Widening the field
The impact of incontinence in a school-aged child has wide ramifications and is not something that can be kept hidden within the home. As a growing developing person, the child has connections with institutions within the wider world of which the school is the most significant. Reference has been made to the way in which soiling problems affect many areas of the child’s life: cognitive capacity, learning and curiosity and friendship and peer relationships are all compromised. This is particularly troubling where children have missed a great deal of school due to the exclusive medicalisation of the problem. This is then combined with the parents’ belief that the child will be unable or be too embarrassed to cope with demands of the school environment because of their incontinence. By expanding the therapeutic endeavour with the parents’ agreement to include the school, we widen the support system for the child. In the first instance this ensures that the child continues to attend and is not held back from school. Secondly, we may find that school staff have long-standing experience with the many children in their care.
Working out a plan with the child, parents and the school about how the problem will be managed is part of the therapeutic endeavour. It gives a message to parents that they are not encouraged to come into the school specifically to attend to their child’s soiling. It also gives the child a sense of responsibility in managing their own body and is often the point at which apparently sudden improvement takes place. As mentioned earlier we should not overlook how the incontinence problem has caused a developmental hiatus for the child and this may also affect their learning. If they have missed school and they are behind in their educational performance it makes it all the harder for them to want to return to school. The sensitivity of teachers in being able to recognise this problem is critical in making the school environment a place for the child where they can catch up on their learning and their friendships. School also provides a neutral haven for children who experience a high level of parental conflict.