0-19 Public Health Integrated Nursing Service (PHINS)
0-19 Public Health Integrated Nursing Service (PHINS offer both Night time wetting support and Continence assessments and product ordering.
Continence is the ability to control your bladder and bowel. Incontinence is the involuntary loss of bladder and bowel control.
0-19 PHINS provides care to families in the context of community messages, family customs, cultural beliefs, attitudes, and public health messages. Bladder and bowel habits often are avoided in general conversation. Stigma and embarrassment prevent discussion and understanding of what normal body functions is.
ERIC website and the Bladder and Bowel UK website offer a wide range of helpful advice and support to those wanting to know more.
Promotion of good eating habits, healthy activity and discussions of normal bladder and bowel habits of babies, children and young people are discussed at every contact with 0-19 PHINS. Early intervention to help babies and children develop a healthy attitude and approach to weeing and pooing is part of the 9-12 month and 27-month development contact. Early toileting from 9 months from when a child can sit supported is now thought to help with good toileting routines and the prevention of continence problems. Accessibility to a potty/toilet is essential, time given to daily routines, praise and reward in the early days and developing independence and good bladder and bowel habits. The ladder of continence is promoted as all children can develop some level of continence.
Some children require additional support if they have not become continent over the age of 5 years. 0-19 PHINS will offer both night-time wetting support and continence product support for children requiring continence products, intervening early to prevent problems developing or worsening.
Referrals for continence support to Leeds Community Healthcare (LCH) services should be made via the GP so that medical issues can be assessed prior to LCH nurses performing a clinical triage into the nurse led services. This means GPs can refer into LCH on one referral form that is then triaged to ensure it is passed to the appropriate service. 0-19 PHINS will offer night-time wetting support for any child or young person between the age of 5 years and 18 years, and ICAN offer daytime wetting support for any child who is toilet trained and between the ages of 5-16 years.
Children with Complex Needs who require continence product support are assessed from 4 years of age and if they are not able to be toilet trained, they may be provided with a suitable product supply as dictated by local and national guidance. All children receiving prescribed continence products will require 6 monthly reviews to ensure the products are suitable and that toilet training support can be provided when the child is ready. 0-19 PHNS work closely with SILC Nurses in Specialist Inclusion Learning Centres and with Children’s Specialist Nursing teams to meet the continence needs of these children and young people. All children requiring products at 19 years will be referred to the Continence, Urology and Colorectal service (CUCs) service.
Ways to get in touch with 0-19 PHINS
Please speak to a member of the 0-19 Public Health Integrated Nursing Service if you or your family would like additional support.
You can contact us via our Single Point of Access (SPA) on 0113 843 5683
Professionals who wish to refer into 0-19 PHINS or would like to obtain advice please call or Clinical Triage Team (CTT) on: 0113 8432358
Further information about the service can be found here: click here
You can also access their social media for evidence-based health information:
Children and Young people over 16
If you have been known for continence products by children’s services they will refer you to the Continence, Urology and Colorectal service (CUCs) service at 19 yrs.
The Continence, Urology and Colorectal service (CUCs) is for any person sixteen or older, with a bladder, bowel or stoma problem or who experiences incontinence.
The service provides advice and education to community nurses and other health, social or informal carer.
Many referrals come to the Continence, Urology and Colorectal Service by a general practitioner or community nurse, although patients may refer themselves to the service.
Find out more here: click here
Toilet and Potty Training
Becoming toilet trained is an important milestone for most children. However, many families have lots of questions about how to start working on the skills that their child will need to learn to use the potty. The information here will help provide you with the answers.
Children with additional needs can usually start to work on the skills for toilet or potty training at about the same chronological age as all children.
You information on toilet and potty training visit the Bladder and Bowel UK website.
Bladder & Bowel UK have also produced the following information Sheets that you may find useful:
Toilet Training Children with Additional Needs
The information provided here will help you to understand the extra help and support that some children with additional needs may need to learn to use the toilet or potty. The information in the leaflets may be helpful for all children, although some of the leaflets are designed for children with named conditions.
Pants4School Top Toileting Tips
Pants4School are resources developed with Positive About Down Syndrome to help toilet training children with learning disabilities. The aim is to enable children with Down syndrome to be toilet ready for school.
Families of children with other learning disabilities, or whose children who do not have additional needs, but who are finding toilet training challenging, may also find these information leaflets useful:
ERIC website and the Bladder and Bowel UK website offer a wide range of helpful advice and support to those wanting to know more.
ICAN Nursing Service (Constipation and Daytime Wetting Pathway)
The Integrated Children’s Additional Needs Service (ICAN) supports children and young people who have additional needs due to developmental delay or disorder. We see children who are having difficulties managing daytime wetting and/or constipation that has not resolved with first line treatment.
Constipation
Constipation is when the poo is hard, infrequent, painful or difficult to pass. There could also be some liquid or solid poo in the child’s pants when they are not aware that it has happened. Around 1 in 3 children will experience constipation at some point and about 10% of children will have long term constipation. If your child is constipated, you should initially take your child to their GP who can treat mild to moderate constipation with laxatives and lifestyle interventions. Children need to take a laxative medication daily for a period of at least a few months. If they are toilet trained, they also need to be guided to sit on the toilet daily usually after breakfast or evening meal to see if they need a poo. Constipation in children is different from constipation in adults for the following reasons:
- Children will try to hold their poo in out of fear that it will hurt to pass, or because they are too busy playing to go to the toilet.
- Children are reluctant to take regular medication
If the GP has prescribed consistent laxative medication for a period of at least 3 months & your child has taken it, the constipation should improve. If your child is still not having a regular soft poo whilst taking the medication, then the GP can refer the child into the LCH Community Paediatric Clinic. Here they will be offered a Paediatrician review to check for underlying causes of constipation, and you will be supported by the ICAN Nurses to help you learn what constipation looks like in children & how to manage the laxatives and toileting interventions for your child. It is important to understand that some children will need to take laxatives for a long time until they start to respond to the urge to poo and stop holding their poo in. The ICAN offer is a short term intervention and your child will still be on laxatives when they are discharged from this service.
For more information on constipation in children please see: Children’s bowels - ERIC
Daytime wetting
Sometimes children who were previously toilet trained begin to have daytime wetting accidents, often due to changes at home, school, or other identifiable events. If simple lifestyle adjustments do not improve the situation and the child is aged 5–16 years, the GP can refer them into the Nurse‑Led Daytime Wetting Pathway, where families receive behavioural toileting advice and lifestyle interventions focusing on diet and fluids. Parents are asked to keep a record of wees, poos, and accidents to help identify any patterns, and this can be started as soon as wetting becomes a concern. Because many children who wet during the day are also mildly constipated, monitoring bowel habits helps families identify issues early and seek support from their GP. If a child is wet both day and night, daytime wetting must be managed first. The service is entirely nurse‑led and aims to confirm that daytime wetting is the primary problem, offer evidence‑based behavioural strategies, and request your GP to refer onward where necessary. Families first complete a digital education package, including prerecorded and live workshops covering the causes of daytime wetting and behaviour‑modification techniques. One‑to‑one support with a nurse is only offered if, after completing the digital education offer, parents are still unable to self‑manage their child’s wetting.
For more information about constipation and bladder health in children, families can visit ERIC website and The Children’s Bowel & Bladder Charity website.