“It means starting the course and parents starting to request reports so that at three years old they allow the little ones to go to school with diapers.” This is how primary care pediatrician Teresa Escudero begins her complaint, who points to the lack of knowledge and attention to diversity as the causes of this situation. “My head breaks with this type of thing, because there is a huge lack of knowledge about sphincter control, which is not something that can be forced, and if it is forced it will always go wrong. Up to 30% of children between three and five years old have not reached this maturational milestone, just as many children have not stood up at 12 months. Like any milestone, it is a process of physical and psychological maturation, which can last up to five years. Boys and girls need their rhythms to be respected,” says the pediatrician.
Sphincter control is, as Escudero points out, a maturation process that is considered normal up to the age of five, as supported by different studies and the Spanish Pediatric Association. The Haizea-Llevant development table, cited by numerous pediatricians and professional associations, establishes the age ranges at which boys and girls are usually prepared to control it: 50% of them leave the diaper at two and a half years; 75% at three years and 95% at three and a half years. If from that age they have not yet been able to control their sphincters day and night, pediatricians do not begin to worry until they are five years old. This means that it is normal for many boys and girls to pass the second cycle of early childhood education – between the ages of three and five – without achieving it. Especially if they were born between September and December, because in that case they will start the course before turning three years old.
I asked a child psychiatrist friend to sign a paper recommending that my daughter stay in a diaper until she acquired the necessary level of physiological, maturational and behavioral development. It is tremendous that it has to be called a pathology to be able to free yourself from that stress.
María Muñoz Morente is a primary care pediatrician, in her case in rural areas. She has also had to sign numerous developmental delay reports. “Many children, some as young as two years old, join the educational system having to present themselves already from the deficit. They come to school with a need specific to their age that the system does not want to respond to,” he points out. For her, it is essential not to pathologize child development, and that is why she takes great care when writing her reports: “The boy or girl always has to be safe from these demands, so I include verbatim the classification systems of the World Health Organization, where it is clear that we can only speak of lack of sphincter control from the age of five, and that therefore there is an obligation to adapt to the evolutionary needs of the boy or girl,” he explains.
Pressure on boys and girls and families
Despite this, there are many schools that continue to require that boys and girls begin their Early Childhood Education stage without a diaper. It is something that is usually emphasized at the centers’ open days and welcome meetings, which is why it ends up becoming an important factor for families when choosing a school.
“You have the whole summer ahead of you to achieve it, but the course starts without a diaper,” they told Marian when she enrolled her son in a private center. The same message that Olga received. Marian managed to withdraw it to the limit, that same summer, although she admits that her son peed almost every day at the beginning of the school year. Olga did not succeed – she did not try either – so she sought a medical diagnosis so that her daughter’s rhythms would not be forced.
Forcing the diaper to be removed is a very big stressor for boys and girls, which can affect their adaptation and therefore their schooling. But this cannot fall on the teachers either, as we often have ratios of 25 three-year-old children per classroom.
Andrea Martinez
— teacher
“I asked a child psychiatrist friend to sign a paper recommending that my daughter keep the diaper until she acquired the necessary level of physiological, maturational and behavioral development,” explains Olga, who is also a psychiatrist. The school they chose recommended withdrawal before the start of the course, but she refused. “As a professional, I knew that altering my daughter’s physiological process could have serious physical and psychological consequences. Seeing that she was going to go all out, the school accepted the report and let her go with a diaper, but it wasn’t easy. It is tremendous that we need reports and that we have to call it pathology to be able to free you from that stress,” he says.
The pedagogue Nieves Manrique also obtained a medical report for her second child. When her oldest son started school, he was pressured to remove his diaper, even though he was not ready. But when it was her youngest son’s turn, a urinary pathology made it even more important to respect his rhythms. “In your case, I have a medical report that allows you to wear a diaper, so there is a person who changes you. But it is not normal that a child who has a medical report is allowed to take it and if he is a healthy child who simply cannot control his sphincters, they do not allow him to do so. “They are putting a lot of pressure on parents and children, at a time that is already stressful like entering school,” he denounces.
The vision of the teaching staff
Although in many schools and educational centers families are invited to start the school year without a diaper – at different intensities and with different methods – a large part of the teachers are aware of the needs of the boys and girls and are willing to respect its rhythms. Montse Álvarez, a public education teacher, is one of them: “Years ago we decided that the issue of needing a diaper could not be considered a difficulty. At our school we allow them to use them, we change them and we accompany the families when, together, we begin to help the boys and girls take them off,” he explains.
Andrea Martínez, a teacher in the public system who has gone through Early Childhood and Primary, also knows that it is a process that cannot be forced. But it demands more means to be able to attend to each case in a respectful manner. “Forcing the removal of the diaper is a very big stressor for boys and girls, which can affect their adaptation and therefore their schooling. But this cannot fall on the teachers either, as we often have ratios of 25 three-year-old children per classroom, because if we are changing clothes or diapers we neglect the rest of the boys and girls. There should be a caregiver who can change their situation and is always available,” defends the teacher.
A criterion that pediatrician Teresa Escudero agrees with: “The pressure cannot fall on the boys and girls, on the families, or even on the teachers. It is the educational system that must provide classrooms with resources. And there has to be a person who can change diapers at least until they are five years old, because there are different rhythms in the acquisition of this process and the logical thing is to address that diversity. Furthermore, accelerating the process can bring side effects such as incontinence or self-esteem problems,” warns Escudero.
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