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Tiamat Tiamat is offline
 
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Tiamat
 
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Toileting issues
Old 11-08-2018, 02:28 AM
 
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I'm not a kindergarten teacher (which is just as well for many reasons) but our K teacher is in despair and I said I'd ask here to see if anyone has dealt with something similar.

We have a child in our K class. He is nearly 6 and is developmentally and intellectually average. He is proceeding on schedule academically and is a personable little guy to talk to.

Except he isn't remotely toilet trained. Today, between 9am and 1pm he had six accidents. And not just wetting. This was a bad day, but the "usual" day is 4-5 accidents over the course of the day. He is sent to the toilet every 30 minutes, but of course, nobody can follow him in, and we think he has no idea what to do when he gets there. He certainly has no idea how to clean himself when he is sent to the office to change - Mum or Dad are called to come and deal when it's more than just wetting. Pullups contain the mess somewhat but not the smell and the clean up is still an issue.

Parents just shrug and say the doctor says there is no problem.

His older brother (in my room - Year 3) just shrugs and says "my little brother doesn't know how to use a toilet". The brother has no such issues.

Our Kindergarten room stinks; it's an old wooden building and very hard to get any real airflow to air it out. Our office staff (no nurse, we are a very small school, and they aren't a feature in Aussie schools anyway) are on the point of revolt. The teacher is on the verge of tears. We are getting the carpet cleaners in monthly, and believe that isn't enough.

It's bizarre.

Has anybody ever dealt with this or anything remotely like it? Principal is investigating whether he can tell the parents child is not able to come to school until this is solved. He is young enough that doing K again next year (school year starts in January) is not off the table. Any other ideas at all?


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Old 11-08-2018, 06:57 AM
 
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It's not a long term solution, but if you think he's not going when you send him, could you have the brother follow him once a day? Maybe he can show him what to do a couple of times?
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Old 11-08-2018, 07:23 AM
 
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I wish I had answers. I don't understand why the doctor is not concerned about the frequency of the accidents. Maybe it has been a while since the parents brought up the topic with the doctor or maybe they haven't accurately described the situation to the doctor. Many children are potty-trained by three years old. While it is not uncommon for a five-year old child to have an accident, the frequency of the accidents this child is having and the fact that it is a daily occurrence is concerning.

Let me preface what I am going to say. I am discussing normal five-year old development and not a child with developmental delays, a disability or medical issue that requires modifications/accommodations stated in an IEP or in a 504 Plan.

First, I would suggest a visit to the pediatrician to rule out any medical reason for the accidents. Provide data for the parents to share with the doctor. They might not have worded it so the doctor is fully aware of the extent of the accidents. It might be helpful for the doctor to see in writing how many times it happens/type of accidents in one day. The parents might have brought it up when the child was three-years old and haven't brought it up since.

There can be different causes. Some children are constipated and that can cause them to have accidents. I don't know the medical terminology, but maybe the child does not have sensation in that area and is unaware or doesn't feel the urgency to go. Is the child on any medication? Could it be a side affect of the medication?

Maybe document the time/type of accident each day for one or two weeks. Is there a pattern? Are some of the accidents because the child is attempting to avoid an activity or because the child is so engaged in activity that he waits to the last second?

A few years ago, one of my colleagues had a student who refused to use the toilet in school and had wetting accidents daily. For some reason the child was terrified of using the bathroom in school. (Our K classrooms have a single bathroom in each classroom. The other wing in our building has a girls bathroom and a boys bathroom with multiple stalls. There is also a bathroom in the nurse's office. The child would not use any of them.)

The teacher did not make a big deal about it. (Teachers do not go in the bathroom with the students. Our students keep a change of clothing in their cubbies. We can hand the student his/her bag with change of clothing, but we do not go in the bathroom.) The teacher met with the parent to set up a plan where the parent came in at the beginning of the lunch period and took the child into the bathroom while the other students were in the cafeteria so the classroom bathroom was empty.) The parent stayed in the bathroom with the child for a few minutes. Then eventually introduced the child to sitting on the toilet seat. It took a while before the child was comfortable going into the bathroom alone, but the child finally started using the bathroom.

I pulled this statement from an article on the internet. Some children "refuse to learn to use the toilet for a variety of reasons, including excessive parent and child conflict, the child’s parents attempted to start training too early, irrational fears about going to the bathroom, a child’s difficult temperament."

