Dr Nguyễn Huy Nga, former director of the Preventive Medicine Department under the Ministry of Health. Photo giaoducthoidai.vn

Dr Nguyễn Huy Nga, former director of the Preventive Medicine Department (under the Ministry of Health) talks to Giáo dục & Thời đại (Education & Times) newspaper on the hygienic problems in school restrooms and their effects on children’s health. 

Many children are still reluctant to go to the restroom at school because of poor sanitary conditions. What effects does that have on their health?

The issue of children holding themselves back from going to the school restroom has been attracting the parents’ and public’s attention. The first cause is the unsanitary conditions, and there are many more reasons for this situation. In addition to this, it could be because first graders are used to using the restroom at home, or that the school restroom is clean but the children don’t know how to keep it that way, which results in others do not dare to use the restroom at school. 

Not going to the restroom can lead to many health consequences. If they refuse to defecate for a long period of time, this can cause constipation and haemorrhoids in children. In addition to this, these faeces can cause bacteria to grow and lead to colitis. 

Children who hold their bowels for a long time could also suffer from frequent constipation, leading to abdominal pain and discomfort, which can also cause a difficult bowel movement. That will make them even more afraid to go to the restroom. If this condition continues, the situation can get worse and lead to bleeding.

Holding back urine can cause the fluid to pool in the bladder. There, bacteria will multiply and go back up the urinary tract to the kidneys, causing nephritis in children. It could also accumulate into kidney and bladder stones, and in the long run, turn into kidney disease in children with serious consequences. 

Refraining from going to the bathroom at school can have a big impact on children's psychology. Sometimes they feel the need but don’t dare to go, so they can't concentrate on studying. In those moments, children tend to be afraid of being discovered by others, so they would try to hold it in.

It is uncomfortable for them, and they will not be able to concentrate on the lesson. They want to use the restroom but don’t dare to and just want to go home. That will affect their ability to learn.  

This situation happens not only in small provinces but also in major cities. What are your recommendations for schools and localities?

The reality is many schools have not met the sanitary requirements in design, quantity, and keeping up hygiene. Children mostly go to the restroom during breaks, however, not all of them can do that because of the limited restroom stalls at school. Meanwhile, when children need to use the restroom during lessons, sometimes teachers don’t allow them to.

Schools need to follow standards in designing and ensuring enough stalls for children. At the same time, it is necessary to have toilets suitable for children, regular cleaning, and sufficient toilet paper and water. 

Many children use flush toilets at home, but they have to use squat toilets at school. That is one popular reason why children don’t use school restrooms. In addition to that, overweight children struggle with using squat toilets. Therefore, schools need to conduct surveys and pay attention to these issues.

Children must also be given instructions on how to use the school restroom, especially first graders. Schools should also guide children on how to keep clean and use toilet paper and water. 

What’s important is children must be allowed to practice going to the restroom in the new environment, because many of them are used to the toilet at home. Meanwhile, most school restrooms use squat toilets, so children may be afraid of falling on the slippery floor. In the immediate future, schools must ensure hygiene according to the standards of the Ministry of Education and Training, as well as the Ministry of Health, both in terms of quantity and quality.

Parents also need to work with schools. Where the school doesn’t have enough facilities, parents can contribute. Paying fees for children’s restrooms is reasonable.

For primary schools, cleaners are needed. At the secondary school level or above, schools can assign students to cleaning duties in turns or on a community service day. High school students can also participate, provided that they are given instructions to ensure hygiene. 

What can parents do to help children overcome their fear of going to the restroom at school?

For younger students, parents have to prepare their children and remind them to go to the restroom and not hold themselves up, as it can lead to serious effects on their health. Parents can practice with children at home before or after school. It can help limit bower movement while at school. 

Regarding urination, many children would refrain from drinking water, which could affect the kidney or cause kidney stones. Parents need to guide children on drinking water at school or bring water along.

They should also instruct their children on going to the restroom, and talk with teachers if the students are afraid of using the facilities. Children don’t always go to the restroom on a regular basis, therefore instructions are needed, especially for Grade 1, 2 and female students. 

In addition, parents must teach children restroom skills. It will not be formed in a day, it is a habit. Parents need to guide children, from wiping for example, because many do it for their children at home. They should teach children the correct way from front to back, as the other way around can cause bacteria to enter the genitalia and urinary tract and lead to inflammation.

Children can even carry tissue paper in their bags and use it when going to the toilet at school. The school doesn't always have toilet paper, and sometimes even when the toilet paper is available, children will take it out to play or drop it on the floor. 

Parents play a very important role in restroom training for children, especially girls. Many girls are afraid of crowds and do not dare to go. Therefore, the school needs to ensure security and safety for female students.

To do that, it is necessary to have close cooperation between the school and the family. Building habits, restroom skills, and hygiene in children must have efforts from both the school and the parents. — VNS