Toileting, Continence and Intimate Care in Wales: A Practical Guide for Families from Nursery to University

A Wales-focused parent guide to toileting, continence and intimate care support from nursery to university, including IDPs, IHPs, school nursing, safeguarding, Health Board routes and peer support.

This article gives general information for families in Wales. It is not legal, medical, therapeutic or safeguarding advice. If a child or young person is unwell, in pain, unsafe, at risk, or there are urgent safeguarding concerns, seek appropriate professional or emergency help.

Toileting is one of the hardest topics for parents and young people to talk about.

Many parents do not ask about it publicly. Young people may be too embarrassed to raise it at school, college or university. Families may search privately late at night for things like:

• Can school refuse to help my autistic child wipe?
• My child is in Year 3 and still cannot wipe properly.
• Who should help a disabled child use the toilet at school?
• What is an intimate care plan?
• Can a school say they will only verbally prompt toileting?
• Where do I get continence help in Wales?
• Does toileting support go in an IDP or an IHP?
• What happens at college or university if a young person needs toileting support?

These are real questions. They are not silly, shameful or rare.

Toileting, continence and intimate care can affect whether a child or young person can stay clean, comfortable, safe and dignified enough to learn. If a learner is worried about accidents, smells, wiping, changing, pain, constipation, periods, bullying or being refused help, they may not be able to focus on phonics, maths, GCSEs, college coursework or university lectures.

This is not just about “toilet training”. For some children and young people, toileting support is linked to disability, health, development, sensory processing, interoception, mobility, communication, learning disability, anxiety, trauma, chronic illness or physical access.

The practical question is not:

“Are they too old for help?”

The better question is:

“What support does this learner need to stay clean, safe, dignified and able to access education?”

Quick navigation

If you need somewhere to start:

• Under 5: speak to the health visitor, GP, nursery lead or local authority Early Years ALN team.
• Primary school: ask for the ALNCo and school nurse to review the toileting or intimate care plan.
• Secondary school: involve the ALNCo, school nurse, pastoral lead and safeguarding lead if needed.
• FE college: contact the college ALNCo, learner support or wellbeing/disability team.
• University: contact the university disability service early, and also speak to the GP or adult social care if personal care is needed.
• Age 18 to 25: consider GP, adult continence services, adult social care, community nursing and education support together.

School won’t help my child wipe. Can they refuse?

A parent asks:

My son is in Year 3 and has a diagnosis of ASD. He is not yet independent with wiping himself. It has not been an issue before because he had not had a poo in school, but over the past few weeks he has. School have put a toileting plan in place but say he needs to be independent with intimate care, so they will only provide verbal prompting and supervision. This will not meet his needs because he cannot do it yet. Can they refuse to help him?

In plain English: if verbal prompting does not meet the child’s needs, the plan needs reviewing.

A school would normally be expected to consider what support the child actually needs, rather than simply saying “he needs to be independent” when the child is not yet able to manage intimate care because of disability, developmental need, health need, sensory need, communication difficulty or additional learning need.

Schools can and should promote independence where that is realistic. But independence should usually be built gradually, safely and with dignity. It should not be used as a reason to leave a child soiled, distressed, embarrassed, excluded from learning or at risk of bullying.

For a Year 3 child with autism who cannot yet wipe effectively, the family can reasonably ask for:

• an urgent review of the toileting or intimate care plan;
• involvement of the ALNCo;
• advice from the school nurse or relevant health professional;
• consideration of whether an Individual Healthcare Plan is needed;
• consideration of whether the support should be reflected in the child’s IDP if toileting affects access to learning;
• clear agreement about who will help, how, where, when and how privacy will be protected;
• a plan to build independence over time, if appropriate.

Toileting is not always “behaviour”

Toileting difficulties may be misunderstood as refusal, laziness, poor parenting, defiance or attention-seeking.

Sometimes the issue is actually:

• constipation;
• overflow soiling;
• bladder or bowel condition;
• delayed development;
• autism;
• ADHD;
• learning disability;
• global developmental delay;
• cerebral palsy;
• spina bifida;
• muscular dystrophy;
• Down syndrome;
• Ehlers-Danlos syndrome or hypermobility-related difficulties;
• inflammatory bowel disease, including Crohn’s disease or ulcerative colitis;
• epilepsy or neurological conditions;
• mobility impairment;
• visual impairment;
• dyspraxia or motor planning difficulty;
• sensory processing differences;
• interoception difficulty, where the person does not reliably notice internal body signals;
• severe anxiety, trauma or school-related distress;
• communication difficulty;
• ARFID or restricted eating patterns affecting bowel health;
• medication side effects;
• menstrual care needs;
• personal care needs linked to complex disability.

