"We've identified a problem and now we need to figure out a solution."

--Christopher Cooper, M.D.

Children may not get enough of them at school, study shows

Moving on to first grade often means less access to the bathroom for many school children, potentially leading to accidents or other urination problems, according to a study based on surveys of Iowa public elementary school teachers.

However, better training for teachers about children's normal and abnormal bathroom needs could help children with their voiding, or urinating, practices, according to a University of Iowa Health Care study, which appears in the September 2003 issue of the Journal of Urology.

It is believed to be the first study to query teachers on the topic of elementary bathroom conditions.

Children spend about half of their waking hours at school, so how much bathroom access they have is important, said Christopher Cooper, M.D., the study's principal investigator and a pediatric urologist at University of Iowa Children's Hospital, located at UI Hospitals and Clinics. "Pediatric voiding problems are fairly common and can be socially devastating. However, very little seems to be known about it from the teacher standpoint."

In their responses, only about one in five teachers said they ever had received instructional information about abnormal voiding or bowel problems in children.

However, the researchers found that teachers with more classroom experience had a better idea of what could be a bladder problem. These teachers also were more likely to involve a school nurse when children had bladder or stooling accidents.

Kindergarten teachers were the most likely to give free access to the bathroom and to believe children who said they needed to go. Sixty-nine percent of these teachers let kindergartners use the bathroom whenever they asked. This easy access dropped to 40 percent for first grade and 25 percent by third grade.

"Statistically, we found a big difference between kindergarten and first grade for free access to using the bathroom," Cooper said. "However, there is no physiological difference between five-, six- and seven-year-olds in terms of voiding function."

Children in those age groups still are developing and have some unstable bladder contractions. As a result, it is better for them to urinate whenever they feel the urge rather than to try to hold it, Cooper said. The majority of teachers also reported bathroom safety and sanitary concerns which may also limit access.