School Policy on Drinking and Toilets: Weaknesses and Relation With Children's Hydration Status

Objective: To investigate school policies and practices related to drinking fluids and toileting and test their association with children's hydration status and toilet behaviors. Design: Cross-sectional study in 2014. Setting: Seventeen Belgian primary schools. Participants: A total of 416 children (aged 7-13 years). Main Outcome Measures: Hydration was measured by urinary osmolality in a pooled school-day sample and by impedance-based body water percentage. Children reported how much they liked school toilets. School policy and practices were reported by schools on 59 items over 10 policy components. Analysis: Multilevel logistic regression analyses adjusted for age, sex, region and socioeconomic status. Results: School's weaknesses were the lack of policy participation by parents and children; official agreements (only in 11%); organizing education on drinking and toilet visits; and toilet infrastructure. Children's hydration was higher in schools that (1) made water available, (2) organized toilet and drinking related education, (3) had formal agreements on drinking and toilet visits, and (4) had good toilet maintenance. Children liked school toilets more in schools that (1) organized toilet and drinking related education, (2) had an official policy on drinking, (3) had good toilet infrastructure, and (4) allowed policy participation by parents and children. Conclusions and Implications: Specific action points for school management and government to improve children's hydration at school were detected by focusing on both drinking and toilet practices/infrastructure.