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Incontinence!


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Hi!

I currently support a little boy in reception in the afternoons who has a bowel incontinence issue ( ie, he's still in pull ups!). I also change him at other times when I am working elsewhere. He doesn't have a diagnosed problem as yet but is delayed in this area. I change him as and when necessary ( :blink: ) and use the disabled toilet area as this has a couch. At present I have to change him with him lying down ( depsite LA advice that any child who can stand should be changed standing) as he puts his hands in it and spreads it etc. For my own protection I never shut the door, but yesterday another reception child came in, looked amazed then went back to class and told the teacher I was 'chnaging him like a baby'. The Head has suggested I should shut the door, but I am struggling to balance his privacy with my own safety child protection wise.

What do other people do/ would do in this situation?

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Does the school not have a policy covering this? If not I suggest you ask for one to be written and, in the meantime, you need to decide how you can protect this child's privacy and dignity (which are paramount) in a way which you are comfortable with.

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Definitely would not be happy closing the door - goes against everything said in the Plymouth Serious Case Review and could put you at serious risk.

K

The balance between meeting a child's right to privacy and protecting practitioners is always a very thorny issue. We would change children in much the same way you describe, Madmum - in the accessible toilet on a changing mat (on the floor in our case). Because of the layout of the toilets we could leave the door ajar so that we could be heard, but not so far that anyone walking by to the toilets could see the child and so their privacy could be maintained fairly easily.

 

We as a staff team discussed how we would approach the issue, especially with regard to maintaining children's privacy. We were a pre-school setting so we were changing children of all ages, but special care was necessary with the older children so that they weren't teased by the other children who didn't need as much toileting support.

 

You don't say how the situation was handled by the classroom teacher, but I felt so sorry for the child you were changing to know that this had all been witnessed by a child who then proceeded to tell everyone all about it. Plenty of opportunities here to promote children's personal, social and emotional development and especially how we perceive difference and individuality - difficult concepts for some children to grasp.

 

A childminder working in their own home caring for only one child has no-one to witness the 'safety' of the intimate care they provide for the child, so I wonder what the perceived difference is between two professional childcare practitioners who have undergone the same checks?

 

I guess the question you're asking is how do you balance the child's right to privacy and your right to be protected from a false allegation made by a child? Without knowing how your setting is organised, it is difficult to know what to suggest - I'll be interested to hear what other people think!

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When we change our children we do try to keep the door open/ajar - as the owner/manager of the setting I believe it is my responsibility to offer my staff a degree of professional protection (sad in this day and age but unfortunately as well as protecting the children the staff have to be protected too).

 

This is however in a pre-school environment where several children wear nappies so "no one stands out" so to speak.

 

We did have a child that we had to do catheterisation for and in this instance even though we were trained and the continence nurse said that it could be done by one person we always had two people present given the very very intimate nature of the procedure.

 

We currently have lots of children (in and out of nappies) who suffer chronic constipation and are on Movicol this can lead to some quite "explosive" episodes. In these instances it usually takes two of us to sort the child out as it involves a full strip down change of clothes and a bit of a wash and brush up.

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We are fortunate that we have enough staff for two adults to work together when intimate care is needed. Staff were very uncomfortable being alone, even with the door open.

 

Did someone complete a risk assessment for this process?

 

What, in reality, is the risk to staff of changing a child's nappy or pull-ups in a room alone with the door open?

 

 

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sorry but in my opinion he should be entitled to his privacy. The child who saw him is likely to tell others and this could cause serious self esteem issues with this child . If your head is happy for you to change and the parents have given consent then i would be doing just that. Our safeguarding advisor (senior social worker) is perfectly happy with us changing children on our own when we are an established team member and comply with the rules of the setting.

Edited by finleysmaid
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Thank you for all your thoughts!

Mum has given signed permission and a risk assessment has been done in accordance with our policy. At present I am the only staff member willing to do it ( long story......!). I don't have an issue with changing him on my own, and I'm always within earshot, and he can't be seen unless someone comes in on purpose.

I think I will suggest to the class teacher that some input in PSE on being different may be a good idea. I am waiting for some advice from the school nurse on the next step with the whole situation as it's not improving at all!!

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Much respect to you Madmum for being the only one in your setting willing to support this little boy - you're the (probably unsung) hero who is making it possible for this him to attend school. :wub:

 

It sounds like you've got it all pretty much under control - perhaps also some help for the children to understand the issues of privacy so that they don't come barging in? Maybe you need an 'in use' sign for the door to show the children when there is someone in there - having the door slightly open is probably confusing them?

 

Good luck with getting the help and support he needs - it can't be easy for anyone!

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