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School Nurse

 

School Health Nurse Contact Details:

 

Primary Tel: 01454 866944, Secondary Tel: 01454 866756, Email:melanie.coombs@cchp.nhs.uk

You can also communicate with me via your child’s HomeSchool diary or by letter marked ‘School Health Nurse’ and sent in with your child.

About Me:
My name is Mel Coombs. I have worked as the School Health Nurse for New Siblands since May 2012. I have 23 years children’s nursing experience with a background in Neurosciences at Great Ormond Street, General Paediatrics and NICU at Southmead Hospital in Bristol and most recently in Burns and Neurosciences at Frenchay’s Barbara Russell Children’s Unit.

I work across both of the New Siblands school sites and am based in the School premises. My work days are term-time only, Monday to Friday, approximately 8.30 am to 2.30 pm. I can be contacted on the numbers above and messages can be left for me outside of these hours.

New pupils

Prior to your child starting school, you will be sent an appointment for a School Health Needs Assessment. At this appointment we can then identify if your child needs a Health Care Plan in school and if you need any other support and advice. It is very important that you attend this appointment, and in some cases your child will not be able to start school until this appointment has occurred. Appointments for Nursery children will be sent during the June and July prior to them starting in Reception. During your child’s journey through school I can help ensure that your child has access to Paediatrician appointments and that you are signposted and referred to the most appropriate place should you need additional help with any health, developmental or behavioural issues.

I am your first point of contact for all continence assessments and toileting issues and liaise closely with the Paediatric Continence Promotion Service for South Gloucestershire. Children are eligible for this service after they enter Reception class at school regardless of age, but only after six months of formal toilet training has taken place.

SCHOOL CLINICS

Various clinics are held at New Siblands School:

Doctors’ Clinics in school

Dr Emma Heckford, Paediatrician, holds a morning clinic on the 3rd Tuesday of the month (apart from in the school holidays). Dr Heckford has taken over Dr Brooks’ school caseload.

Dr Russell Jones, Community Paediatrician, holds a morning clinic on the 3rd Monday of the month. Dr Jones will be leaving during the summer holidays and so his last clinic will be in July 2016 and from September Dr Jones’ replacement will be Dr Caroline Bodey.

We can offer 80 Paediatrician clinic appointments per year at New Siblands. It is very important to attend your appointments in school or, if you cannot attend, to let me know in advance so that I can offer that appointment to someone else on the waiting list. You can contact me on melanie.coombs@cchp.nhs.uk or 01454 866944 or via you child’s HomeSchool diary to request an appointment or to make changes to an existing appointment. I send out a slip in advance letting you know of forthcoming appointments. An appointment letter will also be sent from Kingswood Hub with a tear off section at the bottom indicating your availability: this must be returned to me in school.

Community Eye Team

Julie Parker, Senior Orthoptist, holds regular vision checks in school. These are usually on a Tuesday and a slip will be sent to you advising of when this will occur. Please make sure that your child’s glasses are in school daily if they have been prescribed. Staff can support your child increasing and maintaining wear of glasses in school which will have a beneficial affect on their learning ability and sometimes behaviour.

Sue Fraser, Senior Optometrist, holds this eye clinic every term. A consent form is sent out as drops are used to dilate the pupil as part of the assessment process. This consent needs to be completed and returned to me before your child can be assessed.

Please let me know if you need a referral to the Community Eye Team or if you do not want your child’s vision to be checked regularly in school.

Special Needs Dentist

The Special Needs dentist, Dr Khurram Rashid, and his team visit every year to carry out dental screening across the whole school. A consent form is sent out prior to the Screening date and needs to be returned to me before screening. Children cannot be seen if the consent form is not returned. Once your child has been checked, Dr Rashid can refer for treatment if he feels this is necessary.

Please let me know if you feel that your child needs a referral to the Special Needs Dental Team.

 

Toileting Advice

 

Toilet training is not just about coming out of nappies, pads and continence protection. It includes a wide range of skills a child needs to become reliably clean and dry and acquire reliable control of their bowel and bladder. There is a lot of advice available and I would recommend ERIC at http://www.eric.org.uk/ and Promocon at http://www.disabledliving.co.uk/Promocon/Publications/Children/Toilet-Training

Potty Training

Potty training is an important milestone for your child, but learning to gain control of the bowel and bladder is a complex process and your child needs to be emotionally and physically ready to start potty training. To help our children become emotionally and physically ready it is important to remember that the earlier toilet preparation is started, the easier the skill will be acquired. Any delay in the preparation will delay formal toilet training. One of the best things we can do for our children is to teach them to be able to use the toilet appropriately and increase their independence and self esteem. All staff in our school will fully support toilet training at all stages.

Remember the Mantra: “All things toilet, stay in the toilet” for example only changing a nappy in the toilet (and not in the bedroom or anywhere else) can help the child register that this is where wee and poo should go.

Another thing that helps your child to understand is to always allow them to see that the contents of a dirty nappy (not the actual nappy) are put down the toilet and flushed away. It can also help for your child to be able to see you use the toilet too.

Contact me for more toileting information.

Your child will gradually learn to understand and know how to react and respond to the feeling that they need to empty their bladder or bowel. They will also need to understand what you want them to do and how to do it.

Download the very popular ERIC’s Guide to Potty Training leaflet which answers questions about knowing when to get started, how to get ready, and includes a step-by-step guide for potty training. The leaflet signposts to ERIC’s Guide to Children’s Bowel Problems and ERIC’s Guide to Night Time Wetting. It is good to read these guides to learn how to avoid weeing and pooing problems and also to know what to do in case your child is showing signs of having problems with their bladder or bowel.

