A pediatric urologist explains why young students should have free access to the bathroom during school.
Should K-12 students have open access to school bathrooms so they can freely heed nature's call? Or should teachers limit bathroom passes so kids don't disrupt class or screw off in the hallways?
Controversy erupted on this issue last week when a Houston mom vented on TV about the policy at her son's school. According to the mom, Sarah Moreno, students were told they could earn restroom passes—"coupons"—for good behavior. Said Moreno: "We should all just have the right to go to the bathroom, period, because we're alive on Earth."
The school district countered: "The restroom...coupon is simply one of many incentives created by classroom teachers to motivate and encourage students to maximize their instructional time."
Then a parenting blogger mocked Moreno on Facebook, unleashing charged retorts on both sides.
As a pediatric urologist, I stand with Moreno.
Though I'm sympathetic to the challenges of managing a classroom, I believe students must be allowed to use the restroom when the urge arises—not 10 or 20 or 60 minutes later. It's a health issue, and it's no joke. Suppressing the urge to pee can damage a growing bladder, thickening and aggravating the bladder wall and increasing a child's risk for accidents, bedwetting, and urinary tract infections.
Ignoring the urge to poop wreaks even more havoc, as I explain in our free download, "The K-12 Teacher's Fact Sheet on Childhood Toileting Problems." Stool piles up, stretching the rectum and pressing against the bladder. Constipation, epidemic among U.S. children, causes increased urinary frequency and urgency and is the direct cause of virtually all bedwetting as well as daytime accidents. Some of these accidents occur in the classroom or on the gym floor.
Yet school districts nationwide routinely restrict restroom access, by limiting passes and even by locking restrooms at lunchtime or after school, when kids head to the bus. (Never mind that students may have a 45-minute ride home.)
Other schools dangle prizes for not using bathroom passes. Students can earn trinkets, "money" for the student store, even pizza parties—all for ignoring their bodies' signals.
I know this happens because my patients tell me and because I talk to teachers and school nurses. A new University of California at San Francisco survey of 4,000 elementary teachers confirms these practices are common. In the survey, presented at a recent American Urological Association meeting, 36 percent of teachers reported rewarding students who don't use restroom passes or punishing those who do.
Guess what happens when kids are rewarded for holding their pee? They hold it!
As one mom posted on Facebook: "My daughter was holding her bladder—or, at worst, coming home with damp panties because she couldn't hold it—so she wouldn't 'waste' her pennies on a potty break." (Students in that class earn "pennies" for good behavior and can use their pennies to "buy" a bathroom pass or shop at the class store.)
Schools may consider this evidence that these policies work. Students stay in class! The halls are clear! But what "success" really means is that kids are damaging their internal organs—and self-esteem. Truly, nothing is more mortifying for a child than having to traipse to the school nurse with pee-soaked pants.
Few teachers receive training on childhood toileting problems—only 18 percent, according to the UCSF survey — so it's unsurprising that teachers may not realize their bathroom policies pose health risks to students.
Still, it surprises me when teachers assume students requesting to use the bathroom are trying to game the system.
One Facebook commenter, a former teacher, insisted that when students ask for a bathroom pass, it's for reasons unrelated to biology, including "boredom, curiosity, to play around in the bathroom, because their friend needed to go, to get out of doing other things."
She wrote that Sarah Moreno and her defenders "obviously never had to try and teach a class full of children who need to go to the bathroom all day long."
This woman obviously has never worked in a pediatric urology clinic! When kids need to use the bathroom urgently or frequently, it's often because constipation has irritated their bladder nerves, causing the bladder to hiccup. If a student frequently and/or urgently requests to use the bathroom, that's a red flag for constipation (see our free download, 12 Signs a Child Is Constipated"), and the teacher should alert the parents and school nurse.
This former teacher continued on Facebook: "I don't get up during meetings to go to the restroom. That's not how life works, people."
Yikes, harsh! This person is an adult—with a fully grown bladder, unlimited bathroom access, and no fear of being bullied in a restroom stall at lunchtime.
Interestingly, the UCSF teachers survey was conceived and co-authored by a former teacher, Lauren Ko, now a Harvard University medical student. Before entering med school, Ko taught second grade at a Bronx school that limited bathroom access to certain times of the day.
"I noticed kids having accidents in the classroom," Ko told me, "and I know it was really humiliating for them."
I know teachers have the very tough job of managing a classroom on top of countless other stresses, and I know there will always be students who take advantage. But if students who claim they have to pee are in fact roaming the hallways, surely measures can be taken that are unrelated to restricting bodily functions.
As one mom posted on Facebook: "Using the bathroom is a biological necessity, not a privilege to be earned or denied."
I couldn't agree more.
Steve Hodges, M.D., is an associate professor of pediatric urology at Wake Forest University School of Medicine and co-author, with Suzanne Schlosberg, of It's No Accident and Bedwetting and Accidents Aren't Your Fault.