeks, unless you are advised otherwise by your child’s healthcare professional.
What is the difference between constipation and impaction?
Children who are constipated tend to pass infrequent formed stools, which may be very large and hard. There may be some smaller poos, soiling or skid marks in their pants due to them holding on and stopping themselves from doing a poo, but they are generally clean in between bowel movements.
Children who are impacted are often unable to pass any formed poos at all. They tend to pass loose, mushy or semi-solid poos, sometimes numerous times per day. They may also pass small hard bits of stools. They often do this without any awareness and so will deny it has happened.
It is not always easy to recognise the difference between constipation and faecal impaction, as the symptoms are similar. However, it is important to distinguish between them as they require different approaches to treatment. Because diagnosing these conditions in children is not always straightforward it is important to ask your child’s healthcare professional for advice.
- Download this information as a document (PDF)
- Constipation information for children (picture story)
- Understanding the management of faecal impaction and constipation
- Understanding Macrogol laxatives
- Understanding constipation in babies and toddlers
Bowel problems in children and young people that are not caused by constipation or a problem that is present at birth include toddler diarrhoea, children only wanting to poo in a nappy and smearing of poo.
All these problems can feel difficult for families to manage. The leaflets in this section are designed to help you understand these issues and help you to manage them.
Click on the links below to read Bladder & Bowel UK’s information about other bowel problems in children and young people.
What is toddler diarrhoea?
Toddler diarrhoea is the most frequent cause of chronic (that is persistent) diarrhoea in children between aged 1-5 years. It is more common in boys than girls.
How often do affected children poo?
Affected children will poo between two and ten times a day
What is the poo like?
The poo will be loose and watery. Sometimes it is pale coloured. It may be more smelly than usual and may contain undigested food.
How long does toddler diarrhoea last for?
Toddler diarrhoea continues for more than 3 weeks. It has usually stopped by the time the child is old enough to start school (about four to five years old).
Is the child ill?
No, children with toddler diarrhoea are well. They continue to grow and thrive. If your child is unwell, losing weight or not developing as you would expect, or if you have any other concerns, then take them to see their GP
What else could it be?
If your child is unwell with tummy and/or headache, has diarrhoea, a raised temperature, is struggling to drink enough, is not as responsive as usual, or is vomiting, you should take them to see their GP. These symptoms could be caused by an infection.
Diarrhoea may be caused by intolerance to certain foods. Speak to your child’s GP if they appear to have a bloated or swollen tummy, have wind, loose stools, or tummy cramping, especially after eating certain foods. You should also speak to your child’s GP if you see blood in your child’s poos.
If your child’s poos are unpleasant smelling, sticky, infrequent (less than four poos per week), large, hard, painful, or if they are pooing in their pants, your child may have constipation. Speak to their GP or Health Visitor if this is happening. There is also more information about constipation in the information library.
What causes toddler diarrhoea?
The cause of toddler diarrhoea is not completely understood, but is thought to be caused by a decreased bowel transit time: the food moves through the bowel more quickly than is usual. The large bowel absorbs water from the poo, so if the poo passes through too quickly, there is less time for the large bowel to absorb the water, so more water than usual remains in the poo, making it loose.
Some young children have a bowel that is slightly immature, so some foods may cause them to have diarrhoea.
How can the diarrhoea be helped?
Time and making some changes to your child’s diet can help to make toddler diarrhoea better. It will usually get better for most children by their fifth birthday.
What changes can I make to my child’s diet?: The four F’s
Always speak to your child’s health visitor or other healthcare professional before changing your child’s diet.
Children should get around 35% of their energy from the fat in their food. Fat slows the digestion in the gut and reduces the speed at which the food passes through the system. Adults need to eat less fat to guard against heart disease and obesity; this is not the case with young children.
Children should be given a range of foods with different fats in them, such as full-fat milk, yoghurt and rice pudding, butter, olive and rapeseed spreads and oils, dips like low-salt hummus, a few olives (these tend to be high in salt), avocado, meat, fish, eggs, almond/cashew/peanut butter, cheese, coconut milk, sunflower seeds. (Please be aware of any allergies or food intolerances your child has and if your child sees a dietician always follow their advice)
Children need to drink 6-8 cups of water-based fluid each day (about 1 – 1.5 litres per day, depending on the age and activity levels of your child). Some children drink excessively, this can increase the diarrhoea. Excessive drinking is best managed by giving your child smaller amounts each time they ask, or just having drinks at set times, such as with meals and at snack times. Stick to water where possible.