For autistic children and young people, toileting can also be linked to sensory and interoceptive differences. Interoception is the sense that helps a person notice internal body signals such as hunger, thirst, pain, temperature and needing the toilet. A child may genuinely not recognise the need to go until very late. Another child may know they need the toilet but be unable to tolerate the smell, sound, lighting, hand dryers, locks, other pupils, or lack of privacy in school toilets.

A learner may also be able to manage at home but not in school, or manage in primary school but struggle again in secondary school, college or university when the environment becomes larger, busier and less predictable.

When to seek medical advice promptly

Not every toileting issue is educational. Some need medical advice.

Parents should seek medical advice promptly if there is:

• blood in poo or urine;
• severe constipation;
• repeated soiling or wetting after a period of being dry or clean;
• pain when passing urine or poo;
• tummy pain, vomiting or bloating;
• repeated urinary tract infections;
• weight loss or poor growth;
• sudden loss of bladder or bowel control;
• new weakness, numbness, back pain or walking difficulty;
• extreme thirst or passing urine much more often than usual;
• fever or signs of infection;
• a child who seems very unwell;
• distress, fear or safeguarding concern linked to toileting.

Parents do not need to work out the cause alone. A good first step is to contact the GP, health visitor or school nurse and ask:

“Could constipation, overflow soiling, infection, pain or another health issue be contributing to this?”

Constipation and soiling: why this matters

If a child is soiling, having poo accidents, avoiding the toilet, passing very large or hard stools, complaining of tummy pain, or having runny stool leak into underwear, constipation should be considered.

The NHS explains that soiled pants in a child over 1 can be a sign of constipation because runny poo can leak around hard constipated poo. This is often described as overflow soiling. The NHS also says constipation and soiling are not something a child is doing on purpose, and recommends seeking help early because constipation can become harder to resolve the longer it continues [1].

NICE has guidance on constipation in children and young people up to age 18. It covers diagnosis and management, including early identification, treatment, diet and lifestyle, psychological support, and information for families [2].

This matters because if the underlying issue is constipation, punishment, shame or “try harder” approaches can make things worse.

Support and independence are not opposites

It is reasonable for schools, colleges and families to want a child or young person to become as independent as possible.

But independence does not usually come from leaving a learner unsupported before they have the skills, body awareness, confidence or physical ability to manage.

Support and independence can sit together.

A good plan might include:

• meeting the learner’s current need;
• protecting dignity now;
• teaching one step at a time;
• using visual prompts or social stories;
• practising skills at the right time and pace;
• reducing adult help gradually where appropriate;
• recognising when full independence may not be realistic;
• reviewing progress without shaming the learner.

The aim should be:

“What can this learner do now, what support do they need today, and what is the next realistic step?”

Not:

“They are old enough, so they must manage.”

What is an intimate care plan?

An intimate care plan is a written plan for support with personal care tasks that involve privacy, dignity and bodily care.

It may cover things such as:

• wiping after using the toilet;
• changing continence products;
• cleaning after accidents;
• changing clothes;
• washing hands;
• menstrual care;
• help transferring on or off the toilet;
• use of disabled toilets, accessible toilets or Changing Places toilets;
• supervision for safety;
• communication support;
• privacy arrangements;
• infection control;
• recording and review;
• how independence will be encouraged safely.

The plan should be specific. It should not simply say “verbal prompting” if the child actually needs physical assistance.

A good intimate care plan should answer:

• What exactly does the learner need help with?
• Who will provide the help?
• What training do they need?
• Where will it happen?
• How will privacy be protected?
• How will the learner’s views be heard?
• How will staff communicate with parents or carers?
• What will be recorded?
• What happens on trips, transport, exams, placements or residential visits?
• What is the plan for building independence, if that is realistic?
• When will the plan be reviewed?

Who should wipe a child or young person?

This is the question many people avoid.

The safest practical answer is:

The trained adult identified in the intimate care plan, following the setting’s safeguarding, dignity, hygiene and recording procedures.

It should not be:

• another child;
• a sibling in school;
• a random available adult with no plan;
• a volunteer without appropriate checks and boundaries;
• “nobody” simply because the child is considered too old.

