1. School Age Children’s Continence Parent Seminar School Nursing

2. Welcome Aim of today’s session is: To look at daytime and night time wetting and constipation/soiling. To provide information and awareness to help you support your child.

3. Information on the Kidneys and Bladder

4. Kidneys Ureters Bladder Urethra How the kidneys and bladder work

5. General Information about the bladder Between 2 – 3 years bladders mature and child can become dry Usually pass urine 6 – 8 times a day Urine usually pale yellow in colour How much the bladder holds depends on age 83.6% of children are dry at night by the age of 7 years

6. How the Bladder works

7. How much a bladder can hold AgeBladder Capacity 5180mls 6210mls 7240mls 8270mls 9300mls 10330mls 11360mls 12390mls

8. Daytime Wetting 1 in 75 children have day time wetting

9. What can cause day time wetting Fluids – not drinking enough or types of fluids Urinary Tract Infection Constipation Delay in emptying bladder Overactive bladder – twitchy bladder Small bladder size Physical or learning needs

10. What can be done Gradually increase fluids – water based & take a drink to school Reduce dark coloured fluids and fizzy drinks Regular toileting throughout the day Counting Use a reminder to go to the loo

11. What can be done See your doctor Reward charts Avoid constipation Easily removable clothing Stay calm and relaxed Opportunity and access to toilet

12. Drinking

13. Night time Wetting 1 in 10 age 5 - 6 years bed wet, decreases with age

14. What can cause night time wetting Fluids – not drinking enough or types of fluids Arousability – not waking to signal of needing the toilet Lack of vasopressin Constipation Overactive bladder – twitchy bladder Genetic

15. What can be done Treat day time and constipation first Fluids – encourage to drink and look at types Praise Toilet prior to bedtime and return 5-10 mins Easy access to toilet & Night light Advisable not to lift

16. What can be done Alarm Medication Reward charts Child’s responsibility

17. Constipation Affects 30% of children

18. How the bowel works Liver Large Intestine Stomach Small Intestine Rectum Appendix

19. Information about constipation can cause Many parents/carers don’t recognise the signs and symptoms of constipation Signs: small hard stools; less than three times a week; painful; night time soiling

20. Bristol Stool Chart Which one is the ideal poo?

21. What happens when constipated

22. What can be done Exercise Diet Fluids Toilet routine Toilet comfortable Position on toilet & foot stool Praise & rewards Medication

23. Restricting fluids Telling your child off Having too high expectations Thinking you’ve failed Taking all the responsibility yourself Traffic Lights Family/Environmental History Your child as an individual Fluid intake Frequency of toileting Bedtime routine Your own reaction To your child To yourself The support offered To others experiences

24. Baseline Charts Input & Output - 4 days for wetting Baseline - 14 days for wetting Soiling & toileting charts - soiling

25. Remember …. For all continence issues: You and your child are not alone Don’t tell off – they are not doing it to annoy you Listen to advice Work with your child Increase fluids Praise! Praise! Praise!

26. Further Information and help Enuresis Resource website – www.eric.org.ukwww.eric.org.uk School Nurse website – www.healthforkids.co.uk/illnesswww.healthforkids.co.uk/illness School Nurse GP