News Release

Elementary schools need a lesson in bathroom breaks

Peer-Reviewed Publication

University of Iowa

Kids don't give up only naps after kindergarten. Moving on to first grade often means less access to go to the bathroom -- which can lead to unnecessary accidents or other urination problems.

However, better training for teachers about children's normal and abnormal bathroom needs could help kids with their voiding, or urinating, practices, according to a University of Iowa Health Care study based on surveys of public elementary school teachers. The study, which appears in the September issue of the Journal of Urology, is believed to be the first to query teachers on the topic of young students and bathroom access.

Children spend about half of their waking hours at school, so how much bathroom access they have is an important issue, said Christopher Cooper, M.D., UI associate professor of urology and the study's principal investigator.

"Pediatric voiding problems are fairy common and can be socially devastating for children. However, very little seems to be known about it from the teacher standpoint," Cooper said. "Most teachers aren't trained to recognize that it can be a health or medical problem."

The researchers sent 1,000 21-question surveys to public elementary teachers in Iowa. Nearly 47 percent of the surveys (467) were returned. In their responses, only about one in five (18 percent) 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.

Nearly 80 percent of teachers reported set times for student bathroom breaks, and one-third of the teachers said children are asked to wait if they request a bathroom break in the middle of class.

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. By third grade, as children mature, teachers see fewer wettings.

"If you based public school toileting on data, third grade would seem like a better time to impose restrictions," Cooper said.

At the same time, he understands the dilemma teachers face. The survey uncovered several issues. Teachers are concerned that older children want to go to the bathroom for social or other reasons, or that children will be subjected to bullying or teasing by peers in an unsupervised place. Teachers also noted the lack of cleanliness of bathrooms, especially the boys' room.

"It's difficult if kids are jumping up and running to and from the bathroom. There's no perfect solution, but we need to do more to let kids respond to their urge to urinate or defecate during school hours," Cooper said.

"Incontinence occurs because children hold off urinating. In addition, when kids get too good at holding off, they can't relax enough to void when they have the opportunity, or they stretch their bladders and do damage," he added.

Cooper, who treats many children with urinary incontinence and some with problems defecating, became interested in the issue of elementary schools and urination problems after hearing many parents complain that their children were not being given the opportunity to frequently use the bathroom at school.

He also heard kids themselves saying they "do not use the bathroom at all" while at school and wait until they get home.

While Cooper hears such comments from young patients, he noted that the study was limited to teachers' perception and did not include what children think.

Other researchers on the study included Chadi T. Abousally, a former UI medical student who graduated in 2002, and J. Christopher Austin, Margaret A. Boyt and Charles E. Hawtrey, all in the UI Department of Urology.

Cooper and colleagues next will survey universities and colleges to find out if teachers learn about childhood toileting. Cooper said the team also plans a pilot in-service teacher program on normal toileting for children.

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


University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at

STORY SOURCE: University of Iowa Health Science Relations, 5137 Westlawn, Iowa City, Iowa 52242-1178

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