Fruit juice/fruit squashes and fruit
Fructose is the natural sugar found in fruit. Drinking too much fruit juice may contribute to toddler diarrhoea. The immature gut cannot absorb fructose easily, so large quantities of fructose from fruit juice may be a cause of toddler diarrhoea.
Sugar and sweeteners
Sorbitol is a sweetener found in many fruit drinks and foods. Large amounts of sorbitol may act like a laxative and cause diarrhoea.
Refined sugars are present in many ready-made foods, such as sweets, chocolates, cakes, biscuits and desserts and these may also cause looser poos.
The fibre in the foods we eat, acts a bit like blotting paper in our gut. It soaks up some of the water, making the contents a bit bulkier. It also slows the gut contents down and helps the gut muscles to push the poo through, so helping us know when we need open our bowels. This is why eating fruit is unlikely to cause toddler diarrhoea, but drinking lots of fruit juices, which do not have the fibre in them, may cause a problem for some children.
If your child has a low fibre diet, try increasing their daily fibre intake. However, too much fibre may also irritate the gut and cause the diarrhoea. Keeping a food diary for a few days will help you to look at and adjust the fibre content of your child’s diet. Your health visitor may also be able to make suggestions.
High fibre foods include:
- All vegetables
- Beans, peas, lentils and other pulses
- Potatoes, particularly if the skins are eaten
- Nuts and seeds
- All fruits
- Wholegrain cereals, brown, wholegrain or seeded breads, whole wheat pasta and oats.
Managing potty training when a child has toddler diarrhoea
Toilet training should not be delayed due to toddler diarrhoea. If loose poo means that your child does not get much warning when they need to open their bowels, a small disposable pad in their pants, or washable training pants to protect their clothes might be helpful. Sitting them on the potty or toilet 20-30 minutes after meals, drinks, snacks and bath time may help you catch a poo in the right place as the gut speeds up at these times. Remember to praise your child if they do manage to get a poo in the right place.
If your child does not manage to get the poo in the potty or toilet, they should be changed as soon as possible, to reduce the likelihood of sore skin. Thinly applied nappy rash cream can protect their skin and prevent soreness.
Products and equipment
Continence products are absorbent pads or underwear designed to contain urine (wee) and/or faeces (poo) in people who are not able to get to the toilet either some or all of the time. There are many different sizes, shapes and makes of product available. Some are disposable (designed to be used once then thrown away), others are washable (designed to be cleaned, dried and reused).
This information is about disposable products. Products to contain incontinence are usually called continence containment products, nappies, pads, or products. In this leaflet they will be referred to as products.
Where can I buy products?
Products are available to buy from most supermarkets, chemist shops, disability shops as well as online. They are available from the Bladder & Bowel UK shop. Some online suppliers will provide a limited number of free samples.
Are products available free of charge?
Products may be available from the NHS to children from their fifth birthday, depending on local policies if
- They have additional needs and
- They have had a specialist assessment of their bladder and bowel health and
- They have undergone a toilet training programme, supported by a healthcare professional with specialist knowledge for at least six months and
- They have been assessed as unable to toilet train within six months of their assessment and toilet training programme
Products are not available to children with treatable conditions, even if the child has a disability or additional need. Most bladder and bowel issues are treatable, including in children with additional needs. Many children with learning disabilities can be toilet trained at the same age as their typically developing peers, although this may take longer and they may need more support. There is information in the toilet training section of this site.
Bedwetting, daytime wetting, constipation and soiling are all treatable conditions. Therefore, products are not provided for these, but children should be offered treatment.
Children who are not able to be continent due differences to their bladder and bowel anatomy, as a result of a problem they were born with, or that has developed due to illness or an accident, may be provided with products without undergoing a toilet training programme, depending on local policies and procedures.
How do I find out if my child should be given products by the NHS?
If you think your child may be entitled to have products provided for them, speak to their health visitor or school nurse. They will know who should do the assessment for children’s bladder and bowel health in your area. All children should have an assessment before products are provided, to make sure that children do as well as they can with toilet training and that their bladder and bowel is healthy.
What type of product will be provided?
Your child should be provided with a product that meets their assessed needs. In some cases they will be offered a different product for overnight to the one they are given during the day. For the smallest children the product provided will often be a nappy. As they grow they may continue to be offered a similar style of product.
