Healthy Child


When school bathrooms pose a challenge

By Darcy Lewis

September means returning to school-an exciting time for some students and a fearful one for others. But even kids who like school can find one room to be particularly scary: the bathroom. Many children-especially younger ones-refuse to use school toilets, at least temporarily.

The reason: Fear.

"When a child realizes that the school toilet feels strange-different size, different shape, different configuration-it can trigger anxiety," says Dr. Dana Brazdziunas, a behavioral-developmental pediatrician at Loyola University Medical Center in Maywood. "[The early toileting years] are a natural time of anxiety. Those who get temporarily stuck in that developmental stage haven't resolved their bathroom issues yet."

But the issue isn't always psychological. Among preschoolers, the problem is more likely distraction. They get so engrossed in what they're doing that they don't heed their bodies' signals, says Mary MacIntosh, director of Alcuin Montessori, a prekindergarten-eighth grade school in Oak Park. "We're very careful to let children know it's OK to forget occasionally. Hearing this usually reduces their anxiety and stops more serious bathroom fears before they start."

MacIntosh says embarrassment kicks in around kindergarten. "By the time they're 5 and over, accidents are more likely to come from being in circumstances where they can't get to the bathroom in time, like on the playground," she says. "Then when it happens, they're very worried about how other children will react. Once embarrassed, children can develop great bathroom anxiety, so teachers must always handle accidents sensitively."

For half-day pupils, problems can often be avoided when parents have them use the home toilet before leaving. But for full-day students who consistently refuse to go at school, it's time to talk to the teacher, says MacIntosh. Perhaps he or she can give your child regular bathroom reminders or extra bathroom time.

Your conversation with the teacher should include making sure there's no bullying or teasing in the bathroom. "School bathrooms often aren't well supervised, particularly in elementary school," says Brazdziunas. "It's important to rule out a social problem in a child who's previously used the school bathroom but suddenly becomes anxious."

Then, it's time to talk to your child. "The more you question children, the less they'll answer and they may pick up anxiety from you," says MacIntosh. "It's far better to let the topic come up naturally."

For example, you might mention how hard it can be to get to the bathroom in time, then casually ask if that ever happens. "You're basically implying this is a normal situation, and that's very reassuring," MacIntosh says. If your child mentions another child who's had a bathroom accident, ask how the other child solved the problem and what your child did to help.

Focus on the mechanics Another simple way to help prevent bathroom anxiety is to give your child only easy-to-operate clothing. Even frugal parents should avoid the temptation to squeeze additional wear out of almost-too-small pants. Formerly manageable snaps and zippers become hard to handle when the fit gets too snug. "Kids don't have a lot of time to waste, and complicated or tight garments make it harder for them to get to the bathroom in time," says MacIntosh.

It's important to realize that what starts as anxiety can occasionally morph into a physical problem. If your child has repeated daytime bathroom accidents, or if you consistently find small deposits of feces in your child's underwear, call your pediatrician. "Children might start to leak urine or stool because there's so much bladder or bowel pressure," says Brazdziunas. "Medicine and a low-key but regular toileting schedule-even if they don't feel the urge-will get most kids back on track."

Sometimes a child dreads what's happening inside his body, particularly if elimination hurts. "Constipation can definitely become painful enough to make a child fear using the bathroom," Brazdziunas says.

Help your child avoid constipation if at all possible. Make sure your child drinks enough water, gets adequate exercise and eats enough fruits and vegetables. For most children, that's enough to keep constipation at bay.

If additional help is needed, Brazdziunas suggests drinking pear or apricot nectar: "They've got pulp and corn syrup, both of which will help naturally." Stool softeners can help when bowel movements are regular but hard or dry.

Laxatives are for when bowel movements are soft but irregular. But call your pediatrician before giving over-the-counter constipation remedies to children, says Brazdziunas.

Perhaps most important, don't make a problem where none exists. Not even a kindergartner appreciates having his bathroom performance scrutinized constantly.


Darcy Lewis is a writer who lives in Riverside with her husband and two boys, ages 9 and 3.


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