Kindergartners in Diapers? Schools Keep Getting This Wrong
- 4 hours ago
- 6 min read
By Steve Hodges, M.D.
Here we go again.
Another school district, this time in Florida, is cracking down on the supposedly “alarming trend” of kindergartners in diapers—threatening to send home students who are “not fully potty trained.”
Utah recently passed a law mandating that kindergartners be toilet trained, while a similar attempt stalled out in Kansas. A Maryland school district now requires teachers to help kindergartners “work toward toileting independence.”
All these efforts are based on the same assumption: that kindergartners who need diapers were not adequately potty trained by their parents.
That assumption is wrong.
If a child is still having accidents at age 5, this is not a sign that anyone—parent or child—“failed” at potty training.
In reality, these kids are toilet trained. “Training” has nothing to do with it. Accidents are a symptom of chronic constipation—in other words, a rectum enlarged by a pile-up of stool.
What schools perceive as a behavioral or societal problem is actually a medical one.
Here is what’s going on: When kids delay pooping, as they often do, a pile-up of stool stretches the rectum to the point of losing sensation and tone. Kids stop feeling the urge to poop, which causes even more stool to pile up—and even more rectal stretching.
Eventually, the rectum becomes floppy and overloaded. In some kids, poop simply drops out of the child’s bottom without the child even noticing.
This is called encopresis.
In others, the enlarged rectum aggravates the nearby bladder nerves, triggering wetting accidents day and night. The bladder “hiccups” and abruptly empties before it’s even full and before the child has a chance to sprint to the toilet.
This is enuresis.
No amount of toileting instruction—or legislation—is going to dislodge the stool mass triggering these accidents or restore normal rectal sensation and tone.
These kids need constipation treatment—not potty-training mandates, sticker charts, or additional instruction at home.
Not only are school officials off base, but they’re also hyping a trend that does not exist.
For at least 20 years, headlines have announced a “shocking new epidemic” of kindergartners in diapers, yet the articles never cite studies—just stories.
In 2008, a UK outlet warned that children were “still wearing nappies to SCHOOL—with dire risks to their health.” In 2014, teachers in Washington state declared untrained kindergartners a growing problem. Two years later, a British tabloid blamed parents who were supposedly “too lazy or busy” to potty train their school-age children. In 2021, Australian media reported a “heartbreaking rise” in children arriving at school in nappies. By 2023, U.S. teachers were allegedly seeing more kindergartners in diapers “across the country.” And so on.
Like every official quoted in every story, the Utah legislator behind his state’s law conceded he had no supporting statistics. But that didn’t stop him from calling the kindergartners-in-diapers phenomenon “pretty widespread.”
You know what actually is widespread? Blaming parents.
“It is not the kindergarten teacher’s responsibility to be changing diapers for kindergartners,” a Florida superintendent said last week, suggesting parents had fallen down on the job.
Even Maryland officials, while taking a more compassionate approach, have framed accidents as the result of “what their parents didn’t do,” adding, “No child should be penalized for that.”
But accidents are not caused by lazy, clueless, or excessively permissive parents.
These families are dealing with a highly treatable medical condition that is routinely overlooked and misdiagnosed by medical professionals.
Doctors frequently miss even severe constipation because some of the signs are subtle and not well known and because the most common diagnostic methods, such as the Rome IV criteria, are inadequate.
Want proof a child is constipated? Get a plain abdominal x-ray.
Instead, accidents are attributed to stress and anxiety, behavioral problems, an underdeveloped bladder, or a delayed “bladder-brain connection”—or simply, inattentive parents.
When anecdotes accumulate, school jurisdictions overreact—with an elaborate framework of potty-training mandates, instructional guides, and behavioral plans, all aimed at a medical problem they fail to recognize.
Utah’s 26-page Toileting Practices Toolkit even includes a list of 30 potty-training books for parents to read with their children.
Trust me: Reading “I’m A Potty Superhero” 100 times will not empty a child’s clogged rectum.