For many children, once they outgrow a nappy-style product, they will be offered a two-piece product. These consist of an absorbent pad, that is very similar to the main part of the nappy, with a pair of pants (known as fixation pants) to keep it in place. These are as effective as the one-piece product for many children and young people, but are more discrete under clothing and easier to change in those children and young people who are mobile.
Pull ups or disposable pant style products are not usually provided. This is because they are not helpful for toilet training and are often not as absorbent as other one-piece and two-piece products.
What will happen if products are provided?
This will vary slightly according to where you live and local policy. What is provided will depend on what the assessment of your child has shown. However, once the decision is made by the healthcare professional that your child does need products, they should provide you with samples. The samples will be of a product or products that are available locally and that should meet your child’s need for containment of their incontinence.
When you have tried the samples on your child, you will need to contact the healthcare professional to let them know whether the product worked well. If it did, the healthcare professional will order a supply of products and let you know how and when to get more.
The healthcare professional should show you how to store and apply the product and when to change it. There is also information on how to use products in the Bladder & Bowel UK leaflet How to get the best out of your continence products. Most manufacturers also provide product fitting guides online.
You will be told how many products per day are going to be supplied for your child. The maximum number per day is usually four. Products are usually delivered to home and you will be sent several weeks supply at once.
Your child should have a reassessment of their bladder and bowel health and their product needs at least once a year, although this will vary slightly depending on local policy.
I keep running out of products – can I get more?
Your child should be given sufficient products to meet their assessed needs. Products do not need to be changed as soon as your child has passed urine, as they are designed to keep the top layer next to your child’s skin dry. They should be left on until they are full or nearly full. For more information on when to change the product see the Bladder & Bowel UK leaflet How to get the best out of your continence products. If other people look after your child some of the time, make sure they understand when the product should be changed.
If you are running out of products regularly, speak to your child’s healthcare professional. They may be able to reassess your child’s needs or provide a product that needs changing less often.
If you need to purchase extra products for your child, your healthcare professional will be able to tell you where to get these. Products are available to purchase online from most of the companies that supply the NHS. They are also available from disability shops including the Bladder & Bowel UK shop. Supermarkets and chemist shops also sell some products.
My child has grown, or the product no longer works well for them
If your child grows or the products start to leak regularly, then contact their healthcare professional. You should try to do this about six to eight weeks before their next delivery is due. This allows time for an assessment to be done, samples of a different product to be tried and a decision made about which product will be best for your child now.
In most areas, once a delivery has been made the product cannot be changed before the next delivery.
What should I do with products that my child no longer needs?
Products are provided by the NHS on a named person basis. They should be used for that person only and not be given to or sold to anyone else. Most areas will arrange a collection of any unused products that are no longer needed.
Contact your child’s healthcare professional to find out what the local arrangements are.
The resources below have been developed to help staff working in education to support children and young people affected by bladder and/or bowel issues. They will also be helpful to parents in starting conversations with school about the care their children need.
The sample care plan and intimate care policy, as well as the school toilet charter are all provided in Word so that they can be easily adjusted to meet the needs of your school.
Click on the links below to access Bladder & Bowel UK’s resources for nurseries, schools and colleges.
What is potty or toilet training?
Potty or toilet training is the process of teaching your child the set of skills that they will need to be able to wee and poo in a socially acceptable place.
How will I know that my child is ready to start to potty or toilet train?
Many children will never give any signs that they are ready to potty or toilet train. Therefore, it is not helpful to wait for your child to seem to be ready to learn to use the potty or toilet.
Children need to be taught the skills they will need to potty or toilet train, in the same way as they need to be taught other skills, such as washing, brushing their teeth, or feeding themselves. This teaching can start at any time and, as with other developmental skills, your child should gradually become more independent with time and practice.
When should I start teaching my child the skills they will need to use a potty or toilet?
It is never too early or too late to introduce your child to the skills needed for potty and toilet training.
In previous generations children were introduced to the potty or toilet gradually from the early weeks and months of life, and in some cases from the first days. Parents would hold their infants over a potty when they were most likely to want to wee or poo. This included after their feeds, food or drinks and when they woke up from sleep.
Babies are born with some awareness of when they need to do a poo or wee. Some babies will appear to concentrate, move or hold themselves in a certain way, or pull a certain face when they are about to do a wee or poo. If their families notice this, they can use these cues to hold their child over a potty, toilet, or other container at the right time to catch the poo or wee. This is sometimes called infant-led pottying.
This helps their child learn to recognise the signals from their body that they need to wee and poo. It also helps them learn that there is a right place to go. With this method many children are reliably clean and dry well before their second birthday.
