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Paediatric White Paper

Guidance and considerations in the provision of toilet aids for disabled children

Using functional rooms – including the toilet – is the second-biggest problemfaced in daily life for families with a severely disabled child. Using the toilet is a bigger issue among children than most people realise: continence affects 1 in 12 young people.

Everyone goes to the toilet on average eight times a day. Even able children can struggle to sit on and use the toilet, facing issues of height, balance.To go to the toilet, and be properly clean afterwards, with little or no help, has a huge impact on a child’s feelings of independence and acceptance,and their self-care skills.

It also has similar, corresponding benefits for the child’s carers and family.

The choice of toilet aids is influenced by a number of factors:

  • how long will the child need it
  • how capable is the child at transferring on/off the toilet
  • what level of support system may be required
  • can the child sit in the correct position on the toilet
  • can the child balance unaided on the toilet
  • can the child wipe clean themselves
  • can the child operate the toilet.

Those considerations need to be addressed in the present, short and long-term future.

The W.C.

Is the child using a conventional WC or a wash and dry (automatic shower)toilet?

Whichever type of toilet is being used, the child needs to feel secure andstable. The child must be sat comfortably, with their back supported against the cistern, and their torso and legs forming a 90° angle.

Sitting Position

The child’s buttocks need to be supported but slightly parted to enableeffective bowel evacuation.

 

Sitting Position

If a carer’s support is required, the carer needs to able to provideappropriate intimate care easily.

A wash and dry toilet eliminates that requirement for comprehensive intimate care. It combines a toilet, bidet and drier in one unit. The toilet cleans and dries the user after use, removing the need for manual cleansing with toilet tissue, and all the associated hygiene and contamination issues.It also enhances the child’s independence and self-care skills. At home, it can also be used by the other family members; at school, by other users of the educational establishment.

Cleaning with toilet tissue requires manual, mental and physical dexterity,flexibility, and balance. It requires intimate hand: body contact, either by the user or their carer. Cleaning with a shower requires only the ability to sit in the right place, and trigger a mechanism.

Selection of a wash and dry unit will be influenced by need, budget, location and length of need. The cost is not just that of whichever unit is chosen,but what adaptation – if any – will be required to accommodate the unit,and ensure it works, and the length of time it is envisaged the toilet will be needed. There is also the associated reduction in care cost/time.

Smearing of faeces is a comparatively common activity among children withlearning disabilities. As a wash and dry toilet effectively washes the anal area, this eliminates the potential for the child to smear.

Support systems

For most disabled children, some variant of support system will be required,to provide them with security and stability when sat on the toilet, regardless of their personal mobility.

Fixed support systems

Lateral body supports fitted to the WC provide stability on both sides, and fold away when not required.

Lateral Body Supports Technical Diagram

Clip-on support systems

If trunk support is required, an orthopaedic system fixed to a mechanism mounted on the back of the toilet will provide the required stability and security without impinging on the child’s seating position over the pan. These will require substitution/replacement with larger versions as the child grows, and need to be removed for the toilet to be used by other members of the family.

Options are available that will also encompass head support. Lap straps are also available for added security when in use.

Rifton Clip On

Shower chairs

These roll over the toilet, enabling the child to ‘go’ without carer having to clip a support system onto and off the WC. The latest evolution is a HTS(hygiene & toileting system). Most can be tailored to each child’s needs, with lateral supports and security straps and rests.

Rifton Shower Chair

Closomat

The UK’s first, and still biggest-selling, supplier of wash and dry (automatic shower) toilets, the Closomat wash and dry toilet has sold over 55,000 units since it was introduced some 55 years ago, many of which are still in daily use at least 30 years after first being installed.

Today the Closomat Palma Vita floor-standing automatic toilet is the industry benchmark, being the only one of its kind developed specifically for disabled people.

The Palma Vita is the only unit of its kind to achieve Medical Device Class 1 certification.

Closomat has extended its expertise to now offer a range of accessible toilet, bathroom and wetroom equipment, including shower chairs, Apres Shower body driers, and the Aerolet range of toilet lifters.

As a result, the company is unique in delivering in house design advice,supply,installation, commissioning and aftercare service & maintenance through its own dedicated team of engineers.

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