Many students, not just kindergartners but children in all grades, including high school, struggle with encopresis and/or enuresis, no fault of their own or their parents. These are the kids I see in clinic.
READ: Dear Bedwetting Teenagers: Your Condition is 1.) Common, 2.) Not Your Fault, and 3.) Totally Fixable
Is my clinic busier than it was 20 years ago? Not really. Throughout my career, there’s never been a shortage of children struggling with bedwetting or daytime accidents. However, I have noticed an increase in severe cases requiring more aggressive treatment.
So, while evidence of an “alarming trend” of kindergartners in diapers is lacking, my experience—along with much research—has long pointed to an epidemic of chronic constipation in children. Heck, that was the topic of my first book, back in 2011. (Don’t buy it! It’s outdated and has been replaced.)
Indeed, many children become so stopped up that they land in the hospital with acute abdominal pain or because they haven’t pooped in days—or longer.
Just this month, the UK’s Royal College of Nursing warned that hospital admissions among kids with severe constipation have jumped 60% in a decade.
Why are so many children harboring a belly-load full of stool? The answers are many, and I address them here: Why Is Your Child Constipated? Because We Live in the 21st Century.
Ironically, schools themselves contribute to the constipation epidemic by restricting restroom passes and rewarding students who override their bodies’ signals (“Just hold it till the bell rings”).
It’s not my patients, or their parents, who need more education about toilet training; it’s school personnel.
In one study, only 18% of elementary teachers surveyed had received professional training on voiding health or dysfunction, and 88% reported encouraging students to hold their pee. Some 36% of teachers reported offering rewards to students who don’t use bathroom passes or punishing those who do.
Over the years, I’ve created several school-related resources—for teachers, counselors, nurses, and parents—because these misunderstandings are so widespread. These include the K-12 Teacher’s Packet on Student Toileting Troubles and the Mental Health Counselor’s Guide to Enuresis and Encopresis, both available as free downloads, plus the Parent’s Guide to Advocating for Your Child at School, included in my treatment manual, the M.O.P. Anthology.
Parents who want a deeper understanding of why constipation causes accidents, and how to reverse it, can also find step-by-step treatment guidance in the Anthology.
Every state and school district crafting potty-training mandates is careful to exclude children with disabilities from penalties or requirements. Utah’s regulations state that when a child has “persistent toileting challenges,” schools should evaluate whether an “underlying disability” is involved.
But the vast majority of children with enuresis and encopresis have no disabilities.
They’re just constipated.
Furthermore, accidents among children diagnosed with autism or ADHD are routinely attributed to those conditions rather than to constipation. So these kids miss out on treatment, too—usually for many years longer than neurotypical kids.
School officials seem to believe their mandates and regulations benefit children. One Utah school board member said:
“It is not in the best interest of the student to be in school when they are not trained. [This rule] is not just for teachers; it’s for that student’s well-being as well. That label can be carried with them into future grades. It’s just heartbreaking.”
I assure you that nothing is more heartbreaking for a child with enuresis or encopresis than being sent home from school.
I’ve had countless patients suspended from school—or forced into homeschooling they did not want—because they were deemed “not potty trained.” These policies crush the self-esteem of children who already feel embarrassed and isolated.
Schools are looking for a quick fix that can’t be had.
Even when treated aggressively and diligently, chronic constipation can take months, sometimes over a year, to fully resolve. A rectum stretched for years will not regain lost sensation and tone overnight.
It’s nuts to send children home while their rectums heal.
One mom in our private support group told me that once her daughter’s school became supportive—and once the girl's constipation was properly treated—her entire personality changed. Before, she said, her daughter avoided hugging classmates or making friends because she was terrified other children would smell an accident.
But when the accidents stopped, “her social anxiety disappeared, and she blossomed.”
Children with enuresis and encopresis do not need more legislation or “toileting independence” mandates.
They need appropriate medical treatment.
And they need schools that offer support, flexibility, and compassion while that treatment takes effect.