Are there any advantages to start working on the skills for potty or toilet training early?
There is some research to suggest that babies who are exposed to infant-led pottying have less unexplained crying than infants who use nappies all the time.
There is also some research that suggests that potty or toilet training before the age of two years old helps children’s bladders become mature more quickly. It may also make it less likely that children will develop bladder problems later in childhood. If your child is older than this, do not worry: it is never too late to start working on the skills for potty or toilet training.
Children whose families are able to catch wees and poos on the potty or toilet from the time they are a few weeks or months old, will need fewer nappies than those who do not learn the skills until later. This can save money on washing nappies or on buying disposables. Using fewer nappies is also better for the environment.
Using the potty or toilet may also help with constipation. This is because it is easier for the bowel to empty completely when the bottom is well supported, feet are on a flat surface and knees are higher than hips (a semi-squat position).
Will my child potty or toilet train more quickly and easily if I wait until they are older?
Some children will learn the skills needed to use the potty or toilet more quickly if teaching does not start until they are older. However, if you wait until your child is older the advantages of starting early, that are described above, may be lost.
For many children, including those with developmental differences and/or disabilities, learning the skills for potty or toilet training early may make the whole process more straightforward and successful. This is because the routines associated with potty or toilet training have been introduced earlier. You are not trying to change behaviours around weeing and pooing that have been established for longer.
There is more information to help you with potty or toilet training if your child has developmental differences or learning disabilities in the Bladder & Bowel UK library.
What skills does my child need to be able to potty or toilet train?
To be able to learn to use the potty or toilet, your child will need to develop a set of skills. The skills needed for potty training include:
- Knowing the right place to wee and poo
- Understanding the feeling when it is time to wee or poo
- Being able to tell you that they need the potty or toilet
- Being able to wait until they get to the potty or toilet
- Getting to the potty or toilet
- Being able to get undressed before using the potty or toilet and then dressed again afterwards
- Being able to sit in the right place for long enough to wee and poo
- Being able to wipe themselves clean
- Washing and drying their hands
- Getting back to what they were doing before the potty or toilet visit
You do not need to wait for your child to be able to do all or any of these things before you start to teach them the skills that they need for potty and toilet training.
How can I start to introduce the skills my child will need to use a potty or toilet?
You can start to prepare your child for potty or toilet training by:
- Change your child in the toilet or bathroom and tip any poo down the toilet and flush it away. This will help your child see where poo should go
- When your child can stand up without support, change their nappy with them standing up.
- Show your child their nappy and use positive language: ‘well done, you have done a wee’ or ‘that is a good, big poo’
- Get them to start to help you pull their clothing up or down.
- Have some time each day when your child has a bare bottom, or wears just loose jogging bottoms or a long t-shirt and no nappy
- Let your child see you and other members of your immediate family use the toilet. Explain to them what you are doing
- Use story and picture books and apps to help them learn about going to the potty or toilet
- Help your child to learn to wash and dry their hands.
How should I introduce sitting on the potty or toilet?
- Note that if they are using the toilet then your child will need a seat reducer and step
- You may want to start this once a day at a time when you are both relaxed and gradually increase how often each day you sit your child on the potty or toilet
- You could have them on the potty while you are using the toilet
- If your child is unsure, then use role play with dolls or teddies first
- You may start by sitting your child on the potty or toilet with them fully dressed and gradually reduce the amount of clothing they have on their bottom when you sit them on
- You may start with sitting them for just a few seconds and gradually increase the time they are sitting for
- Start to introduce sitting on the potty or toilet after your child has had a feed, drink, meal or has just woken up from sleep
- Use toys that your child just has when they are on the potty or toilet. Seaside windmills, or kazoos to blow, squeezy or other toys may help your child to stay sitting on the potty or toilet
- If your child is old enough and not upset by the flush, you can start to teach them to use it after a visit to the potty or toilet.
What other skills will my child need and how can I work on those?
- Make sure that your child has a way of telling you when they need the potty or toilet.
- If your child can speak you can teach them words for wee and poo, potty or toilet.
- It is helpful if everyone looking after your child uses the same words
- If your child is not able to speak then have a sign that they can do with their hands, or picture cue card they can use. Many children can learn to use signs from about 6 to 9 months old.
When should we stop using nappies in the day?
If you are taking your child to the potty or toilet when they wake, after drinks and meals (or feeds) and if you notice any signs from them that you think they need to go, then you should start to catch wees and poos in the potty or toilet. When you are catching about half of all their wees and/or poos, stop using nappies in the day.