Extra help with potty training

For extra information, read the A-Z of Potty Training Tips.

If you need additional potty training help, ERIC’s Helpline (Tel: 0845 370 8008, Monday to Thursday 10:00 am – 2:00 pm) can offer you the support you need to successfully overcome any problems, or you can post a message on Eric’s parents’ message board for other parents to offer you an insight into how they tackled toilet training.

Constipation

Constipation must always be treated before any formal toilet training is started. It is very difficult for a child to have any control over his or her bladder if they are at all constipated. Constipation is very common in children and for many there is no known reason why it happens (this is known as idiopathic constipation).  Research has shown that 29% of 4½ year olds and 27.5% of 9½ year olds in the UK suffer with constipation.

A child is considered to be constipated if they poo less than 3 times a week. However, every child’s pooing pattern is different and some children will need to poo twice a day whilst others will go only every other day.

Download some free leaflets and resources on children’s constipation and bowel problems here.

Coping with constipation and soiling

In 2009 100,000 children in the UK were treated by their GPs for constipation and soiling problems.  For most children, constipation can be successfully resolved.  It can be a long journey, needing ongoing support from health professionals and much patience and encouragement from parents and carers. The quicker a child has an assessment by their GP, the easier it will be to manage and resolve the problem.

 Causes of constipation

  • Withholding poo/ stool withholding (avoiding going to the toilet) – see more below
  • Fear of the toilet (sometimes associated with pain or discomfort)
  • Lack of a toilet routine (some children have such busy lives that it can be difficult to find time to sit and relax on the toilet each day)
  • Resistance to toilet training and an insistence that a nappy be put on to poo in
  • A diet that is not fully balanced
  • Low fluid intake
  • A change in routine
  • Anxiety and emotional upset
  • Some medications may cause constipation
  • Illness

Withholding poo/ stool withholding 

Stool withholding is when a child feels the need to use the toilet but resists it. Resisting the need might involve crossing the legs, sitting on the back of the heels, clenching the buttocks and being fidgety. The stool gets bigger the longer the child holds on to it and eventually when they absolutely have to go it is very painful and difficult to pass. This can lead to a vicious cycle of holding on and pain.

A child might start withholding stools for several reasons – they may have experienced passing a painful or difficult stool; they may have a sore or anal fissure which makes pooing painful; or they might not want to use strange or smelly toilets and prefer to hold on until they get home.  

Recognising the signs of constipation

  • Pooing less than three times a week
  • Regular and foul smelling wind
  • Foul smelling poo
  • Painful tummy
  • Distended tummy
  • Poo looks like hard pellets
  • Pain when pooing
  • Straining
  • Withholding poo
  • Poor appetite
  • Lack of energy
  • Unhappy, angry or irritable mood
  • Soiling

The Bristol Stool Form Scale can help you identify whether poo is becoming constipated.  The ideal poo is number 4 on the scale – a soft, smooth sausage shape. You can download the Bristol Stool Form Scale here

Establishing a routine

The pace of life can be so busy that it is easy to neglect the need to ensure there is time in the day for children to have a relaxed sit on the toilet for a poo.

Putting a toilet routine in place will ensure that sitting on the toilet for a poo is a regular part of a child’s day and will encourage the complete emptying of the bowel on a regular basis, helping to lessen pooing accidents and avoid constipation.

A toilet routine is especially important for boys who, once they begin to stand up to wee, have to make a special effort to sit on the toilet for a poo and pooing can become rushed or simply forgotten.

Tips for successful pooing on the toilet

The correct way to sit on the toilet to have a poo

Tips on what to do when a child prefers to poo in a nappy

What is soiling?

Children soil when they poo in their pants, on the floor or in other inappropriate places.  Some children have a more regular and persistent difficulty.

Why soiling happens

Constipation is the most common cause of soiling.  When children don’t poo regularly, the bowel can become loaded with large poos that are hard to pass. This is sometimes called faecal impaction.

Poo can appear runny (like diarrhoea), in small lumps or can be visible around the bottom and difficult to wipe away.  Soiling occurs when runny poo leaks around the hard lump that is blocking the way; or if there has been a longstanding problem of constipation the lower bowel and rectum may have become overstretched.  Soiling can happen several times a day as the child does not always receive the message that they need a poo or is not always aware that the poo has come out.

Treatment for constipation and soiling

Most parents seek help initially from their health visitor, school nurse or GP. Keeping a record of how often pants are soiled, poo is passed in the toilet and the type of poo passed will help health professionals assess the problem and offer appropriate intervention.

Treatment is likely to include:

  • Medication to relieve constipation and clear faecal impaction (this is likely to be Movicol but could be a stool softener, stimulant laxative or bulking agent). The medicine is then continued to ensure that the poo remains regular and easy to pass, stopping the medication too soon can result in the constipation building up again
  • Suggestions for appropriate changes to the diet and fluid intake
  • Establishing a regular routine of sitting on the toilet for a few minutes at least once a day, 15-20 minutes after a meal
  • Checking that your child is positioned comfortably and securely on the toilet (using a child seat if necessary), and ensuring that feet are firmly on the floor or supported on a step will help your child push poo out
  • Teaching your child the technique of gently rocking forwards and back when sitting on the toilet
  • Motivating your child by involving them and offering simple rewards for achieving targets
  • Occasionally, psychological help is useful to explore anxieties or stress that may be associated with, or aggravating the problem

Always consult your GP if your child is showing signs of constipation or there are changes in bowel patterns.