Bladder Control - Children who do not pee at school.

Most parents do not know how many times their child pees at school. Unless the child has a problem with daytime wetting, most parents do not inquire about this basic health-related behavior.

When I assess an elementary-aged child I always ask the child about their school day voiding behavior. Almost every child is able to offer a good description of how often and when they pee at school. The answers offer important clues about bladder control and hydration in the child.

If a child does not pee at all at school, this has several possible and important implications.

1. At the very least, the hydration of the child at school is very poor. When a child goes 7 or 8 hours and does not pee, the most common drinking patterns include not drinking at all, limiting drinking to milk at lunch, or infrequent visits to the fountain. 
2. There might be a bathroom phobia concern in the child. There are many reasons why children do not like school bathrooms. Bathroom cleanliness is the most common reason offered when I ask children about why they choose not to pee at school.  
3. The teacher might restrict access to the bathroom to break times (recess, snack, lunch). Many children are very reluctant to use up this precious peer time for something as mundane as peeing. 
4. Some children avoid peeing at school by "learning" to hold their pee for long periods of time. 

Most children who do not pee at school learn to hold their pee under pressure for variable periods of time and most are in a rush to pee when they get home from school. 

Regardless of the reason why the child does not pee at school, the school day hydration of the child is compromised. Poor hydration at school is an important health concern. In children who wet the bed, and whose parents limit evening fluids, this means the hydration of the child is poor during the school day, after supper when the parents limit fluids, and all night while they sleep. Some of these children are only well hydrated in the few hours from arriving home to whenever the parents starts to limit evening fluids! Ouch! 

Parents should ask their children how often they pee at school. Depending on their bladder capacity, a well-hydrated child will need to pee 2 to 4 times at school.  

If your child arrives home thirsty, your child did not drink enough at school. 

Make sure your child drinks at least one oz (30 ml) for every year of age at breakfast to get started on the morning hydration. 

Water is the best liquid for hydration. Milk should not be counted as a hydration fluid. Milk is good nutrition but poor hydration.