Take your child to the potty or toilet whenever you think they need to go, but after waking from sleep, after drinks or feeds and meals. If your child is wetting more often than this you should take them more frequently, but gradually increase the time gap between potty or toilet visits, until your child can go about 1 ½ – 2 hours between potty or toilet visits.
Consider removing the daytime nappies when you can spend time getting your child to the potty or toilet. If possible, try to do this when there are no big changes happening at home, such as a new baby being born, or moving house.
Once your child starts to wear pants in the day, they should wear them all the time that they are awake, including when you are going out. Putting a nappy or pull up on, even for a short time, may confuse your child and they may then take longer to learn to stay dry.
Should we use disposable nappy pants (pull ups) or trainer pants when we stop using nappies?
Disposable nappy pants feel like a nappy to your child. They may not understand that they are not meant to use these in the same way as they did the nappy. Therefore, they are not recommended for toilet training.
Washable trainer pants are available and can help with toilet training. They will absorb some wee and therefore offer some protection to your child’s other clothes, your furniture and floor coverings. However, they are similar to ordinary pants, as they allow your child to feel wet, which is part of the learning process.
If you are worried about car seats or furniture getting wet, you could use washable or disposable waterproof sheets, to protect them.
Is potty or toilet training something that should just be done at home?
It is important that your child learns that they can use the potty or toilet wherever they are and whenever they need to. Try to make sure that you have your child’s potty or toilet seat and step with you when you go out, so that they can use the equipment they are familiar with.
It is also important to make sure that everyone looking after your child knows how you are approaching teaching them the skills for potty and toilet training. Ask them to do this in the same way as you do.
What should we do if our child continues to be wet lots of times every day?
Wetting or soiling (accidents) are common to start with and are a good learning opportunity for your child. When you notice they are wet or soiled, take them to the potty or toilet and clean them up with the minimum fuss and then have a time for them to sit on the potty or toilet. Remind them that is where wee and poo go. If your child has been used to using a nappy it is a big step for them to learn that they are no longer expected to wee or poo wherever they are.
Do not be tempted to take your child to the potty or toilet too often. If they are encouraged to empty their bladder more than they need to, then their bladder may get used to only holding smaller amounts of wee and then need to empty more often than it should. If your child is wetting often, take them before you expect them to need to go, but then gradually increase the time between potty or toilet visits, until they can go 1 ½ – 2 hours and stay dry.
If you are struggling to catch wees and/or poos in the potty or toilet, you can try to work out your child’s normal habits. If you put a piece of folded kitchen towel into their nappy, when your child wakes up and then check it every hour, that will give you an idea of how often your child wees and how long they can stay dry for. Note down on a chart (such as the Bladder & Bowel UK baseline toilet training, which can be found in the Bladder & Bowel UK children’s information library) whether your child’s nappy is wet or dry. Also write down when your child has their bowels open and when they have a drink.
Do this for at least three days. This will help you to see patterns of when your child is most likely to want to wee or poo and you can use this information to get them to the potty or toilet at the time they are most likely to want to go. As your child learns to go in the potty or toilet, then slowly increase the time between potty or toilet visits.
If your child continues to be wet frequently, then ask your healthcare professional for advice and support. They may have an underlying problem that needs assessment and treatment, such as constipation.
What about night time control?
Children cannot learn to be dry at night in the same way as they learn to be dry in the day. Most children become dry naturally within a few months of potty or toilet training in the day. You can support your child to become dry at night by:
- Making sure they are drinking plenty of water-based drinks in the day
- Stopping food and drinks an hour before they go to bed
- Make sure they use the potty or toilet just before they settle to sleep
- Take them to the potty or toilet if they wake in the night, but do not wake or lift them to use the potty or toilet if they are not awake
- Have a good bedtime routine
- Try to make sure they are not constipated
- Wetting during sleep, after the age of five years old, if your child has been potty or toilet trained in the day for at least six months, is considered to be a medical problem called enuresis. Assessment and treatment can be offered for this, so speak to your child’s healthcare professional for more advice and support. There is more information about bedwetting (enuresis), what causes it and how it is usually treated in the Bladder & Bowel UK information library.
My child is struggling with toilet training. Does this mean that they are not ready yet?
Up to a third of all children may have a problem with their bladder or bowel. Most of these are treatable. Therefore, if you and your child are struggling with potty or toilet training you should be offered assessment to make sure that there is no underlying problem such as constipation.