Another colleague had a difficult situation last year. It was similar to the situation you described. She had a student who defecated in his pants on purpose-sometimes twice a day. The child was seen by a pediatrician and it was determined that there was no medical cause. It was a control issue. I wish I could say that it got better, but it didn't. It lasted the entire year. The parents were in denial and did not follow through on seeking counseling for the child and did not attempt toilet training at home at all. (It was just easier for them to put him in a pull-up.) The teacher was worried about his self-esteem. The other students were fully-aware of what was going on. (The stench would permeate the classroom. Custodians had to come in to clean up the bathroom afterwards.) The other children were kind and did not make fun of the child.

Have a meeting with the parents to share concerns about how this affects the child's self-esteem. Right now students may not make fun of him, but as he gets older, they will. Express concerns for his health. Stress that it is not normal for a five-year old to have accidents all day long. Suggest that parents take the child to see the doctor again to rule out a medical issue. Find out if the child uses the toilet at all at home. Is the child afraid of using the toilet (fear that he will fall in, afraid of sitting on the toilet seat because of germs or afraid the toilet will swallow him when he flushes) or does the child not like the sensation of having a bowel movement (maybe was very constipated one time and it hurt him to have a bowel movement)? Is it a sensory processing issue? Is it a control issue? Mention the sanitary concerns-making sure the child is cleaned up/hands washed and cleaning up the bathroom, carpet and other items in the classroom. It is also disruptive to the learning environment for the individual student, as well as, the other students in the class.

Once a medical issue is ruled out, then develop a plan together for toilet training. It is going to be hard work and it will take time. Everyone has to be on the same page and be consistent. Tell the plan to the child and come with a reward that means something to the child.

First and most important, no pull ups allowed in school.(Yep-initially it is going to be a pain and be more messy, but it will allow the child to experience the sensation of wetness immediately.) The parents can take the child to pick out/buy his favorite underwear. Stress how important it is that the parents need to reinforce it at home, too. Pull-ups only at bedtime and eventually not at all.

It is also the parent's responsibility to teach his/her child how to wipe him/herself. It is not the school's responsibility. It might be helpful for the parent to purchase the wet wipes for the child to use when cleaning up himself at school, but one of the parents also needs to show the child how to use the wipes and how to dispose of the wipes afterwards. (The used wipes are bio-hazardous materials and need to be disposed of properly. Even though some wipes are flushable, they might clog older school toilets.)

Be matter of fact when dealing with it. Do not react with anger or frustration. The child is responsible for cleaning up. At home, the child can help rinse out the clothing before putting the clothing in the washer. (Adult can supervise and help as needed, but give the child the responsibility.) At school, the child puts the soiled clothing inside a ziplock bag. No, it is not a punishment. It is a natural consequence.

Develop a bathroom schedule. Maybe even have one of the parents spend a day or two at school with him taking him into a bathroom every 30 minutes, staying with the child, allowing time for child to sit on the toilet...

The bottom line is that the parents have to assume some responsibility in helping their child. If they are unwilling, I don't know whether there is a legal recourse. Is it considered neglect if the parents don't do anything? If so, contact social services. Does the school have the legal ability to say the child can't attend until toilet-trained if there is no documentation of a medical issue?
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Old 11-08-2018, 11:16 AM
 
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Not knowing what your options or laws are where you teach... We had a kindergartner come to school that was not potty trained at all. Very similar reaction from the parents - the doctor isn't concerned, he'll be ready in his own time, etc. What it came down to for us was that it was a health and sanitation issue. We could not allow a child to be at school that was regularly urinating on the carpets, furniture, etc. Pull-up can only hold so much fluid and once they're full, the next time everything just comes out. We ended up telling the parents that they needed to withdraw the child for 3 weeks (to start) to concentrate on potty-training OR if there was a situation where an accommodation was needed to provide us with the necessary paperwork.

Kindergartners are going to have potty accidents. Not every one of them, but every kindergarten teacher knows that at some point in the year, you will be helping a child with a potty accident.

The child your describing is not having accidents - they are completely untrained.
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Old 11-08-2018, 12:08 PM
 
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Thank you all. I think we're all thinking along the same lines. To answer some questions:

1. We tried sending him with his brother. They got fifteen minutes free playtime before somebody went looking for them. Brother has some intellectual challenges unfortunately.
2. The parents say they saw a doctor this year. He hasn't seen the pediatrician (we only have one). Pressure is on for them to re-visit the doctor with documentation and ask for a referral.
3. Teacher has been keeping records, which have been shown to the parents.
4. the accidents are all day, every day, and we can't connect them to any avoidance or forgetfulness. He'll wet himself at recess when he has free access to the toilet, which is right there. It doesn't seem to be on purpose - he really seems unaware.
5. We cut out the pullups because they weren't helping.

At the moment, he isn't getting teased by his classmates or others, but that will almost certainly come if this continues.


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