Are more and more children going to kindergarten in nappies?
Fabian* played, did arts and crafts, listened to stories, sat in a circle and ate snacks. Just like his mates in kindergarten. But there was one thing he didn't do: use the toilet. Although he wore pants and no nappies, he held his wee until he got home. There he quickly put on a nappy and did his business.
Fabian is now in second grade and has been going to the toilet for some time. «But it's been a long road,» says his mother, who wishes to remain anonymous. The fact that a child is not yet dry when they start kindergarten is still taboo. There is a lot of pressure on parents to get rid of their children's nappies before they start kindergarten, as independent toilet visits are considered a criterion for kindergarten readiness.
Putting the child under pressure to become dry is stressful for everyone and often has the opposite effect.
Hannah Gräber, developmental paediatrician
Fabian started going potty when he was around three years old and wanted to be nappy-free. One day, however, urine and faeces went down his trousers. «He was so scared that he didn't want to be without a nappy after that,» says his mother. If he wasn't wearing a nappy, he held it all in.
«We therefore spent a lot of time in the toilet, played games and later also made agreements with Fabian,» recalls his mother. She covered the toilet ring with a terry towel because Fabian was disgusted by it or found it too cold. In the end, cranio-sacral therapy - a gentle alternative medical body therapy - and probably just time helped.
Don't miss the sensitive phase
The current doctrine says that around 90 per cent of children are dry during the day by the age of four. This means that 10 per cent are not. These figures are based on the Zurich longitudinal studies by paediatrician Remo Largo. He compared two generations of children. The first from the 1950s, the majority of whom were already potty-trained in their first year of life.
The other from the 1970s and 1980s, when the advent of the disposable nappy meant that cleanliness education had taken a back seat. It was shown that «an early start and a high intensity of cleanliness education does not accelerate the development of bladder and bowel control».
Getting dry and clean is a complex maturing process that takes place on various levels.
Hannah Gräber, developmental paediatrician
This is also the opinion of developmental paediatrician Hannah Gräber, who co-directs the paediatric practice «Praxis Kind im Zentrum» in Zurich. «There is a sensitive phase in which the child signals that it is ready to go to the potty or toilet,» she explains. Recognising this and supporting the child is important.
It is also essential not to create any pressure: «This is stressful for everyone and often has the opposite effect.» Getting dry and clean is a complex maturing process that takes place on different levels. For some children, this happens earlier, for others later. «This difference is one of the basic laws of development,» says the doctor.
Teachers notice an increase
There are no more recent and equally comprehensive figures on bladder and bowel control in Switzerland than those provided by Remo Largo. Some newspaper articles have recently featured complaints from headteachers and teachers that more and more children are sitting in nappies at nursery and school. Opinions differ among the people interviewed. Hannah Gräber does not see an increase in older nappy-wearing children in her practice.
Barbara Huwiler, a nursery school teacher in Fislisbach in the canton of Aargau, has noticed an increase in her 36-year career. However, nappy-challenged children are still the exception in her day-to-day kindergarten life. One reason for the increase is the earlier starting age, which is now four years in most cantons.
She sees another cause in social changes and family structures: «Today, parents no longer have as much time to simply let their children run around without nappies and then wash them once more in the event of an accident.» Would that make a difference? «Yes,» says Hannah Gräber, «if the child already senses when it needs to, then not wearing a nappy can reinforce this perception.»
We condition our children to wear nappies. However, newborn babies show when they need to eliminate by crying or fussing.
Rita Messmer, therapist and author
The nappies that are too comfortable
Rita Messmer paints a completely different picture. The book author and cranio-sacral therapist from Faoug VD has been dealing with this issue for 40 years and coaches parents whose children wear nappies for long periods of time. In her practice, she sees many desperate parents whose children refuse to go to the toilet and can only - or want to - do their business in a nappy. She believes that the number of unreported cases of incontinent nursery and school children is high. «A look at the supermarket shelves and the internet shows this: There are now nappies and pants with pads for twelve-year-olds,» says Rita Messmer.
She identifies two causes for the increasing nappy dependency. Firstly, the super-absorbent nappies in which children no longer feel that they are wet. Secondly, the conventional wisdom that children will dry themselves when they are ready.
«We condition our children to wear nappies. But newborns indicate when they need to eliminate by crying or being restless,» explains the therapist. In the long term, it is therefore much more effective to hold babies over a container at certain times, for example after sleeping or breastfeeding or when they indicate that they need to eliminate. This reflex is lost around three months after birth if the parents do not react to it.
So what is true? No significant increase, more nappy babies, but still isolated cases, or a huge problem with a high number of unreported cases? The opinions of those surveyed are diametrically opposed. The problem: nothing can be quantified. There are no reliable, up-to-date studies from Switzerland. «Longitudinal studies are complex, expensive and take a long time,» explains Hannah Gräber.
Nappies are not a reason for restitution
But what can parents do when the start of kindergarten is approaching and the child is still wearing nappies? «Definitely talk to the teacher,» says Barbara Huwiler. As a rule, kindergarten teachers are understanding and have ideas on how the nappy can be removed before kindergarten starts. It can also happen that after starting kindergarten, a child who was previously dry suddenly starts wetting again. Sometimes going to the toilet is simply forgotten because of all the playing and new things. «That's no drama,» says Barbara Huwiler, «we also protect the child from being laughed at. After all, it's happened to everyone at some point.»
Our son, who wet himself until the 5th grade, suffered from this and avoided overnight stays in kindergarten or at school.
Affected mother
Both Hannah Gräber and Barbara Huwiler only consider a deferral from kindergarten to be sensible if the child is also lagging behind in other areas of development. However, one thing is clear: kindergarten teachers do not change nappies. If the big business is nappies, the parents have to step in. Simon*'s mum also experienced this. Just like Fabian, Simon no longer wanted nappies when he was around three years old, and that was during the summer holidays.
«At home, however, this suddenly stopped working and he was constantly wetting his pants,» says his mother, who also wishes to remain anonymous. When he continued to wet himself regularly in the second kindergarten, they went to the paediatrician. Investigations then revealed that Simon's neuronal connection to the brain for bladder control was not yet fully developed.
«Parents are not to blame»
It was not until fifth grade that Simon was finally completely dry. Every now and then an accident happened when he didn't have the opportunity to go to the toilet immediately. For this reason, he wore pants with absorbent pads. «He suffered from this and avoided occasions such as sleepovers at nursery or school,» says his mother.
Such situations are not only stressful for the child, but also for the parents involved. Many wonder whether they have done something wrong or argue because they disagree on how to proceed. Those around them may also react with a lack of understanding. However, all of the experts we interviewed are sympathetic to the parents. «It's not their fault,» emphasise both Rita Messmer and Hannah Gräber. And Barbara Huwiler adds: «The most important thing is to remain calm and confident.»
* Names known to the editors
