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THURSDAY, Aug. 28, 2003 (HealthDayNews) -- The move from kindergarten to first grade is a big step. School lasts not half a day, but a full day. And the rules are tougher, including less access to the bathroom.
But some young elementary school students' bladders just aren't mature enough to handle that restricted access. And that could lead to potential problems such as infection and incontinence, say University of Iowa researchers who surveyed public schools about their bathroom policies. Their report appears in the September issue of the Journal of Urology.
A team led by Dr. Christopher S. Cooper, an associate professor of urology, analyzed 467 surveys returned by public elementary teachers in Iowa who taught kindergarten or early elementary grades. Nearly 80 percent said they set specific times for bathroom breaks, with teachers of higher grades more likely to do so than the kindergarten teachers.
Overall, one-third said they asked children to wait if they requested a break in the middle of a class. Only 40 percent allowed a child to go to the bathroom at any time during class.
When Cooper's team looked at policies by grades, they found that 69 percent of kindergarten teachers allowed free access to the bathroom, but by first grade only 40 percent of teachers did. By second grade, only 35 percent did so, and by third and fourth grades, just one quarter of the teachers OK'd free access to the bathrooms.
But Cooper says there's not much difference between children in these age groups when it comes to having a mature bladder. If bathroom access must be restricted, starting in third grade might be physiologically easier on the children, he adds.
Incontinence occurs in about 5 percent to 15 percent of school-age children, Cooper notes in his report.
While he acknowledges that teachers need uninterrupted time to teach --and that some students ask for a bathroom pass just to get out of class -- Cooper is concerned about the long-term effects when a child delays urinating too often.
They do so by tightening the urinary sphincter muscles and waiting for the contraction to go away, he says. But they can train these sphincter muscles so much that when they do go to the bathroom, they can't relax the muscles enough to get all the urine out.
"If that goes for a long period of time, I start seeing them for problems such as infection and incontinence," Cooper says. "It's related."
Cooper also asked teachers how likely they were to report potential bladder and bowel problems to parents, and found that 82 percent mentioned it. Teachers with more experience were the most likely to report possible problems to the school nurse.
"To my knowledge, this is the first study to look at the problems [tied to limiting bathroom access] at the schools," Cooper says. Next, he hopes to examine university teacher-training programs, to be sure future educators are getting accurate information about children's toilet needs and bladder development.
Dr. Dennis Woo, chairman of the department of pediatrics at the Santa Monica-UCLA Medical Center, says the new study confirms what many pediatricians already know. He agrees with Cooper that teachers may have to be a bit more patient about young students' bathroom needs.
"Were very compassionate with our kindergarteners," he says, speaking of typical school policies. Then, most schools get progressively tougher about bathroom access, he says, and some children's bladders just aren't developed enough to go a long time without urinating.
When Woo sees a young patient who is having trouble adjusting to a school bathroom break policy, he often writes a note to the teacher, explaining the problem and how he and the young patient are working on it.
Cooper notes biofeedback can help a child learn to relax the bladder muscles after he or she has held it for too long.
More information
For tips on starting the new school year right, visit the National Education Association. The association also has suggestions on how a parent can be involved at school.