Waiting until your child is a bit older is not helpful for most children.
My child has additional needs or disabilities. Will it be easier for them to learn if I wait until they are older?
If your child has additional needs or disabilities their bladder and bowel should be the same as that of other children their age. As potty or toilet training can help the bladder mature, there is no reason why it should be delayed simply because of the additional need or disability. However, your child may need an occupational therapy assessment to see if they would benefit from any adaptations or from specialist equipment to help them feel safe and secure while using the potty or toilet.
Different children take different amounts of time to be successful learning new skills. Most children can learn at least some of the skills needed for potty or toilet training. However, some children will always need extra help or support to use the potty or toilet. They may need reminding to go, especially if they are busy, distracted or somewhere new. They may need help to get to the toilet, or managing their clothes, or with wiping. However, it is important that your child is supported to become as independent as they can with toileting.
Children with disabilities or additional needs are more likely than their peers to have an underlying problem with their bladder or bowel. Therefore, if they are struggling to toilet train, they should be offered an assessment of their bladder and bowel health and appropriate support. It should not be assumed that any ongoing wetting and soiling is due to their disability, additional need, or a behaviour problem.
Children with additional needs or disabilities who are struggling with potty training may have sensory differences that are impacting Or it may be that they need a different approach. Ask your healthcare professional for support or for a referral to a local children’s bladder and bowel service if there is one in your area. Delaying toilet training is not helpful and children who are finding it difficult should be referred for further support in the same way as would happen for other developmental difficulties.
- The Bladder & Bowel UK guide to potty and toilet training
- Ready or not? When to start toilet training your child
- Trouble shooting potty or toilet training
- Understanding toilet refusal
What do we mean by additional needs and disabilities?
This information is designed to be used alongside the Bladder & Bowel UK information on toilet training and on trouble shooting toilet training. It has been written for families whose children who have any differences in their development. This may be due to a physical disability, learning disability, or developmental difference, such as autism or attention deficit hyperactivity disorder (ADHD). Children affected by any of these may need specific help with toilet training.
It is important to remember that many children with typical development find learning the skills for toilet training difficult. Information in this leaflet may be helpful for them as well.
How will I know when to start toilet training my child with additional needs or disabilities?
Many children, including those with additional needs and disabilities do not show the signs that families have been encouraged to rely on to know when to start potty or toilet training. Not showing the signs does not mean your child cannot potty or toilet train.
Rather than waiting for your child to appear to be ready to potty or toilet train, it is recommended that you start to teach your child the skills that they will need to use the potty or toilet as early as possible. This will mean that your child is not expected to change their routine of using a nappy as they get older, which they may find difficult.
As with all children, those with additional needs benefit from a calm, consistent and persistent approach for as long as they need. It is helpful if everyone follows the same routines and starts the process at the same time. Good communication between you and anyone else involved in your child’s care (e.g. nursery or school or grandparents) is important.
If your child is struggling to learn the skills for potty or toilet training, they should be offered an assessment and support from a healthcare professional. This should include making sure there are no underlying problems, such as constipation. Therefore, if you are not sure when or how to start working on the skills for potty or toilet training, ask your child’s health visitor, school nurse or specialist nurse for advice and support.
What equipment do I need for potty or toilet training my child?
Most small children find a potty easier to use than a toilet. If they can walk, they can get off the potty when they are ready. The position on the potty (bottom well supported, feet flat on the floor and knees higher than hips) is the best position for them to fully emptying their bowels, as well as for doing a wee.
However, if your child finds changing their routines difficult, you may want to go straight to the toilet, rather than using a potty. Most children will need an insert or reducer seat and a footstool to make sure they are comfortable and feel safe and stable while on the toilet. The insert seat should be small enough to support their bottom well. The footstool should be high enough to allow their feet to rest flat on it and their knees should be higher than their hips.
If your child has physical disabilities, their occupational therapist will be able to provide a specialist toilet seat or other adaptations to suit their individual needs. For wheelchair users this may include a urinal, (urinals are available for boys and for girls), or a bottom wiper or other specialist equipment.
If your child has problems with mobility, or balance, or you are struggling to know what will suit them best ask their healthcare professional or occupational therapist for support.
How should I use routines for potty or toilet training?
