These children who refuse to go to the toilet at school

School: when going to the bathroom becomes torture for children

Dr Averous : The subject is still taboo. However, it is essential to know that many students do not use the toilet enough during the day. Often involved in the lack of privacy or hygiene in certain school sanitary facilities. There are also those who prefer to play in the yard, and forget to go to the toilet during recess. According to Dr Michel Averous, pediatric urologist and specialist on the issue, this is a real public health problem, which affects many children.

How can we explain that some children are reluctant to go to the toilet at school?

Dr Averous : There are several reasons. First of all, lack of privacy, especially in kindergarten. Sometimes the doors do not close. When the toilets are mixed, sometimes the boys annoy the girls, or vice versa. Some children do not accept this lack of privacy, especially when they are used to closing the door at home. Some say: “they are still small”. But, at 3 years old, children can be very modest.

There is also the problem of school timetables, even if adults are generally more permissive in kindergarten. Children are forced to go to the toilet at precise times, during recess. And the transition to CP can be difficult. Some students prefer to play, discuss and hold back afterwards. Others still don’t want to go right now, but when they want to go, it’s too late! In some villages still, the toilets are far from the classroom, or are not heated, which can be unpleasant for the children in winter.

Sometimes there is a cleanliness problem …

Dr Averous : Yes, it’s true. The toilets are sometimes very dirty, and some parents tell their child especially not to put the buttocks on the seat. I work with the Quotygiène laboratory which manufactures seat covers that can be put in children’s pockets. This may be a solution.

Is it really effective? Isn’t there a greater risk of catching infections like this?

Dr Averous : It is to reassure ourselves that we say that. On the other hand, I agree, a child should not sit on a dirty toilet. But, just because someone sat down before us does not mean that we are going to catch diseases. And then, I insist, it is important to sit well to urinate. While standing halfway, girls and women are forced to push and their perineal floor is contracted. By forcing, they pee several times and do not always empty their bladder properly. It is the door open to infections.

Precisely, what problems can arise in these children who hold back too often?

Dr Averous : First, when children hold back, their urine will have a stronger odor. But, above all, this bad habit can lead to urinary tract infections, and even digestive disorders since both sphincters are walking at the same time. This is called the perineal synergy between the urinary sphincter and that of the anus. This causes a buildup of material in the colon. The children then suffer from stomach aches, constipation or diarrhea. It should also be added that little girls are more vulnerable than boys.

Why is that ?

Dr Averous : Quite simply because anatomically, the urethra is much shorter. A little girl will have to squeeze a lot more than a little boy to avoid a leak, and to pee on her. Clothing also plays a role. In winter, parents put tights on children, and over pants. As I have seen in consultation, children do not always lower their pants below the knee. And when it comes to a little girl, she can’t spread her legs like she should. She is not comfortable passing urine properly.

Are many of the children you follow in consultation encounter this kind of problem at school?

Dr Averous : Absoutely. It is very common. And you should know that these daytime disorders (urinary tract infections, stomach aches, etc.) can also lead to bedwetting when the child has a shallow sleep. However, just because a child wets the bed does not mean that he does not go to the bathroom enough during the day. But, if these disorders are related, parents will not be able to resolve the nighttime pee until the daytime disorders are treated.

Should parents be more vigilant and ensure that their child goes to the toilet regularly?

Dr Averous : When parents notice a complication, it is often too late. In fact, you have to educate everyone from the start. Tell children to pee regularly throughout the day, during recess, whether they want to or not! Even though, the older the child, the more he controls his sphincters, he cannot go three hours without emptying his bladder. It is also good to tell them to have a glass of water after using the toilet. By drinking, you regularly empty your bladder and reduce the risk of complications. And no half-standing pee for little girls!

And on the side of the professionals and the municipalities that manage the establishments?

Dr Averous : We should first reach school doctors and teachers. And especially to solve this problem of co-education in the toilets by separating the girls from the boys. The subject is discussed more and more, but it is essential to recall good habits. I can see some progress, especially in kindergartens. They are a little more informed but progress remains to be made …