Age alone is not the deciding factor. Need is.

A 4-year-old, 8-year-old, 14-year-old, 17-year-old or 22-year-old may need support with toileting or personal care because of disability, health, mobility, learning, communication or sensory needs.

That does not mean support should be casual or unplanned. It means the support should be planned properly.

Safeguarding: intimate care should be safe, not shameful

Intimate care is a safeguarding-sensitive area. That does not mean no one can provide it. It means it must be planned properly.

A well-designed intimate care plan protects the learner and the staff member.

Staff should not be expected to provide intimate care without:

• a clear written plan;
• training;
• management support;
• safeguarding procedures;
• clarity about recording;
• appropriate facilities;
• a route to raise concerns.

Families also need reassurance that intimate care will be provided respectfully, privately and safely.

Good safeguarding practice usually means:

• parental involvement for children;
• learner involvement wherever possible;
• clear staff roles;
• appropriate training;
• safe recruitment and checks;
• respect for privacy;
• appropriate recording;
• agreed communication with parents or carers;
• no unnecessary audience;
• no humiliating language;
• clear escalation if concerns arise;
• review if the learner becomes distressed or the plan is not working.

A setting should not use safeguarding as a blanket reason to refuse intimate care. Instead, safeguarding should shape how intimate care is delivered safely.

Welsh Government’s Keeping learners safe guidance is the statutory safeguarding guidance for local authorities and governing bodies in maintained schools and further education institutions in Wales [3].

Why schools may be nervous

Some schools are not trying to be cruel or obstructive. They may be worried about:

• staff confidence;
• allegations;
• privacy;
• lack of training;
• unclear policy;
• infection control;
• staffing levels;
• uncertainty about what they are allowed to do;
• fear of getting it wrong.

Those worries are not irrelevant. But they should lead to proper planning, not refusal.

A calm way to frame it is:

“We need a plan that protects my child’s dignity and safety, and also gives staff the training and clarity they need.”

What does Welsh guidance say schools should do?

Welsh Government guidance on supporting learners with healthcare needs applies to maintained schools, pupil referral units and local authorities in Wales [4].

The guidance explains that medical conditions can affect children and young people’s social development, ability, confidence and educational attainment. It also says seamless support services should be available to meet learners’ needs and allow continuity in accessing educational opportunities at school, at home, in hospital or another setting, in cooperation with parents, carers and the learner’s usual school [4].

In practical parent language, this means:

If toileting or continence needs are affecting education, the school should not treat it as an awkward favour. It should be planned as part of the learner’s access, health, dignity and safeguarding support.

School nursing and Individual Healthcare Plans

In Wales, school nursing advice is often a key bridge between health and education. Where toileting or continence needs affect the school day, parents can ask the school to involve the school nurse and consider whether an Individual Healthcare Plan is needed.

An Individual Healthcare Plan, often called an IHP, may be relevant where a learner has healthcare needs that require planned support in the education setting.

For toileting and continence, an IHP may be relevant where the learner has:

• constipation or overflow soiling;
• bladder or bowel condition;
• prescribed medication such as laxatives;
• continence products;
• catheterisation or stoma care;
• mobility or transfer needs;
• a diagnosed health condition affecting toileting;
• a need for emergency procedures;
• health-related personal care support during the day.

An IHP should identify what support is needed, who will provide it, what training is needed, how information will be shared, and when the plan will be reviewed.

IDP or IHP: which plan should toileting support go in?

Some families are told:

“That is medical, so it cannot go in the IDP.”

Others are told:

“That is school support, so health does not need to be involved.”

Real life is often not that tidy.

Toileting support may sit in:

• an intimate care plan;
• an Individual Healthcare Plan;
• an Individual Development Plan;
• a care and support plan;
• a university disability support plan;
• more than one of these.

The question is what the toileting need affects.

If the issue is mainly health-related, such as constipation treatment, medication, continence products or clinical advice, an IHP may be needed.

If the toileting difficulty affects the learner’s ability to access education or training, or they need support that is additional to or different from what is generally available to learners of the same age, it may also need to be considered through the ALN system.

Welsh Government’s parent guide to rights under the ALN system says a child or young person may have ALN if they need extra support to learn because they find it harder to learn than others of the same age, or because they have a disability that means they cannot use, or find it difficult to use, facilities for learning in a local nursery, school or college. The extra support is called additional learning provision, or ALP [5].

