Toileting and intimate care in nursery and reception: what settings need to know

Can a nursery or school refuse a child who is not toilet trained?

No. No law lets a nursery, childminder or school in England refuse a child because they are not yet toilet trained. The EYFS, which covers nurseries, childminders and school nursery and reception classes, says providers must ensure there are "suitable hygienic changing facilities for changing any children who are in nappies" (group and school-based framework, 3.88; childminders' framework, 3.87, in force from 1 September 2026).

Refusing a disabled child could also be discrimination under the Equality Act 2010. Private, voluntary and independent nurseries and childminders must not discriminate "by not providing the person with the service" (section 29), and schools must not discriminate "by not admitting the person as a pupil" (section 85). Refusing a child because of something linked to their disability, such as still needing nappies because of their autism, is discrimination unless the setting can show it is "a proportionate means of achieving a legitimate aim" (section 15).

The child does not need a diagnosis. The Equality and Human Rights Commission's statutory code for services, in force since 5 August 2026 (GOV.UK), says "There is no need for a person to establish a medically diagnosed cause" for an impairment, and lists "going to the toilet" as a normal day-to-day activity (EHRC code, appendix).

The charity ERIC says it is "not acceptable for a school to refuse or delay admission to children who are not yet continent". For refusal and exclusion more widely, see refusing or excluding an autistic child.

What does DfE's toilet training page say?

It backs early support for every child, but it is not an admissions rule. DfE's page for early years providers (updated 18 August 2026) says "Almost all children can learn to be clean and dry, including children with SEND", and "You don't need to wait to start toilet training children with SEND" (DfE, Toilet training).

It also says: "Most children should be out of nappies before starting Reception year in school. The only exception should be children with a diagnosed medical need, such as a bowel or bladder condition."

The page says nothing about refusing or delaying a place, and it cannot change the Equality Act, which protects disabled children with or without a diagnosis. Some children start school while still waiting for an autism assessment. Use it as a prompt to plan early with the family. The page also asks settings to encourage parents to talk to their GP or health visitor if a child is struggling.

What do schools need to do in reception and Key Stage 1?

Reception classes follow the EYFS, so 3.88 applies. Schools also have their own guidance.

Plan for staff, not parents, to change the child. DfE's statutory guidance on supporting pupils with medical conditions (December 2015) says school policies should be explicit about practice that is not acceptable. Its advice says it is "not generally acceptable practice" to "require parents, or otherwise make them feel obliged, to attend school to administer medication or provide medical support to their child, including with toileting issues" (DfE medical conditions guidance, para 25).

Write the plan down. ERIC calls it good practice to document continence care in advance, for example in an individual healthcare plan, with the parents' consent for named staff to give care (ERIC).

Treat intimate care as part of safeguarding. Keeping children safe in education 2026 says child protection policies should reflect the extra barriers to recognising abuse of children with SEND, including "the need for intimate care" (para 249). Any report of abuse involving a child with SEND needs "close liaison" between the designated safeguarding lead (DSL) and the SENCO (para 250) (KCSIE 2026).

Our guide to autism in reception and Key Stage 1 covers SEN support more widely.

What should an intimate care policy cover?

Intimate care here means helping a child with nappy changing, toileting, washing and dressing. There is no national template, so check your policy covers the points below. The EYFS says providers must ensure "Children's privacy is considered and balanced with safeguarding and support needs when changing nappies and toileting", and that there is "an adequate supply of clean bedding, towels, spare clothes, and any other necessary items" (3.88).

The table also draws on KCSIE and the Safer Recruitment Consortium's Guidance for safer working practice (February 2022), which is not statutory but is listed in KCSIE and covers early years settings too.

How can we support toileting day to day?

Teach toileting as one routine, done the same way every time and the same way as at home. Common difficulties for autistic children can include knowing when they need to go, telling someone, using different toilets and the sensory side of bathrooms (NAS professional practice).

