Using Data for Continence Success

Many providers suggest that children sit on a regular schedule, but not every body needs the same schedule! This video explains how to know how often, and when, your child needs scheduled sits.

A full transcript of the video appears below.

Hi, I’m Chayah Lichtig. I am the project director and occupational therapy consultant for the Vermont Continence Project. In this video, we are going to talk about gathering and using data to plan a toileting program for your child.

You may be asking, “What? More data?” And it’s true. In the first unit, we did talk about taking data to support your communication with your child’s PCP or other professionals supporting you. Now we’re going to talk about taking data that you would take after any necessary medical intervention.

Why? Well, it’s likely that your child’s patterns of how frequently they’re going, indicators that they need to eliminate, and even their body’s ability to sense the need to go have changed. We want to base our plan on the patterns your child is showing now. So you may be asking, “how much more data?” We suggest that parents take 10 to 14 days of additional data at this point. We know it’s a lot. It’s important, however, to enough data to see patterns. If your child has an off day, eat something that upsets their stomach, has a change in schedule, well, that can affect that day and often a few days that follow it.

More data also gives you a baseline that can help you track progress. If you’re working on toileting with a child who has a more complex disability or health issues affecting continence, a good baseline will help you to see progress over time. Remember, continence isn’t absolute, it’s a process. We suggest that you take this data before setting up any schedule. This enables you to work with your child’s body and patterns instead of applying a schedule that might not make sense for them.

Remember that this data needs to be across environments. Parents and school personnel often assume that a child’s patterns are different in one environment versus another, or different than they really are in one environment versus another. A situation we see all the time is that parents assume that their child is stooling at school. The reality, however, is that no one poops at school. In fact, there’s research that shows that children limit the amount of time that they spend in school bathrooms and that many students dislike the exposed experience of stooling in bathroom stalls. It’s probably relatable. So make sure that you ask your child and work with a school contact to be sure that you’re getting the best data possible. That contact could be a teacher, especially if the bathroom is en suite in the classroom, could be a school nurse, or a paraprofessional.

So you may be wondering how to take this data. Just like in the first round, I recommend that you keep whatever you’re using to collect your data as close by as possible to the place that you are supporting your child to change. That could be a bathroom or another space in your house. You also don’t need to use any specific forms. That said, a table can be helpful because it helps make patterns more visible. There are also several apps available that can help you keep track of your child’s stooling patterns. And you can find one that is going to work for you and your device by searching the App Store for something like elimination diary or a poop journal. All of those words should bring up the kind of results you’re looking for.

This can also be a really great opportunity for rewards. It’s a great inch stone to give a reward. You can tell your child that you are just checking. There’s no shame, there’s no blame, there’s no sitting required. and they get a reward for you just checking in on what’s going on.

So once you’ve collected this data, you may wonder what to do with it. The first thing to do is start looking for some patterns. So one of those patterns might be the times of day that your child is tending to eliminate. Particularly, stooling can happen at pretty consistent times of day. And as you’re looking at that time of day data, you may also wanna ask, hmm, does it have to do perhaps with where that child was at that time? For example, it’s really common for children to stool in the transition from school to home on the bus, and it could be because they’re feeling more relaxed on the bus. Sometimes, it’s also when they are with a specific caregiver, a specific teacher who they just feel a bit safer with.

You’re also going to wanna be looking for frequency. We know about looking at frequency for bowel movements, but frequency for your urination is also important information because it can tell us about bladder volume and any other questions related to bladder function. So how often is your child urinating? If they’re going every 90 minutes or two hours, we’re not going to prompt them every 30 minutes in the future. If it’s more than every hour, as we talked about in a previous video, you’re gonna wanna talk to your child’s PCP. And if your child is going many hours in between urination, like five or six hours, or your child is waking up dry in the morning and then not urinating soon thereafter, that’s also information that you’d wanna share with your child’s PCP, and it’s a good sign that you may not be ready to get them on the toilet soon.

You are also going to want to check out how long after eating or drinking is your child going, and we’re going to talk about that more in detail on the next slide, but you can predict it and increase the chance of a successful sit if you have a sense of how long after eating and drinking they’re going.

You may also wanna look at your child signs that urine or BM are coming. And again, if you could recognize this, it helps the child to learn their own body and patterns and have more success. You’re also going to want to be looking at larger patterns across days and weeks. So this is where multiple consecutive days of data becomes really helpful. For example, some parents after months of watching their child’s patterns have identified a cycle to their child’s constipation. For example, everything seems to be going really well for days or even weeks and then the child may have a harder stool one day, and within a few days, they’re having daily fecal incontinence. So by looking at those signs, you can help your child have more success. So something else that you’re going to want to be looking for is something called the gastrocolic reflex in action. This is a cool fact that there are things that we do that make our bodies start the stooling process. Every time we eat a meal, a larger snack, or even a big drink, it stretches our stomach. That stretch sends a chemical message to our colon, saying it needs to make room for new stuff. The colon answers by moving waste along the intestines to the rectum, and this is called the gastrocolic reflex. When enough stool accumulates, it stretches the rectum, which then wants to empty out. For this reason, bodies very often stool 15 to 30 minutes after meals. The contractions are also stronger earlier in the day, which means you’re more likely to stool after breakfast or lunch than after dinner or maybe first thing in the morning. If your child doesn’t withhold their stool, you’ll know they’re having a bowel contraction because they stool. If your child does withhold, you can still often tell. They’ll have increased gas or they may start to posture, meaning that they hold their body in a way to avoid stooling, such as standing on tiptoes, lying on the floor, or circling rapidly.

So, what to do next? After you’ve taken this data, please check out our video on building a sit schedule. And it’s time to think about getting on the toilet.

Thank you so much for taking the time to watch this video. The information contained in this video is for informational purposes only. It is not a substitute for professional health or medical advice, diagnosis or treatment. Always seek the advice of your physician, or other qualified healthcare professional.