The same guide says young people up to age 25 with ALN are entitled to an IDP if they stay in education, and that the ALP written into an IDP must be provided [5].

We explain the relationship between IDPs and IHPs in more detail here: IDP vs IHP in Wales: What Parents Need to Know.

The practical test for parents is:

“Does this toileting need affect my child’s ability to access learning, attend, participate, stay safe, stay regulated or remain in the setting?”

If yes, it should not be dismissed as “just toileting”.

What might toileting support look like in an IDP?

If toileting affects learning access, attendance, participation, regulation or safety, the IDP may need to describe the need and the additional learning provision clearly.

Examples might include:

• access to a quieter or accessible toilet;
• adult support for toileting transitions;
• a named adult to provide intimate care support;
• visual sequence cards;
• extra time for toileting;
• discreet toilet pass;
• sensory adjustments around toilets;
• access to spare clothes stored privately;
• support to manage continence products;
• agreed communication between home and school;
• support during trips, exams, transport or off-site learning;
• planned teaching of independence skills;
• staff training around the learner’s communication, sensory or personal care needs;
• review by ALNCo and relevant health professionals.

The wording should be specific enough that everyone knows what is being provided, by whom, how often and in what circumstances.

Can school say they will only verbally prompt?

Sometimes verbal prompting is enough. For example, a child may need reminding to go, prompts to use toilet paper, or a visual sequence on the toilet wall.

But verbal prompting is not enough if the learner cannot actually complete the task.

If a child cannot wipe effectively, cannot tell whether they are clean, cannot manage clothing, cannot use the toilet safely, or becomes distressed and dysregulated, then a plan that only says “verbal prompting” may not meet need.

A more realistic plan might include:

• a discreet prompt to use the toilet;
• enough time to go without rushing;
• access to a suitable toilet;
• use of wipes or agreed hygiene products if appropriate;
• adult assistance with wiping or checking cleanliness where needed;
• visual sequence or social story;
• spare clothes and storage arrangements;
• agreed communication with home;
• recording accidents without shaming the child;
• a gradual independence programme;
• school nurse or continence advice;
• review date.

The aim should be dignity and progress, not public embarrassment or forced independence before the learner is ready.

Which professional is most likely to help?

This is often where families get stuck. Everyone agrees there is a problem, but nobody is clear who owns the next step.

This table is a starting point.

What if the school says “we don’t have staff for that”?

Schools and colleges are under pressure, but lack of convenience does not remove the learner’s needs.

If a school says there is nobody available, parents can ask:

• Who is responsible for healthcare needs in school?
• Has the school involved the school nurse?
• Has the governing body’s healthcare needs policy been followed?
• Has the ALNCo reviewed whether this affects access to learning?
• Has a risk assessment been completed?
• What is the contingency plan if the named staff member is absent?
• What reasonable adjustments have been considered?
• What is the plan while advice is being obtained?

What if the school asks the parent to come in and do it?

Sometimes a parent may agree to attend temporarily during an emergency or while a plan is being created. But it should not become the long-term solution if the child needs support to access education.

Requiring a parent to come into school every time a disabled child needs intimate care can affect:

• the child’s dignity;
• the child’s inclusion;
• the parent’s work or caring responsibilities;
• attendance;
• equality of access;
• the child’s ability to take part in trips, lunch, clubs and ordinary school life.

If this is happening, parents can ask for the arrangement to be reviewed urgently.

A useful phrase is:

“I am willing to support the school with information and planning, but I do not think it is appropriate for my child’s access to education to depend on me being available to attend school for toileting. Please confirm what school-based arrangements will be put in place.”

My child is 12, 16 or 20 and still needs help. Have I failed?

No.

Needing toileting or intimate care support at an older age does not mean a parent has failed.

Some children and young people need support because of disability, developmental delay, physical impairment, learning disability, sensory differences, continence conditions, health needs or complex care needs.

Some will become more independent over time.

Some will always need some level of support.

Some may manage at home but need support in unfamiliar, busy or inaccessible environments.

The issue is not shame. The issue is planning.

Older children and young people deserve privacy, dignity, choice and respect. They should be involved in decisions about their own support wherever possible.

For some young people, the most important first step is not a formal complaint. It may be a quiet plan with one trusted adult, a private toilet arrangement, spare clothes, a communication card, and a clear agreement that they will not be embarrassed in front of peers.

Menstrual care and intimate support

For some learners, intimate care needs relate to periods rather than toileting.

