All children and young people attending school presenting with bladder and or bowel problems should be assessed by their GP in the first instance. The GP can undertake a history, physical examination and make a differential diagnosis for the child/young person presenting with a bladder and / or bowel problem. Prior to referral, constipation and urinary tract infection should be considered and treated: this may result in complete symptom resolution for some. Consent for referral should always be obtained
Who to refer
Please refer to the Bladder and Bowel Pathway for Children and Young People.
In Lothian, initial referral for paediatric continence issues is to Health Visitors for pre-school children and School Nursing Service for all school age children and young people. The Children’s Learning Disability Team assesses all those on their case load. There has not ever been a specialist MEDICAL continence service, although there are other avenues for referral for more complex issues (see below). All School Nurses undertake continence work, managing children and young people on their caseload, to ensure continuity. School Nurses attached to each child or young person’s school will meet with the child and family at a convenient location and time (e.g. at home, in school or in a health centre).
For those attending school, referrals are allocated to the appropriate school nurse who will then undertake a continence assessment incorporating the 3 systems approach (Bladder over activity, lack of vasopressin and lack of arousability helping to formulate an appropriate treatment plan ). The school nurse provides any appropriate continence support or advice that is required. Some children need medication to manage a bowel or bladder condition and the GP is then asked by email to the Practice clinical mailbox to prescribe, with dose titration sometimes required. The School Nurses are not prescribers, so, as with all such recommendations, the GP will need to make the usual assessment as to the suitability for prescribing for an individual patient.
Who not to refer – Complex or Medical Issues.
The School Nurses can liaise with the specialist Paediatric Urology Nurses where there are more complex considerations.
If an underlying medical condition is suspected, then initial referral should be to Paediatrics or Paediatric Urology.
CAMHS guidance for enuresis, encopresis or complex soiling is that the child or young person should be referred to a paediatrician to undertake initial screening to rule out physical causes: referrals to CAMHS for this indication will only be accepted from Paediatricians or relevant Nursing services.
How to refer
For those attending school, referrals are allocated to the appropriate school nurse who will then undertake a continence assessment.
There are 4 teams in Edinburgh:
- SE based at Gracemount Medical Centre
- SW based at Slateford Medical Centre
- NE based at Allander House, Leith walk
- NW based at Pennywell All Care Centre
West Lothian team are based in Bathgate Primary Care Centre.
East Lothian team are based in Mussleburgh Primary Care Centre.
Midlothian team are based in Musselburgh Primary Care Centre.
Secure Intranet page School Nurses contact (scot.nhs.uk)
Please complete a “request for assistance form” found here and attach this to the email.
In order to adopt evidence based and best practice guidance in bowel and bladder management, collaborative working between health professionals, parents/guardians and the child/young person is essential.
The ERIC website www.eric.org.uk contains relevant and evidenced based information relating to bowel and bladder management and can be utilised by health professionals for guidance.
All children/young people who are identified as requiring any medication relating to their bladder/bowel problem will be referred to the GP who will prescribe the appropriate medication according to the LJF (which is being updated 2019) and updated guidance (See Resources). The GP will be responsible for reviewing any prescribed medication although any ongoing support that the child/young person requires may still be offered by the School Nurse.
Nice guidelines for constipation www.nice.org.uk/cg99
Nice guidelines for bedwetting in the under 19’s www.nice.org.uk/cg111
Lothian Guideline for management of Idiopathic Childhood Constipation
The ERIC website provides numerous leaflets that can be downloaded free of charge: www.eric.org.uk
