Written evidence submitted by the Paediatric Continence Forum



The impact of Covid-19 on CYP with continence issues
A briefing from the Paediatric Continence Forum


A Summary

As a result of the national response to Covid-19, with school closures and a reduction or temporary suspension of services that are considered non-essential, support that is crucial for some families is no longer available. This is likely to cause significant harm, not only to children’s mental and physical health but also to their safety. Children who are wetting and soiling as a result of a bladder and bowel condition are at increased risk of suffering abuse from their families as a result of the lockdown..

The Paediatric Continence Forum would like to see:

  1. A minimum bladder and bowel service maintained during the pandemic crisis, to deliver support to vulnerable children and young people, particularly those subject to protection plans, who are looked after, or where there are high levels of professional concern
  2. A commitment that bladder and bowel services will be fully re-instated once this crisis is over.

Prevalence and impact of Paediatric Continence Issues

Approximately 1 in 12 children and young people in the UK have bowel and bladder issues, making them among the most common medical conditions experienced in childhood. There is limited understanding that wetting and soiling occurs outside the child’s control and are as a result of these bladder and bowel problems. Where parents or carers consider their child is being lazy, naughty or defiant, punitive responses are common and can cause significant harm.

The safety net of schooling has been put on hold

Attendance at nursery or school is a key mechanism for safeguarding the wellbeing of children and young people. Schools are uniquely placed to understand and raise concerns when a child’s incontinence is not developmentally typical, is causing poor school attendance, attainment and achievement, or where there are other issues that impact on a child’s development, education and broader wellbeing.

Educational establishments are often the first to recognize and highlight continence issues, as well as safeguarding concerns. Schools have strong relationships with children and their families that are invaluable in assessing and raising issues, so that children and families receive appropriate interventions and support.  This is currently inaccessible or not being used by families whose children have been identified as vulnerable and are therefore eligible to continue to attend school at the current time.


Health providers are being redeployed away from paediatric continence service

Specialist paediatric continence services provide assessment, information, support and treatment for children and young people with bladder or bowel conditions. These nurse-led, community-based services, when appropriately commissioned and resourced, improve the health and self-esteem of children as well as their quality of life and those of their families, while generating significant cost savings for the NHS. Furthermore, they are part of the core groups of services that work together to safeguard the wellbeing of children and protect them from abuse.

Paediatric continence nurses are being told that their work is not considered essential and are therefore being redeployed. A nurse reported that the, “enuresis service must be scaled back as it is a non-priority service”.  Another who was told that paediatric continence ‘…is not an essential service was upset that she was not included in the decision and that there did not appear to be any consideration of the needs of vulnerable children. Another nurse said, “I worry about those who have just started on medication, either desmopressin or oxybutynin, as they need regular reviews.

The impact of Covid-19 on children with continence issues

The lack of appropriately timed assessment, advice and support increases the sense of isolation and anxiety in families whose child has an embarrassing and socially unacceptable issue.  They worry about contacting their GP, perceiving that this may increase their risk of contracting Covid-19 or that the GP has other priorities at this time.  Furthermore, continence issues are often poorly understood by generic healthcare professionals, many of whom believe the causes are psychological or not untypical in younger children.  Furthermore, problems may escalate if left untreated e.g. constipation may become faecal impaction that affects the bladder causing uncontrollable soiling and wetting.

We are aware that the government has provided extra funding to local authority children’s services and welcome this initiative.  However, with the heightened distress stemming from the pandemic itself alongside the pressures of coping with social distancing measures and the stay at home advice, lack of access to specialist children’s bladder and bowel services at this time increases the very real likelihood of abusive responses to a child who is wetting and soiling for reasons outside their control.

Our recommendations

Children’s bladder and bowel services have been  neglected for too long.  We are very concerned about reduction to existing services during the pandemic but also the long-term impact that the re-deployment of staff may have. To ensure that children with continence issues, who have increased vulnerability to abuse, have the best chance of protection from harm, we would like to see:

  1. A minimum bladder and bowel service maintained during the pandemic crisis to deliver support to the most vulnerable children, particularly those who are subject to protection plans, who are looked after, or where there are high levels of professional concern
  2. A commitment that bladder and bowel services will be fully re-instated once this crisis is over.

The mental and physical wellbeing of those children whos risk of abuse is heightened due to bladder and/or bowel continence issues and the current national response to Covid-19 must be safeguarded.

About the Paediatric Continence Forum

The Paediatric Continence Forum (PCF) is a campaigning group of specialist health professionals and patient and commercial representatives that engages with the Government and policymakers to raise awareness of childhood bladder and bowel problems and to improve NHS paediatric continence services across the UK. The PCF produces guidance for professionals and campaigns to ensure that all children and young people have access to best practice in health provision in this common, but often poorly understood and neglected area of child health.


May 2020