Professor Michel AVEROUS

Head of the paediatric urology service
at the Montpelier University Hospital.

Health problems for school children related to the sanitary condition of toilets in primary schools.

This is a very serious health issue which should not be ignored as it is a major source of discomfort and even educational setbacks for children. It is absolutely necessary that educational institutions become fully aware of the issue in order to effectively prevent its negative effects.  The number of related medical consultations is increasing every year: 500 in 2004, more than 700 today. Medical treatment, examinations and tests are placing an increasingly heavy load on the social security system.

These kinds of conditions relate equally to boys and girls even if, due to their physiology (longer urethra), the consequences are less serious for boys.

These are:

- minor urinary incontinence during the day which may also be associated with night-time bed-wetting: if the child can easily hold themselves in during the day or even all day long, during the night they may not be woken by their bladder.

- urinary infections: young girls are more vulnerable since germs can access more easily.

A child who forgets to go to the toilet because they don't want to use the toilets during breaks and are not allowed to do so during class will gradually learn to hold themselves in. A bladder which is not emptied often enough (5 to 6 times a day) may lead to leakages caused by overflow and urinary infections. The urinary dysfunctions that affect children will cause their bladders to dilate. The relation between the urinary and anal sphincters will lead to a colic retention which may well cause the stomach pains of which many children complain.

These problems mostly start at primary school, at kindergarten the children are more closely surveyed and accompanied. They may continue and worsen at secondary school and college leading to more serious conditions during adulthood. In fact, from primary school onwards, the systematic use of the toilets is not obligatory and certain teachers do not allows children to go to the toilet during lessons. At primary school teachers must survey and encourage their pupils to use the toilets and drink water during breaks. Their education must allow them to be aware of these needs. In fact healthy living must involve the regular evacuation of the bladder, ideally during the morning, dinner breaks and once or twice during the afternoon without forgetting to drink. Installing the act of going to the toilet into the daily routine allows children to take responsibility and thus avoid disrupting lessons as well causing of urinary dysfunctions which will lead to bed-wetting and discomfort for children leading to urinary infections during adulthood.

The cleanliness and regular inspection of toilets has a direct effect on children's well-being, allowing them to use them regularly with confidence regarding their hygiene and privacy.

Children need to be educated equally at home as at school. These days, a lot of parents ignore these kinds of child-rearing issues:

- systematically going to the toilet at key moments of the daily routine to avoid waiting until the last moment (on getting up and going to bed, at meals, during breaks, on returning home)

- drinking regularly before 6pm

- learning to urinate properly:

I am a young girl: I sit down comfortably with my feet flat on the ground - I lower my clothes and underwear as far as my ankles - I spread my knees - I relax, I don't push and I wait until the last drop - I wipe from front to back - I wash my hands.
I am a young boy: Seated, I get comfortable with my feet flat on the ground - Standing, I undo my trousers to be comfortable - I relax - I lower my underwear properly, I don't push, and I wait until the last drop, I wipe myself and straighten my clothes - I wash my hands.

Information from parents and teachers regarding these good practices, and the consequences of bad hygiene are essential for the child's health.

Professor Michel AVEROUS
Head of the paediatric urology service at the Montpellier University Hospital.

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