1. Agree one approach with the family. The National Autistic Society advises that everyone starts at the same time and follows the agreed approach (NAS guide for parents), and suggests "choosing what words/terms everyone is going to use around going to the toilet" (NAS professional practice).
2. Put a picture sequence by the toilet at the child's eye level: trousers down, pants down, sit, wee or poo, wipe, pants up, trousers up, flush, wash hands (NAS).
3. Give the child a way to say "toilet", such as a sign or a symbol card to hand over. Some children don't notice their body's signals (interoception), and the NAS notes a child may think you know they have had a wee "without realising that they should tell you".
4. Plan trips around the child's pattern, using what the family knows about when the child usually goes. The NAS warns that sitting a child on the toilet every 30 minutes "can be unhelpful".
5. Remove sensory barriers: hand dryers, flushes, fans, echoes, strong smells, bright lights, mirrors and cold floors. The NAS suggests "Switching hand dryers off and providing paper towels instead" (NAS, sensory adjustments). If the flush frightens a child, leave flushing until after handwashing. Our guide to visual supports and sensory adjustments has more.
6. Ask for easy clothes, such as an elasticated waist (NAS), and keep a named bag of spare clothes and wipes.
7. Handle accidents calmly and privately, without blame or comment in front of others, and praise effort and anything that went well. Never tell a child off: the EYFS says providers must not give or threaten "any punishment which could negatively affect a child's well-being" (3.75; 3.74 for childminders).

How do we plan with the family and health services?

Start with the family, before the child starts or as soon as toileting comes up: "parents know their children best" (SEND Code of Practice, 5.5). Agree a short written plan: words and pictures, toilet times, clothing, rewards, who changes the child, supplies and how you'll share news, for example in a home and setting book (NAS). Put it in the child's SEN support plan, which does not need a diagnosis (IPSEA), or, in school, an individual healthcare plan.

Watch for constipation. The NAS says one of its biggest concerns is "the number of children with undiagnosed constipation", and that a child in pain "may not be aware of it or may not communicate it" (NAS professional practice). NICE lists signs such as large, hard poos, straining, pain and soiling (NICE CG99). Tell the parents what you have noticed and suggest they see their GP or health visitor.

Suggest the family asks their GP, health visitor or school nurse about the local continence service. Bladder & Bowel UK's guidance for services (January 2025) says nappies and pads are not supplied before age 5, and after that only after an assessment and at least six months of a toilet skills programme that "must have been undertaken in all settings where the child spends their time". So your part matters. Share information with health professionals only with the parents' agreement, unless safeguarding duties say otherwise.

If the family wants something to read, our parent guides on toilet training and starting nursery or reception can help.

Is there funding for the extra time and support?

Early years settings can get council help for under-5s. From DfE's early years funding guide 2026 to 2027:

• SEN Inclusion Fund (SENIF): every council must have one for "all children below compulsory school age who have special educational needs (SEN), regardless of the number of hours taken", including low-level and emerging needs. Most is paid as top-up grants, and your council publishes how to apply. New for 2026 to 2027, it "should not be used to support children with SEN in reception year at school".
• Disability Access Fund: at least £975 a year to the main setting of a child who gets DLA and takes up any funded hours, for reasonable adjustments, training and resources. "Four-year-olds in primary school reception classes are not eligible."

Councils must take all steps available to stop providers charging parents "additional support costs for children with special educational needs and disabilities (SEND)" in funded hours. Providers can charge for nappies only if parents agree, and must offer alternatives such as supplying their own (early education and childcare guidance, A1.32 to A1.38).

In reception, the school's duties apply and are paid for from its budget, which includes a "notional SEN budget" (SEND Code, 6.96). The new Inclusive Mainstream Fund for 2026 to 2027 also covers reception year groups (conditions of grant).

What does the research say?

Toileting difficulties are common in young autistic children, but research on teaching toileting in nurseries and schools is thin.

• In a large US study of children aged 4 to 5, parents reported resistance to toilet training in 49% of autistic children, 24% of children with other developmental delays and 8% of other children. In autistic children it was linked with constipation and delayed expressive language (Wiggins et al. 2022).
• Autistic children had nearly four times the odds of constipation in a meta-analysis (McElhanon et al. 2014).
• A pilot trial of 33 autistic children aged 3 to 6 found coached parents could carry out toilet training as planned (Mruzek et al. 2019). We found no large trials in nurseries or schools.
• Visual supports, such as picture sequences, and task analysis, which breaks a skill into small steps, are evidence-based practices in a large US review (65 and 13 studies). But 83% of its studies were single-case designs with one or a few children, so treat them as a good starting point, not a guarantee (NCAEP 2020).

Where can staff and families get more help?

For staff:

• your setting SENCO, and in early years your council's area SENCO or inclusion team;
• Experts at Hand, launching from September 2026, which brings occupational therapists, educational psychologists and speech and language therapists into nurseries, childminders and schools, with no diagnosis needed (DfE);
• an occupational therapist for bathroom equipment and sensory needs, and speech and language therapy for a way to ask for the toilet;
• free training: DfE-funded early years SEND courses from Dingley's Promise and, for schools, Whole School SEND.

For families: ERIC and Bladder & Bowel UK for toileting, Contact for families with disabled children, and SENDIASS for local SEND advice.