Support may include:

• changing sanitary products;
• managing heavy bleeding;
• support with hygiene;
• disposal of products;
• access to private facilities;
• pain management plans;
• communication support;
• spare clothing;
• support during trips, exams, placements or residential visits.

The same principles apply: dignity, privacy, safeguarding, reasonable adjustments and access to education.

For autistic learners, learners with learning disabilities, physically disabled learners, learners with communication differences or young people who experience severe anxiety, menstrual care may need to be planned carefully. It should not be treated as a private problem the learner must simply manage alone if they cannot yet do so.

What about older children and teenagers?

Toileting support does not stop being real because a child reaches secondary school.

Teenagers may need support because of:

• learning disability;
• autism and interoception difficulties;
• physical disability;
• continence conditions;
• anxiety;
• trauma;
• menstruation support needs;
• inflammatory bowel disease;
• chronic constipation;
• medication effects;
• mobility issues;
• personal care needs;
• severe sensory distress around school toilets.

Secondary school can make toileting harder because there may be:

• locked toilets;
• rules about not going during lessons;
• busy corridors;
• bullying;
• poor privacy;
• noisy hand dryers;
• strong smells;
• period shame;
• PE changing;
• multiple teachers;
• fear of asking.

For teenagers, plans must be especially careful about dignity, privacy and voice. The young person may have clear views about who supports them, what language is used, where they go, and how information is shared.

Toileting, exams and assessments

Toileting needs can affect exams and formal assessments.

A learner may need:

• a toilet pass;
• rest breaks;
• supervised breaks;
• access to a nearby toilet;
• extra time if appropriate;
• a separate room;
• a smaller room;
• permission to leave discreetly;
• support with continence products;
• spare clothes;
• medication or fluid arrangements;
• access to an accessible toilet or Changing Places toilet;
• a plan for practical assessments, placements or fieldwork.

Parents and young people should raise this early with:

• ALNCo;
• exams officer;
• college learner support;
• university disability service;
• course tutor if placements are involved.

Exam arrangements often need evidence and notice. Do not leave this until the week of the exam.

Changing Places and accessible toilets

Some disabled children and young people need more than a standard toilet.

They may need:

• space for a carer;
• hoist;
• changing bench;
• accessible toilet;
• Changing Places toilet;
• safe transfer space;
• room for equipment;
• privacy for changing clothes or continence products.

This matters for:

• secondary school;
• FE college;
• university;
• trips;
• work placements;
• hospitals;
• leisure activities;
• community learning;
• exams and open days.

Families and young people can search for registered Changing Places toilets using the Changing Places Toilets finder [6].

Parents and young people can ask:

“Is there an accessible toilet or Changing Places toilet available, and if not, what is the plan for personal care support during the day?”

Toileting and attendance

Some children and young people avoid school because of toileting.

This may happen if they:

• fear having an accident;
• are constipated and in pain;
• cannot wipe properly;
• are bullied because of smell;
• are refused permission to use the toilet;
• cannot tolerate the toilets;
• are afraid of hand dryers or locks;
• have periods and cannot manage changing;
• do not have access to a suitable toilet;
• are embarrassed by previous incidents.

If toileting is affecting attendance, the question should not be reduced to:

“Why won’t they come in?”

A better question is:

“What toileting, health, sensory, dignity or safeguarding barrier is making attendance difficult?”

Parents can ask school to record toileting as an access issue and involve the ALNCo, school nurse and relevant local authority staff before attendance escalates.

We discuss the link between sensory needs, attendance, EBSA and school avoidance in more detail here: Sensory Needs, Attendance, EBSA and School Avoidance.

Nursery and early years: where to start

For children aged 0 to 5, toileting concerns may involve development, constipation, communication, sensory needs, disability or delayed readiness.

Parents can ask for help from:

• health visitor;
• GP;
• nursery manager or childcare provider;
• Flying Start health visitor if applicable;
• nursery ALNCo or setting lead;
• local authority Early Years Additional Learning Needs Lead Officer or early years ALN team;
• paediatrician or community child health team if already involved;
• occupational therapist where physical, sensory or functional needs are significant.

Welsh Government’s ALN parent guide says parents of children from birth up to age 5 who do not attend a local authority nursery or school can tell the local authority Early Years Additional Learning Needs Lead Officer or early years ALN team that their child may have ALN. It also says a professional referral is not required and the child does not need a diagnosis for a parent to tell the local authority the child might have ALN [5].

