Do public schools teach voiding dysfunction? Results of an elementary school teacher survey

Purpose: Dysfunctional voiding in children may partly be learned, and constitutes a significant percentage of pediatric urological referrals. Half of a child's waking hours are spent at school, suggesting a significant potential impact on learned toileting behaviors. Nonetheless, data on teacher perception and practice regarding pediatric voiding are lacking. Materials and Methods: A total of 1,000, 21-question surveys were mailed to randomly selected Iowa public elementary school teachers, of which 467 were returned and analyzed. Results: Eighty percent of respondents reported set times for student bathroom breaks. More than half requested all children go to the bathroom at the set times. One-third asked a child requesting a break in the middle of class to wait. Thirty-five percent and 48%, respectively, reported the boys and girls bathrooms were always sanitary. Forty-seven percent and 36% believed bathroom sanitation was progressively worse during the day for boys and girls bathrooms, respectively. Forty-two percent and 34% noticed bullying and lack of supervision, respectively, in the boys bathrooms. Seventeen percent, 16% and 15% suspect an underlying health problem in children who urinate more frequently than normal, or wet or defecate in their pants, respectively. More experienced teachers are significantly more likely to report these suspicions to the school nurse. Only 18% of respondents reported receiving information about abnormal voiding or stooling. Only 8% were aware of specialists trained to treat children with these problems. Conclusions: Teachers report suboptimal toileting conditions for many children at public schools. These conditions appear to become significantly worse following kindergarten. Teachers have the potential to have a significant impact on dysfunctional voiding but are infrequently informed regarding these issues.