Integrating Hidden Health Needs into School Improvement Plans for Learner Inclusion: A Case for Addressing Nocturnal Enuresis

Integrating Hidden Health Needs into School Improvement Plans for Learner Inclusion: A Case for Addressing Nocturnal Enuresis

Wisdom Koudjo Klu

Doctoral Student in Educational Leadership, Acacia University, Arizona USA.

DOI: https://dx.doi.org/10.47772/IJRISS.2025.907000291

Received: 30 July 2025; Accepted: 04 August 2025; Published: 14 August 2025

ABSTRACT

Universally, there have been immeasurable budgetary allocations towards curriculum reforms, procurement of educational materials, teachers’ continuous professional development, and infrastructural amenities. Nevertheless, many school improvement policies do not prioritize the hidden health needs of learners. One frequently cited issue is nocturnal enuresis (NE), also referred to as bedwetting. Available data indicates that nocturnal enuresis negatively impacts 6.7% to 10.9% of children of school-going age globally, with an average prevalence rate of 7.2%. In response to this concern, this study intends to (1) explore the psychosocial influences and prevalence of NE on learner inclusivity, (2) provide evidence-driven solutions for nocturnal enuresis-related issues, and (3) recommend strategies for school leaders and policymakers to incorporate NE programs into school improvement policies. Thus, the research relied on empirical studies from both the Indian context and global meta-analysis data for 2025 in order to integrate information on the prevalence of NE on educational outcomes, with a focus on inclusiveness and learners’ emotional well-being. The study uncovered that, NE is not a serious health issue, it significantly affects learners emotionally, impacts their sleep quality, disrupts school attendance, affects academic performance, as well as learners’ social engagement. In summary, it is recommended that school leaders and policymakers must integrate NE initiatives into school health policies so as to create awareness through seminars and continuous profession development of teachers, provide hygienic facilities to promote privacy, and partner with health care providers and parents to enhance sensitization efforts. Ultimately, these practical actions are vital and can foster inclusion, equity, and trauma-free school environments. In conclusion, though NE is a hidden barrier to school improvement and learner inclusion, it has received insignificant focus from stakeholders over the period. As a result, this has increased its adverse impact on learner academic progress such that those who experience it suffer marginalization, leading to interference with the goals of ensuring inclusive school improvement.

 Keywords: bedwetting, nocturnal enuresis, school improvement, engagement, inclusive education

INTRODUCTION

As an indisputable fact, attempts to enhance school quality historically relied on examination scores, teacher qualifications, and availability of technology. However, critical and emotional needs like nocturnal enuresis continue to cripple learner engagement and academic progress in schools. NE, which is defined as an involuntary urination on bed, among children over 5 years of age, seems not to be given any priority in school policies even though it has significant impacts on learning outcomes. In fact, epidemiological studies established that NE is ubiquitous and alarming. An example is the findings from a study in Ahmedabad, India, that revealed a prevalence rate of 6.7%, whereas that of rural Maharashtra indicated 10.91% (Kumari, Dalmia, & Kunj, 2020; Khadke et al., 2023). Moreover, findings from a 2025 global meta-analysis indicated a 7.2% overall prevalence (Yeshanew, Endalamaw, Dessie, & Ayalew, 2025).

Understanding Nocturnal Enuresis in the School Context

From a clinical perspective, nocturnal enuresis is a disorder linked to the development of individuals and is influenced by physiological and psychological factors. Commonly, children who struggle with NE always exhibit shame, shyness, and fear. Consequently, schools that do not have adequate privacy and empathy record extensive number of learners who show emotional distress, which affects their engagement and attention span in school. Regrettably, it is evident that school health policies and teachers’ professional development programmes do not provide adequate priority to NE initiatives. Substantially, these issues align with available clinical guidelines and medical literature that emphasized the developmental and emotional burden of NE on affected children, and the need for multi-sectoral awareness (National Institute for Health and Care Excellence, 2010; Lauters et al. 2022).

Impacts of NE on School Improvement and Inclusion

Psychosocial and Emotional Consequences

Usually, NE is aligned to feeling of stigmatization, shame, anxiety, and low self-esteem. Learners who experience these challenges always try hiding it from the public so that they will no be teased or punished by parents or guardians. Often, the odour is something that one cannot escape especially with those form very poor backgrounds who cannot afford detergents or soap in ensuring proper hygiene. Findings from a study by Nnubia et al. (2024) discovered that children who experience bedwetting mostly have unpleasant smell, subjecting them to mockery. This makes them feel sad, loss respect and do not associate with peers. These categories of learners find it difficult to participate in groups, class discussions, and field works. When this happens, they become less active in school and always feel sad. Because they smell it is difficult fir them to get closer to peers. Educators need to understand that, when NE becomes a chronic emotional issue, learners withdraw from social activities, they become stressed and demonstrate unwillingness to be in school which severely affects academic progress and the zeal to cater for all learners. As a result, school leaders need to be abreast with these kinds of challenges so that they can focus on socio- emotional learning strategies that promote privacy, empathy, and psychological safety for all learners.

