Clinical update

Childhood continence

Read our clinical update on a new children’s continence pathway.

Read our clinical update on a new children’s continence pathway

Continence problems in children are common and can negatively affect a child’s quality of life. Picture: Alamy 

Essential facts
In the UK an estimated 1 in 12 (900,000) children aged 5-19 experience bowel and bladder conditions. The impact of continence conditions can be profound on a child or teenager’s life and can continue into adulthood. Those affected can have a lower quality of life, miss out on education and social activities and are more likely to be bullied. Most bowel and bladder problems are avoidable and treatable, yet it’s estimated that only 11% of those affected ask for help.

What’s new
A new children’s continence pathway aims to inform nurses, parents and other professionals about the assessment and intervention a child or teenager with a bowel or bladder problem needs. The pathway, designed by charity ERIC (Education and Resources for Improving Childhood Continence), has a flow diagram of the child’s journey through continence care and a range of assessment forms to identify the cause of the bowel or bladder problem. There are also other tools such as drinking and toileting reward charts, an intake/output chart and information about toilet training.

Signs and symptoms
Toilet training issues, constipation, soiling, day time and night time wetting are among the continence issues experienced by children. Soiling is often a sign of constipation.

Causes and risk factors
The exact cause of constipation is not fully understood but pain, fever, dehydration, dietary and fluid intake, psychological issues, toilet training, medicines and familial history of constipation are believed to contribute. Constipation can be the cause of urinary continence problems. 

How you can help your patient
Understand how common but underreported children’s continence issues are and the effect they can have on the whole family. Establish during history taking if a child has constipation or other bowel or bladder issues. Remember that early identification of constipation and effective treatment can improve outcomes for children and young people. Use the ERIC pathway to navigate the most appropriate care for the child.

Expert comment

Brenda Cheer, ERIC nurse:

‘Nurses should remember that childhood continence problems can affect anyone, are extremely common and that they are not just limited to a number of children with complex problems.

‘Any nurse meeting any child for any reason is likely to come across a child with a continence problem, and there is a good chance it will be undiagnosed and their family may not realise that a lot can be done. Signpost families to sources of information, such as the ERIC website. Both parents and professionals can use the ERIC pathway to work out what the problem is and what should be done. 

‘One obstacle is that there is a huge variation in the provision of continence services across the UK. Care is often fragmented with different people providing services for bladders and bowels, for day and night-time problems, for children with additional needs and those without.’

Find out more

RCNi article

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