Most people probably take their bathroom privileges for granted, heading to the toilet in their home or office whenever the need arises without thinking much about it. But at school, children don’t always have that luxury.
A recent survey by the Society for Women’s Health Research found that schools often disregard kids’ restroom rights, often by failing to have a bathroom rule on the books and provide staff with education on bladder health. Absent official policies, parents and doctors tell me, many teachers come up with their own regulations, which anecdotes suggest can border on the absurd. I heard about a teacher who allegedly stipulated that her students could only go to the restroom during class time once every two months, for instance, and read about some school districts routinely locking restrooms at lunchtime or after school to discourage misbehavior.
Schools seek to minimize the amount of time kids spend in the bathroom during class to ensure that they get the most out of their instruction, and generally restrict students’ access to prevent misconduct in the restrooms, where kids tend to be unsupervised. Well-intentioned yet overburdened teachers might adopt such rules to avoid disruptions and ensure that all their students are accounted for. But treating bathroom use as a discipline issue can have serious health implications, especially when a kid needs to go, but can’t.
A majority (84 percent) of respondents in the recent survey, which was distributed among school nurses serving all grade levels nationwide, said students often have ulterior motives when they ask to use the bathroom—maybe they don’t have to go and just want to meet up with a friend, for example, or perhaps they intend to skip the bathroom altogether and cause a ruckus in the hallway. A little more than half reported that kids misbehave in the bathroom. Underlying these assumptions is the fact that few schools have written policies on students’ bathroom use—just 8 percent of nurses said such rules existed, while fewer than half said students on their campus can use the bathroom whenever they please, with permission required only as a formality.
And the survey’s results suggest that such realities persist despite growing recognition of the health consequences. More than a third of respondents expressed concern about the adequacy of kids’ bathroom-break time—and three in four said they were aware of bladder or bowel problems among kids at their school.
A separate 2015 study underscores the disconnect between discipline-focused bathroom policies and kids’ health. While 81 percent of the more than 4,000 elementary-school teachers said they allow kids unlimited access to water, 88 percent also said they encourage their students to hold their pee; 36 percent of participants, meanwhile, indicated they had a “protocol in place to encourage students not to use the bathroom during class time.” Also notable: About eight in 10 of those educators said bullying, misbehavior, vandalizing, or other negative behavior happens in the restroom.
Some experts point to bed-wetting—which according to the American Academy of Pediatrics affects 20 percent of 5-year-olds and can be a symptom of an acutely dysfunctional bladder—as attributable largely to kids holding in their urine or feces. This “voiding dysfunction,” as medical practitioners refer to it, can have severe, long-lasting physiological consequences—a swollen colon can damage the nerves feeding into the bladder, for example—not to mention psychological ones.
Despite the growing body of empirical research showing that holding it is bad for kids, schools’ mind-sets don’t seem to have changed much. This is the case even though awareness among campus officials appears to be growing, if only slightly. In a 2012 survey, fewer than half of the 600 school nurses who responded suspected that children with frequent urination or bladder and bowel accidents were suffering from an underlying health problem. Roughly a decade earlier, in 2003, that number was even smaller when similar questions were asked of teachers. Fewer than one in five participants in a survey of Iowa educators suspected that children who demonstrated frequent urination or accidents were suffering from an underlying health problem. A third of them said they’d ordered at least one student requesting bathroom access to wait.
Christopher Cooper, a pediatric urologist at the University of Iowa who co-wrote the 2012 and 2003 studies, began researching the issue after noticing a high frequency of UTIs and higher rates of voiding dysfunction among his young patients. “It started to seem like, if for eight hours a day you [as a teacher] are the primary caregiver for these children, you’re missing a potential opportunity to pick up on some abnormal things going on,” he says. It’s hard for a kid to advance academically and develop socially and emotionally if she is constantly distracted by her bladder troubles. “Wetting your pants at school is one of the most stressful things a child can face or even imagine,” Cooper says.
One mother in the Seattle area, Maija Brissey, says she will never forget the day her son, who struggles with urinary accidents because of a rare medical condition, came to her at the age of 6 and asked her if he had a disease. Apparently, his classmates had convinced him that he did because he kept peeing his pants. Over the years, Brissey says her son started disengaging from classes and from his neighborhood friend group, retreating to his room right after school rather than playing with his buddies. “We’ve got to do a better job of making using the bathroom more comfortable for kids,” says Brissey, a nurse.
When they’re in elementary school, kids’ bladder systems—and the psychological responses to these physiological sensations—are at a crucial point of development. According to Cooper, children are “very good at ignoring [their bladder] signals” after being regularly denied the opportunity to go when they feel the urge. And the side effects—from incontinence to recurring urinary accidents—can put stress on the bladder, which is a muscle, and thus make it stronger and overactive. Cooper cited the high rates of bladder cancer among truck drivers, who often hold their urine on long drives.
Suzanne Schlosberg, a health and parenting writer based in Bend, Oregon, started advocating for policy reforms and greater awareness after experiencing similar issues with her child. A few years ago, Schlosberg teamed up with Steve Hodges, a pediatric-urology professor at North Carolina’s Wake Forest University, to create an online resource for parents, therapists, teachers, and others seeking to help children who suffer from toileting problems. One of the inevitable challenges of this issue is that many people don’t want to talk about bathroom issues. As universal and mundane as they are, they can be embarrassing to discuss—not only for kids, but also for the adults who care for them. These days, Hodges says he often finds himself writing letters to schools demanding bathroom freedom on behalf of his patients.
Schlosberg says she has often had to contend with teachers whose bathroom policies encouraged her son to resist the urge to go. One teacher, she recalls, relied on the popular classroom-management strategy of rewarding kids for good behavior, in this case through the use of fake money. If students wanted to use the restroom during class, according to Schlosberg, they had to pay a “fine.” “My kid wanted to save his money, so he was having to decide between using the bathroom and saving his earnings,” Schlosberg says. Upon learning of her son’s issues, the teacher was quick to exempt the child, but stopped short of changing the class policy.
On K–12 campuses across the country, children’s bathroom needs are left in limbo because schools seldom have established policies, and teachers lack the training on how best to balance discipline concerns with kids’ needs. Just one in five respondents in the 2015 study of more than 4,000 teachers, for example, said they’d participated in “professional development” on bathroom regulations for kids. This lack of awareness, combined with sometimes-valid fears about misbehavior and academic disruption, leads to a patchwork of inconsistent rules that teachers might devise themselves.
What’s ironic is that most teachers are familiar with students’ bathroom woes—they seldom have the opportunity to relieve themselves during the school day, either. In fact, in a 2015 survey that asked teachers about the quality of their work life, its 30,000 respondents listed this problem as one of their biggest sources of everyday stress.
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