Sleep Disruption and Cognitive Readiness

 Bedwetting distorts the sleep of those suffering from it, due to regularly awakenings or anxiety. Children who fear they will bed-wet again fear to sleep, they stay awake and remain not having enough sleep. A systematic review by Reynaud et al. (2019) revealed that poor quality or inadequate sleep among children shown a relationship with significantly lower their mental faculty and general behaviour. When this happens, they sleep in class and do not get along with teaching and learning. They feel drowsy and lacks alertness and concentration on activities; the excessive pressure on the cognitive domain of these learners adversely impacts their academic progress. Teachers who do not know this misinterpret their behaviours thinking that they are lazy or disrespectful. Thus, for learners not to be judged wrongly, teachers need to be careful by applying diligence in handling individual learners. More so, it is important that teachers design more engaging lessons, allow learners to design what hey want to learn, ensure that the classroom is very interactive in order that learner emotions will not over shadow their interests in class. They must also provide the requisite support to enable learners remain mentally stable for all manner of academic activities.

Academic Performance and School Attendance

Several studies uncovered that learners who exhibit signs of bedwetting mostly struggle with reporting to school on time. According to Kumari et al. (2020), 48% of learners who bed wet exhibit poor academic achievements and high absenteeism records. As educators we need to know that some learners will come to school late, even after morning assembly and or avoid school all together all because they do not wake up on time and want to avoid punishments. As a fact, barriers of these nature undermine continuous improvement and learner inclusive initiatives such games, field trips, community outrage, excursions among others. The unfortunate thing is that some of these learners are mislabelled to be stubborn, truants and careless. School leaders must collaborate with stakeholders to design and implement interventions that are NE informed and frowns upon measures that may rather deepen the trauma these learners go through.

Preventive Health Education Initiatives

A lot of schools operate with limited insights on the issues of NE, which is a clear indication that there are no policy considerations that will rescue the stigma. When parents and teachers are well educated on NE, they turn to perceive it as developmental condition instead of behavioural disorder leading to timely interventions. Some of the interventions that parents can rely on entails: use of moisture alarms, bladder training and counselling. School leaders can outsource these resources by establishing partnership with NGOs, health care providers and professional counsellors. They may additionally embed health education within PTA-led initiatives.

Implications for School Improvement

 Integrating NE in school policies will propel school improvement in the following ways:

Increase Learner Participation: When the learning space is safe and supportive, absenteeism, and lateness are reduced boosting learner interest in school activities.

Fosters Academic Performance: Stable, emotional well-being, and quality time will enhance learner concentration and academic progress.

Encourage Equity and Inclusion: Teachers will better understand that tagging such learners as lazy is demeaning, rather they need to provide support without marginalising them merely because they exhibit involuntary health challenges.

Strengthen Home School Partnerships: Engage knowledgeable caregivers who will collaborate effectively with educators to support learners’ academic achievements.

RECOMMENDATION FOR EDUCATIONAL PRACTICE

To focus on promoting inclusive school improvement practices, with learners who experience NE in mind, the following are worth considering:

Awareness Seminars for Educators: There is the need to design NE support measures that are integrated in teacher continuous professional development programmes and implemented to foster awareness.

• NE Integration into Education Policies: Policymakers in education and school leaders should ensure that NE awareness initiatives form part of school health education programs and policies.
• Availability of Standard Sanitation Facilities: In reducing anxiety among learners who experience NE, the government should provide hygienic and accessible private restrooms in schools.
• Parental/Guardian/Caregiver Involvement: Create NE awareness for parents/guardians and or caregivers using workshops, and PTA conferences to promote empathy and support for learners experiencing NE at home.
• Partnership with Healthcare Providers and Counsellors: Establish partnerships with healthcare personnel and school counsellors to create awareness, train teachers, and leverage support for learners struggling with NE.

CONCLUSION

Nocturnal enuresis remains a hidden barrier to academic inclusion and learner engagement in schools. Irrespective of the fact that it is common and carries weight in tearing apart learner emotions it is still misinterpreted as significant number of school leaders do not perceive it as a priority when drafting their improvement plans. This research provided evidence on the argument that NE negatively impacts learners’ emotional well-being academic achievement, and the generic school improvement. Therefore, school leaders and policymakers must focus on integrating NE-sensitive actions promoting inclusive educational strategies. By expanding the scope of health education, providing well equipped facilities, train teachers, establish collaboration with parents, healthcare service providers, caretakers and the larger community. With these, the school climate can eradicate silent exclusion being caused by NE. In this regard, dealing with NE is integral to the broader mission of achieving inclusive, fair, and complete educational progress where every learner counts. In essence, when schools take hidden health issues as their priorities, they help foster a more empathetic and responsive learning space for all learners. School leaders must prioritize and enforce NE programs and promote inclusive learning environments.

REFERENCES

1. Khadke, D. N., Dasila, P., Kadam, N. N., & Siddiqui, M. S. (2023). Prevalence of nocturnal enuresis among children aged 5 to 10 years in rural Maharashtra. International Journal of Contemporary Pediatrics, 10(1), 22–27.https://www.ijpediatrics.com/index.php/ijcp/article/view/5756
2. Kumari, S., Dalmia, P., & Kunj, M. (2020). A cross-sectional study on prevalence and impact of nocturnal enuresis among school children in Ahmedabad. Indian           Journal of Child Health, 7(9), 791–794. https://www.pediatricsjournal.net/archives/2020/vol7issue9/PartA/7-9-5-355.pdf
3. Lauters, R. A., Garcia, K. W., & Arnold, J. J. (2022). Enuresis in children: Common questions and American Family Physician, 106(5), 549–556. https://www.aafp.org/pubs/afp/issues/2022/1100/enuresis-children.html
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