- Having a time to sit on the potty or toilet as part of your child’s daily routine is one of the first steps for toilet training. This can be introduced at any time from a few days or weeks to a few months old. Children who are not able to sit on their own will need you to support them on the potty or toilet. If not being able to sit on their own is related to a physical disability or sensory issue, then your occupational therapist should be able to recommend some equipment or adaptations to help.
- Start by sitting your child on the potty or toilet for a very short time once a day, when you and your child are relaxed. Gradually build the time of sitting to about one minute for each year of their age, then increase the frequency of sitting. On waking from sleep, after meals or drinks can be good times.
- Your child may need a toy, or attention from you, or distraction such as singing a song, or reading a story to help them to stay on the toilet.
- You could use an egg timer, or an alarm on your phone, or something similar to help your child understand how long they should sit for.
- To start with there should be no expectation that your child will wee or poo on the potty or toilet, they are just getting used to being on the potty or toilet and learning to sit.
- The next step is knowing when your child is most likely to need a wee or poo, as this can help you to get them to the potty or toilet at the time when they are most likely to go. Catching some wee or poo in the right place will help your child understand what is expected. If you check your child’s nappy hourly for a few days, and make a record of when they drink, and when their nappy is wet or soiled then you will know when they are most likely to need to wee or poo and you can take them to the potty or toilet at those times. There is more information about how to record your child’s wees and poos in the Bladder & Bowel UK information at (Baseline bladder and bowel chart link to go here please)
- When you are catching about half of your child’s wees or poos on the potty or toilet, you can remove their nappy and start to use cotton pants. For more information see the Bladder & Bowel UK child information library.
How do I help my child with understanding and communication for potty or toilet training?
- Your child may find it easier to understand what is expected if you use a social story about going to the toilet. Your health visitor, school nurse or community nurse may be able to help you to find one. For more information see the Bladder & Bowel UK child information library.
- Share the story with your child every day, at a time when they are relaxed. Once they are used to the story it can be used just before you take them to the toilet.
- You can also use a sequence of pictures to help your child understand what you want them to do and to remind them of what comes next. These can be the same pictures as you have in the social story. It is important to also have a picture for the activity that will come after the toilet visit.
- You can include toilet time in any visual timetables that you use with your child.
- PECS (picture exchange communication systems), photos, or other pictures, such as the ones available on the Do 2 Learn website, can be used for social stories and picture cues. If school use picture communication cards, they may be happy to give you some to use for toilet train
- Ask other people who look after your child, including at nursery and school, to use the same picture cues as you do. This will help them do things in the same way that you do and will help prevent your child becoming confused or anxious.
- Having a picture of the toilet near your child can help them let you know when they need to go, if they find talking difficult.
- Give your child very clear instructions and give them just one instruction at a time. For example, if your child is just told to ‘wipe your bottom’, they may not realise that they need to use toilet paper. If told to ‘get some toilet paper and wipe your bottom’, they are being given two instructions at once, and not being told how much toilet paper they need. Your child may find it easier if they are told take three pieces of toilet paper and then told, shown or helped to wipe their bottom.
- Using picture cards for each step of the toileting process may make it easier for your child to understand what is expected and also to remember what they need to do next at each stage.
How do sensory issues affect potty or toilet training for my child?
We learn about our world and understand what is happening around us and in our bodies through our senses. However, many children with autism, developmental or learning disabilities experience their senses differently. Your child may be under sensitive in some or all of their senses, or they may be over sensitive, or they may struggle to understand some of the signals from their body.
Differences in how your child experiences their senses may have an effect on how they are able to learn the skills that they will need to potty or toilet train. This is because most of the senses are involved in potty or toilet training in some way. Using a calm and relaxed manner can help your child to relax. However, your child may need you to think about their sensory needs and make adjustments for them to feel safe and comfortable on the potty or toilet.
There is information about how sensory issues, what to think about and suggestions for what you can do to help your child with potty and toilet training in the Bladder & Bowel UK child information library.
You could also ask if your child could have an occupational therapy assessment about their mobility and sensory needs in the bathroom.
How should I use rewards when potty or toilet training my child?
Rewards help to reinforce behaviours that are wanted. If your child responds well to rewards, then use one when they start to learn the skills for potty or toilet training. For example, you may reward them when they are first learning to sit, with no expectation of them weeing or pooing at that point. You might give them the reward to start with for sitting for just a few seconds and then gradually expect them to sit for longer before they get the reward. When they are doing this successfully, the rewards may be used when they have managed to wee or poo in the potty or toilet. Your child may need to be given the reward as soon as they have weed or pooed, even before they have got off the toilet for the first few times, to know what they are being rewarded for.