That is important. Parents do not need to wait until school if toileting is part of a wider developmental or access concern.

Primary school: what to ask for

For a primary-age child who cannot wipe, soils, wets, withholds, avoids school toilets or needs intimate care, parents can ask for:

• review of the toileting or intimate care plan;
• ALNCo involvement;
• school nurse advice;
• GP review if constipation, pain or soiling is possible;
• reasonable adjustments to toilet access;
• visual supports or routines;
• staff training;
• spare clothes arrangements;
• privacy arrangements;
• consideration of an IHP;
• consideration of whether the IDP needs updating;
• review date.

Useful parent wording:

Please can we urgently review the toileting and intimate care plan. My child is not yet able to clean themselves effectively, and verbal prompting alone is not meeting their needs. I am asking the school to consider what support is required so they can remain clean, safe, dignified and able to access learning. Please involve the ALNCo and school nurse, and confirm who will be responsible for intimate care support, what training they have, how privacy will be protected, and when the plan will be reviewed.

Secondary school: what to ask for

For a secondary-age learner, the route is usually:

• form tutor or head of year;
• ALNCo;
• school nurse;
• pastoral lead;
• safeguarding lead if there are safety concerns;
• GP or continence service if health input is needed;
• local authority if the school cannot or will not make appropriate arrangements.

Ask for:

• toilet pass or discreet exit arrangement;
• access to suitable toilet facilities;
• named trusted adult;
• plan for changing and spare clothing;
• period support if relevant;
• anti-bullying plan if there has been teasing or smell-related bullying;
• reasonable adjustments around uniform, PE and changing;
• IHP if health needs are involved;
• IDP review if toileting affects learning access, attendance or participation.

FE college: toileting support at 16+

In Wales, the ALN system can continue into further education. Welsh Government’s parent guide says young people up to age 25 with ALN are entitled to an IDP if they stay in education [5].

At FE college, the young person’s own rights and voice become central. Parents may still support them, but colleges will usually need the young person’s consent to share information unless there is another legal basis.

The young person can contact:

• college ALNCo;
• learner support team;
• wellbeing or disability support team;
• course tutor;
• safeguarding or pastoral team;
• GP;
• adult or young person’s continence service, depending on local pathway;
• social care if personal care support is needed.

Questions to ask college:

• Who is the ALNCo?
• Is there an IDP, and does it describe toileting or personal care access needs?
• Is a healthcare or personal care plan needed?
• Which toilets can the learner use?
• Is there a Changing Places toilet or accessible toilet?
• Who supports the learner during lessons, breaks, trips, placements or exams?
• What happens if the learner has an accident?
• How will dignity and confidentiality be protected?
• Is transport affected?

Where a young person’s needs cannot be met in a standard setting or timetable, families may also need to understand the difference between mainstream college support, additional learning provision, alternative arrangements and EOTAS. We explain EOTAS here: EOTAS Explained.

University and higher education

At university, support is usually arranged differently from school or college.

A student may need to contact:

• the university disability service;
• accommodation team;
• student wellbeing service;
• Disabled Students’ Allowance route through Student Finance Wales;
• GP;
• adult continence service;
• adult social care;
• NHS community services;
• personal assistant or care provider if personal care is needed.

It is important to be clear that university disability services and Disabled Students’ Allowance usually focus on study-related support. Personal care, such as help with toileting, washing or dressing, may need to be arranged through social care, NHS continuing healthcare where applicable, or privately funded care, depending on the person’s circumstances.

A young adult going to university who needs toileting support should not leave this until freshers’ week. Planning may need to cover:

• accessible accommodation;
• ensuite facilities;
• Changing Places toilets;
• distance between accommodation and teaching rooms;
• timetable spacing;
• personal care package;
• emergency support;
• laundry arrangements;
• field trips or placements;
• confidentiality;
• evacuation plans.

Age 18 to 25: when adult social care may be needed

If a young person aged 18 to 25 needs help with toileting or personal care, this may be an adult social care issue as well as an education issue.

Support may involve:

• adult social care assessment;
• carer’s assessment for unpaid carers;
• direct payments;
• personal assistant support;
• community nursing;
• continence service;
• GP;
• occupational therapy;
• adaptations or equipment;
• supported living or accommodation planning.

The Social Services and Well-being (Wales) Act 2014 is the main Welsh framework for care and support. It covers people who need care and support and carers who need support, with a focus on well-being, voice and control, prevention and early intervention [7].

