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. House keeping

4. Information on the Kidneys and Bladder

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

6. General Information about the bladder  Between 2 – 3 yrs 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 yrs

7. How the Bladder Works

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

9. Daytime Wetting

10. What can cause day time wetting  1 in 75 children have 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 capacity  Physical or learning needs

11. What can be done  See GP  Increase fluids – water based & take to school  Reduce dark coloured fluids and fizzy drinks  Regular toileting throughout the day  Counting  Use a reminder to go to the loo

12. What can be done  Reward charts  Avoid constipation  Easily removable clothing  Stay calm and relaxed.

13. Drinking

14. Night time Wetting

15. What can cause night time wetting  1 in 10 age 5 - 6 yrs bed wet, decreases with age  Genetic  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

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

17. What can be done  Reward charts  Alarm  Desmopressin  To use pull ups or not

18. Constipation

19. Information about constipation  Affects 30% of children  13,000 hospital admissions for constipation  Many parents don’t recognise the signs and symptoms of constipation  Signs: small hard stools; less than three times a week; painful; night time soiling

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

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

22. What happens when constipated

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

24. 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!

25. Baseline Charts  Input & Out put  Baseline  Soiling & toileting

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