The right reward will depend on your child’s preferences e.g. a chocolate button, or time playing on an electronic game. Using praise with the reward is helpful for most children, but your child needs to be told, or shown a picture of exactly what they are being rewarded for e.g. ‘Well done Joe, you have done a wee on the potty’. The reward should only be used for the toileting skill you are working on and not for other behaviours. You should avoid letting your child have the thing that is going to be the reward for three or four days before you start to work on the skills needed for toileting.
Once your child is regularly using the potty or toilet to wee and poo, the frequency with which the rewards are given should gradually be reduced, but the use of praise should be continued.
It is important to remember that not all children respond well to rewards. Some children, particularly some children with autism, do not work well with rewards and some children need the rewards to be changed to keep them interested.
How do I introduce my child to toilets away from home?
Introducing your child to different toilets early is helpful. They may need their picture cues, if these are used. Keeping as much of their routine as possible the same as it is at home or nursery or school will help reduce anxiety.
Some children find public toilets difficult. Unfamiliar smells, the sudden or unexpected sound of another toilet flushing, doors banging, extractor fans, or loud hand driers can be upsetting or frightening for your child. Disabled toilets tend to be quieter and more spacious but may need a RADAR key for access. These can be purchased from a variety of different websites.
Having picture cues with the different things that are found in public toilets can help to prepare your child. Wet wipes might make hand washing easier and having a towel from home can help you avoid hand driers.
A gradual introduction to different toilets can also be helpful. You could take your child to a toilet when out and about and just open the door to look in to start with and point out things that are the same as at home. When your child is happy with this, you could start to go in, for example to wash your hands and then when they are comfortable with this, you could try going into a cubicle etc
Using toilets away from home may also be easier if you take any equipment that you use at home with you. For example, if your child uses a potty or seat reducer or wet wipes instead of toilet paper, you could take that with you when you for them to use in a toilet when away from home.
If your child has specialist equipment or adaptations that have been provided by an occupational therapist, ask the occupational therapist for advice about how to manage at toilets away from home. Children with physical disabilities may be able to use a urinal rather than being hoisted onto a toilet. They may benefit from the additional space in a disabled toilet or a Changing Places toilet.
My child is not letting me know when they want the potty or toilet: how do I manage this?
For many children the last skill learnt for potty or toilet training is being able to tell their parent or carer when they want the toilet. Your child needs a way of letting you know when they want the potty or toilet, particularly if they do not talk.
As your child becomes better at letting you know when they want the toilet, either by asking you, or by using sign language, showing a picture, or using their usual communication device, you can reduce how often you remind them to go to the toilet. If you always remind your child or take them to the potty or toilet, they may rely on this, rather than learning to notice their own bladder or bowel signals. They are then more likely to have accidents if you forget to remind them or are not with them.
How do I manage difficulties with potty or toilet training?
Many children with additional needs or disabilities, including physical or learning disabilities or developmental differences such as autism or ADHD can successfully learn to use the potty or toilet once they understand what is expected of them and have had plenty of practice with the skills needed. However, some children do have difficulties. These may be related to a change in their routine that they find difficult to understand. This can make them anxious and upset. Using stories, pictures, or photographs before introducing any new routines can help make things predictable and less frightening.
Many difficulties, including fear or anxiety about the bathroom or toilet, are due to sensory differences. There is information about how sensory issues and toilet training in the Bladder & Bowel UK child information library.
For other tips on how to manage difficulties with potty or toilet training see the Bladder & Bowel UK child information library.
Many parents worry about toilet training and professionals sometimes give different advice, which can be confusing. Families are still sometimes told to wait until their children are showing signs of being ready to toilet train, before starting. However, many children with additional needs or disabilities will not show the usual signs, but are able to toilet train with a calm, consistent and sustained approach.
Most children do well if they are supported to start to learn the skills for potty or toilet training in their first or second year. This may also help their bladder and bowel to develop and mature well and help families to notice if a problem, such as constipation is developing. Therefore ,it is advisable to start working on the skills your child will need for potty or toilet training as early as you can. However, it is never too late to start.
If your child is struggling, or if you are finding it difficult or have questions, ask their health care professional for advice and support.
- The impact of sensory issues on toilet training
- Top ten toileting tips for children with Down Syndrome or learning disabilities (PADS)
- Toilet skill development programme (PADS)
- Potty and toilet training for children with additional needs and disabilities
- Using a wetting alarm to support a toilet training programme
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