Parents should not assume that a college or university can provide personal care simply because the young person is enrolled there. Education support and personal care support may need to be planned together.

Where to go by Health Board in Wales

Continence, toileting and bladder or bowel pathways are not equally visible online across Wales. Some Health Boards publish clearer information than others. In some areas, families may be routed through the GP, health visitor, school nurse, paediatrician, community nursing, bladder and bowel service, continence service, or adult continence service.

For that reason, the safest first step is usually:

Ask the GP, health visitor, school nurse, college learner support team or university disability service: “How do we access the local continence, bladder and bowel, school nursing or community nursing pathway for our Health Board area?”

Use the table below as a navigation starting point, not as a guarantee of a single referral route.

When contacting health, parents can say:

My child or young person is having toileting, continence or intimate care difficulties that are affecting education, dignity and daily life. Please can you advise on the correct continence, bladder and bowel, school nursing, paediatric, community nursing or adult continence pathway for our Health Board area?

If the issue is affecting school, college or university access, ask education at the same time. Do not wait for health and education to decide between themselves. Families often need both routes open at once.

When local authority involvement may be needed

The local authority may need to be involved where:

• the child may have ALN and the school cannot meet need without additional provision;
• the child is under compulsory school age and may have ALN;
• toileting needs are affecting attendance or access to education;
• the school is refusing to make appropriate arrangements;
• the child is out of school because of health needs;
• EOTAS may be relevant;
• social care support is needed at home;
• equipment or adaptations are needed;
• transport arrangements are affected;
• a school-maintained IDP may need local authority reconsideration;
• the family needs information, advice or dispute resolution.

Welsh Government’s ALN parent guide says local authorities must provide impartial information and advice about ALN and the ALN system. It also explains that parents, children and young people can challenge decisions about ALN, including decisions about whether a child or young person has ALN, how ALN is described in an IDP, and the support described in the IDP [5].

If school says “this is not our job”

A calm response is:

I understand that toileting support may involve health advice, but it is affecting my child’s ability to access school safely, cleanly and with dignity. Please confirm how the school will work with the ALNCo, school nurse, health professionals and local authority if needed, so that an appropriate plan is in place.

If the issue continues, parents can ask for:

• the school healthcare needs policy;
• the intimate care policy;
• the ALN policy;
• the complaints policy;
• a meeting with the headteacher and ALNCo;
• school nurse input;
• local authority ALN advice;
• local authority school improvement or inclusion advice;
• social care assessment if the issue affects care and support at home;
• advocacy or dispute resolution where ALN rights are engaged.

What parents can write to school

Subject: Request for urgent review of toileting/intimate care support

Dear [Name],

Please can we urgently review [child’s name]’s toileting and intimate care plan.

At present, verbal prompting and supervision are not meeting [child’s name]’s needs. [He/she/they] cannot yet clean [himself/herself/themselves] effectively after using the toilet. This means [he/she/they] may be left uncomfortable, unclean, distressed, embarrassed and unable to access learning properly.

I am asking the school to consider what support is required so that [child’s name] can remain clean, safe, dignified and included in school life.

Please can the review include:

• the ALNCo;
• school nurse advice;
• whether an Individual Healthcare Plan is needed;
• whether the IDP needs to reflect toileting support as part of access to learning;
• who will provide intimate care support;
• what training staff need;
• how privacy and safeguarding will be protected;
• what will happen if the named adult is absent;
• how school will support gradual independence where appropriate;
• when the plan will be reviewed.

Please can we arrange a meeting as soon as possible.

Kind regards,

[Name]

What young people can say

For older learners, especially in secondary school, FE or university, the wording may need to come from the young person.

They might say:

I have a health/disability need that affects toileting. I need a private support plan so that I can attend and take part without embarrassment. Please tell me who I should speak to about toilet access, support if I have an accident, and keeping this confidential.

Or:

I do not want this discussed in front of other students. I need a named person I can go to if there is a problem.

Or:

I need access to a toilet when I ask. Waiting until the end of the lesson is not always possible because of my condition.

Peer support, reducing stigma and improving navigation

Toileting and intimate care are topics many parents, children and young people find deeply embarrassing to discuss.

That silence can make families feel isolated. Parents may assume they are the only family dealing with the issue. Young people may feel ashamed, anxious or reluctant to seek help.

They are not alone.

