Urology & Continence Care Today | April 2025

With a quarter of children now starting school not toilet trained, ERIC, The Children’s Bowel and Bladder Charity is launching an intervention to help reverse the trend, and is inviting families and healthcare professionals to hop aboard the Toilet Train.

Over the last century, the average age that children are being potty trained in the UK has risen from 12–18 months, to an average of around three or even four years today (Blum et al, 2004).

ERIC, The Children’s Bowel & Bladder Charity, carried out research with the Association of Teachers and Lecturers in 2016 and the National Day Nursery Association in 2018. Both surveys showed that parents are toilet training their children later. Furthermore, research by Kindred Squared (2024) showed that one in four children in England and Wales are now starting school still wearing nappies.

School staff are diverting 2.5 hours a day, on average, away from teaching and towards supporting children who are not school ready. This has a knock-on effect on pupils, who lose around a third of learning time each day (Kindred Squared, 2025).

Support for children and parents is woefully lacking, and this is contributing to a situation where children are starting school underprepared, and where one in nine children in the UK lives with a bowel or bladder condition (Paediatric Continence Forum, 2024).

Later potty training increases the risk of developing wetting and soiling issues later, and also prevents the early identification of bladder and bowel problems. It also has a knock-on effect on other areas of health, education and social care:

• A staggering 25% of children start school still having frequent toileting accidents
• 90% of teachers have at least one child in their class who is not fully toilet trained
• Hospital admissions for childhood constipation have increased by 60% over the past decade (over 44,000 children last year)
• Good bowel and bladder education could reduce the incidence of issues like constipation by as much as 80% (Kindred Squared, 2025; NHS England, 2025).

In ERIC's experience, this trend has significant negative impacts for children, families, and society, namely:

• Health concerns: increased risk of urinary tract infections (UTIs) and constipation associated with prolonged nappy use
• Developmental delays: reduced independence and social confidence
• Emotional impact: children feeling different, social isolation
• Impact on education: lost teaching time for every child in reception year
• Environmental impact: nappies are a significant contributor to waste stream
• Economic burden: purchase and disposal of nappies adds financial strain for families, nurseries, and Local Authorities.

Based on ERIC's working knowledge of the sector, key drivers of this delay include:

• Lack of support and training: early years practitioners do not receive education on potty training as part of their apprenticeship training, and many parents have reduced visits from a health visitor
• Cultural and societal changes: with an increase in dual income households, more children are in nursery from a younger age
• Equally, families with challenging living arrangements (split households, unsuitable housing, challenging lifestyles) struggle to focus
• Marketing influence: campaigns by the single-use nappy industry have promoted myths about ‘readiness’, encouraging later potty training.

There also appears to be a gulf between teachers and parents' expectations of what a child's developmental level should be before school. Almost half of teachers think parents should be more aware of their role in preparing their child for starting reception.

WHAT IS ERIC DOING?

Underfunding and unequal access to services has resulted in a situation where families are struggling to get the support they need. Families often find ERIC online or are signposted to our services by early years settings. Demand for information and advice has never been higher.

Over the last five years, the volume of calls received by our helpline has increased by 215% (from 1900 calls in the year to September 2019, to 5987 calls in the year to September 2024).

ERIC believes that there is a significant opportunity for evidencebased intervention to help tackle these issues, and is working to convene and galvanise key influencers and decision-makers who have the power to enact change. It is only through working collaboratively that we can hope to make a positive impact on children’s lives, so we are having conversations with key stakeholders to start making this happen.
 

ALL ABOARD THE TOILET TRAIN

ERIC also has a number of on-theground interventions to help families directly. Last year, an intervention campaign called All Aboard the Toilet Train was launched, which was aimed at families whose children were due to start school in September and were not yet toilet trained. Almost 3000 families signed up to receive advice and were successfully stewarded through the programme.

This year’s campaign will be even bigger, with greater collaboration between the charity, local authority family hubs, schools and early years settings.

Following feedback from parents/ carers and early years settings, this year’s All Aboard the Toilet Train campaign is being launched earlier in April (as opposed to last year at the start of the summer holidays, which gave parents six weeks to get on top of toilet training), coinciding with primary school places being awarded. This means that parents and carers will have more time to start thinking about their children’s toilet readiness and more opportunities to work with them over the coming months before they start school in the autumn.

How it works

Parents and children are invited to 'board the Toilet Train' by signing up to the charity's online support challenge that will help them prepare for school. They will receive information, advice and support via email over a six-week period to support them in their journey.

ERIC will also send free digital packs to early years settings and primary schools across the country which contain helpful PDF leaflets, advice sheets, and a video they can share with families to help get children toilet ready for school.

These packs are also available for healthcare professionals to download and use with families they support.

They say it takes a village to raise a child; ERIC hopes that All Aboard the Toilet Train helps gather together that village of support that families need as they steer their children towards starting reception.