The other day a mother brought her four year-old daughter (let’s call her Sally) into clinic with a severe and painful rash all over her bum and vaginal area. Poor Sally was really suffering.
I had a look at the rash. It reminded me of the diaper rashes I routinely see in newborns. These rashes are typically caused by chronic exposure of the skin to stool and urine. Since some newborns can pee and poop hourly (or even more frequently), it can be impossible for parents to keep up with the diaper changes and hence, a bum rash results. But in this case we’re talking about a 4-year old child! Diaper rash in a 4-year old?
It didn’t take long to figure out what was going on: this poor girl, who attends a local Junior Kindergarten class, was not yet proficient at wiping herself adequately after pooping. Occasionally, she would be a bit late recognizing the ‘need to go’ and would have an accident. Her bum was getting irritated and corroded by prolonged exposure to urine and feces.
I inquired if she asks her teachers for help when she has to go (or is finished going) to the bathroom. The mom quickly interjected and informed me that kids need to be toilet-trained as a prerequisite to attending this particular school. She went on to explain that the teachers in this school will not help their students with toileting hygiene.
Believe it or not, this is a common school policy in my city/province.
I felt my blood pressure rising.
“So the teachers allow the kids to sit in their soiled underwear all day?” I asked.
“Well, they call me if it’s really bad. What else can they do?” said the mom.
I felt like vomiting – not at the site of the bum rash, but in reaction to the fact that some schools are OK with letting kids sit in their urine and feces all day!
I won’t even start getting into the psychological consequences of a child spending the day with her peers smelling of feces and urine.
Unfortunately this is not an uncommon story and I have a well-established strategy to remedy this kind of rash.
I proceeded to write a letter to the school principle:
Dear Mrs. Principle:
Sally has a medical condition that requires adequate and consistent bathroom hygiene. This means facilitating access to a toilet in a timely manner when required, assisting her with wiping after she has finished urinating and/or stooling, and cleaning her adequately/promptly in the event of accidents. Inadequate bathroom hygiene may result in 1. worsening of her medical condition and 2. an increased risk to others in the school of acquiring fecal-orally spread infectious diseases.
May I suggest that you assist all children in your school with adequate bathroom hygiene when needed as a means to prevent medical conditions from arising in the future for Sally or any other child at risk.
I appreciate your diligence in addressing this matter and trust that you will take the necessary measures to keep Sally and her classmates safe, comfortable, and healthy.
Yours sincerely,
Dr. Flanders
Some cream, a bit of compliance from the school, and a week of healing did the trick. I saw Sally in follow-up and her bum rash was better.
I have informally spoken to teachers and parents about this issue and it seems that there are three (perhaps related) justifications most commonly given for why teachers will not assist children with bathroom hygiene:
1) The union advises teachers against it
2) Teachers could face allegations of sexual assault
3) It is unsanitary (this is more a justification for refusing admission to children not yet toilet-trained)
The more I encounter stories such as this, the more my blood boils, especially given the fact that daycares around the world help 4-year-olds with bathroom hygiene many times daily. Using standard universal precautions (and perhaps with a co-worker nearby), daycares routinely and adequately mitigate the risk of spreading infections, and, as far as I know, daycare workers who help kids with bathroom hygiene are not likely to show up in your neighborhood’s list of nearby sexual offenders.
It is entirely feasible for schools to safely help children with and to learn/improve their bathroom hygiene skills. In fact I argue that it may be a human rights violation to refuse to do so.
If this upsets you too, consider calling your child(ren)’s school(s) to inquire about their policy on this. If they are one of the ‘we don’t do dirty bums’ violators, consider speaking up and pushing them to change.
Thanks very much for this. Our little guy is about to start Montessori and they told us in the orientation that there will be no toileting help. Our little guy is 3 and pretty good, but I know from my older daughter that kids can’t really wipe feces well until they’re 5 or 6. I’ll wait and see what happens, but your post has inspired me to be unafraid to vocally challenge this policy.
As a teacher I had to send kids who had accidents to the clinic to change themselves. Parents had extra clothes at school for the children bc I taught Kg. Older kids often had to call home, though. Our special need skids were attended to by aides who were supposedly trained to do the changes in a sanitary manner. When I taught pre-k we cleaned the child if an accident occurred but another adult was nearby to make sure no one was improper.
Your Comments I would always assist a child to change into clean clothing (if an accident occurs) with another adult present of course. It’s the daily “Will you wipe my bum, that we should not be expected to do. I will talk a child through the process so that they can learn themselves, but, while I am at the bathroom, who is supervising my other 20 children, now that we do not have educational assistants?
That is a mean thing to say. Every child learns at a different pace. Also, we didn’t pay day care so they can come home with a rash and smell like feces. A caring teacher would guide the child to wiping themselves. Often, kids learn better with other children. My LO was potty trained in TWO weeks by hanging around his older cousins when he was 2.5 years old. Yes, 2 weeks. The kid refused to use the potty for over a year but hanging around the cousins – even trained to use the regular toilet at the same time. The LO is still learning to wipe and when he is ready, he will let me know. Forcing a child doesn’t speed the process. If the child is trying then that is all we can ask.
As a Kindergarten teacher, it is not really my place to physically wipe a child, that is too intimate of an action and I do not feel comfortable performing such tasks. I do help children by talking them through anything that happens when they need help, we help students know when they may need to change their clothing so that they are clean, and we do whatever else is needed to ensure the safety of the students in the classroom, and our own. My job is to deliver the curriculum that the ministry has set out, not to toilet students. Remember that day cares are completely different in how they are set up (1 to 8 ratio vs the 1 to 15+ in a Kindergarten classroom), the workers are specifically trained in how to deal with such issues, and have different insurance coverage than we do at a school. I never received training on how to assist students who have had a BM and can’t wipe appropriately. I can empathize with those families who encounter this situation but to blame the teachers is completely inappropriate and immoral.