The Learn Without Limits CIC community exists partly because families often benefit from speaking to people who understand these challenges from lived experience. Peer support cannot replace medical advice, safeguarding procedures, educational planning or professional assessment. However, it can help families understand what questions to ask, where to go for help, and how others have navigated similar situations.

We also believe it is important to reduce the stigma surrounding toileting, continence and intimate care.

No child, young person or student should find nursery, school, further education or higher education inaccessible because adults are uncomfortable discussing toilets, continence or personal care needs.

A learner who cannot access appropriate toileting support may struggle with attendance, participation, concentration, confidence, friendships, health, dignity and educational progress.

One of the reasons Learn Without Limits CIC is interested in this issue is that families repeatedly tell us they struggle to identify the correct route into continence, bladder and bowel support. Across Wales, referral routes can vary between areas and are not always easy for families to find or understand.

Over time, we would like to work constructively with Welsh Health Boards, education providers and other partners to help create clearer, more visible continence and toileting pathways so that parents and young people know exactly where to go for support.

The goal is simple:

Make it easier for families to get help early, reduce unnecessary distress, and ensure that toileting and continence needs do not become avoidable barriers to education, training or participation in everyday life.

What a good plan should avoid

A toileting or intimate care plan should not:

• shame the learner;
• blame the parent;
• assume the child is doing it on purpose;
• leave the learner soiled;
• rely indefinitely on parents attending school;
• make another child responsible;
• discuss the issue publicly;
• remove the learner from trips or lunch without proper planning;
• punish attendance where absence is linked to health or disability;
• ignore constipation or pain;
• ignore sensory barriers;
• set unrealistic independence targets;
• refuse help because of age alone.

The key principle

Toileting is not a small issue when it affects education.

A child or young person who cannot stay clean, comfortable and dignified may be unable to learn. A learner who fears accidents, smell, teasing, pain or being refused help may avoid school, college or university altogether.

The aim is not to make toileting dramatic. It is to make support ordinary.

Quiet planning. Clear roles. Trained adults. Health advice where needed. ALN planning where access to learning is affected. Social care where personal care support is needed. Respect for the learner’s dignity at every age.

Families should not have to fight through shame and confusion to get basic support.

A simple starting sentence is often enough:

My child or young person needs toileting support to stay clean, safe, dignified and able to learn. Please tell me who will help us put the right plan in place.

Related articles

• IDP in Wales Explained
• IDP vs IHP in Wales: What Parents Need to Know
• Sensory Needs, Attendance, EBSA and School Avoidance
• EOTAS Explained

References

[1] NHS, “Constipation in children.” Accessed: Jun. 2026. Available: https://www.nhs.uk/baby/health/constipation-in-children/

[2] National Institute for Health and Care Excellence, “Constipation in children and young people: diagnosis and management,” Clinical guideline CG99. Published May 2010; updated Jul. 2017. Accessed: Jun. 2026. Available: https://www.nice.org.uk/guidance/cg99

[3] Welsh Government, “Keeping learners safe.” Accessed: Jun. 2026. Available: https://www.gov.wales/keeping-learners-safe

[4] Welsh Government, “Supporting learners with healthcare needs.” Accessed: Jun. 2026. Available: https://www.gov.wales/supporting-learners-healthcare-needs

[5] Welsh Government, “A guide for parents about rights under the additional learning needs (ALN) system.” Accessed: Jun. 2026. Available: https://www.gov.wales/guide-parents-about-rights-under-additional-learning-needs-aln-system-html

[6] Changing Places Toilets, “Find a toilet.” Accessed: Jun. 2026. Available: https://www.changing-places.org/find

[7] Legislation.gov.uk, “Social Services and Well-being (Wales) Act 2014.” Accessed: Jun. 2026. Available: https://www.legislation.gov.uk/anaw/2014/4/contents

[8] Legislation.gov.uk, “Equality Act 2010.” Accessed: Jun. 2026. Available: https://www.legislation.gov.uk/ukpga/2010/15/contents

[9] Welsh Government, “The Additional Learning Needs Code for Wales 2021.” Accessed: Jun. 2026. Available: https://www.gov.wales/additional-learning-needs-code

[10] ERIC, The Children’s Bowel & Bladder Charity, “Help and advice for children’s bowel and bladder problems.” Accessed: Jun. 2026. Available: https://www.eric.org.uk/

[11] Bladder & Bowel UK, “Child information library.” Accessed: Jun. 2026. Available: https://www.bbuk.org.uk/children-young-people/children-resources/