Control of elimination used to be one of the earliest skills learned in childhood. However, changes in child-rearing practice, society and resources have resulted in toilet training happening later now than in previous generations. There are, however, still expectations that children will be independent with toileting when they start school, unless they have a disability. For children who do have a delay in attaining continence, it is often mistakenly assumed by families and healthcare professionals that lack of urinary or faecal control may be related solely to behavioural or developmental issues, which a child will outgrow, so that the problem should resolve with time. This is rarely the case and most children and families need proactive support and treatment.
Every child deserves the very best start in life and health visitors play a crucial role in achieving this ambition. Public Health England (PHE) has started a process of refreshing the so called 4–5–6 model for health visiting and the healthy child programme. To feed into this robustly, the Institute of Health Visiting (iHV) consulted its members, as well as mums and other stakeholders, and went to the evidence to determine what its own position should be on necessary changes to these important national initiatives.
