Why are so many four-year-olds not potty-trained before school?

For some parents the countdown to starting school means buying uniforms, labelling water bottles and trying to squeeze in one last summer holiday.

For others there is a more basic question to tackle: can their child use the toilet on their own?

According to a survey by the charity Kindred Squared, almost a third of children starting school in the West Midlands last year were not fully toilet-trained and 42% of those arriving in reception were deemed not school-ready by primary school staff.

This week the charity announced its potty-training scheme, which provides resources and support including increased training for nurseries, schools and professionals, will be rolled out in Solihull.

In a pilot in York, which began in April, parents were sent potty-training and school readiness guides with their offers of a school place. Workshops were held, resources distributed and support offered through GPs, pharmacies, libraries and community hubs.

As a result, the number of non-toilet-trained children starting reception fell by almost half.

An early years specialist based in Wolverhampton has said the conversation about school readiness needs to extend well beyond the toilet.

Ruth Lu-Quee, a former deputy head teacher and founder of My Mummy Teacher, works with parents and schools to support children's development through play-based learning.

She said: "We want to be setting the foundations. Can they talk and have conversations? Are you reading stories to them? Are they moving their bodies? Because all of those things are what then underpin the skills to be able to learn, practising everyday independence. Can they hang their coat or can they take their socks off?"

But she warned that school readiness could become a source of anxiety for families and said it was important to recognise that children reached milestones at different speeds.

"We need to be careful that school readiness doesn't become a checklist that four-year-olds are expected to pass or something that leaves parents feeling they have failed if their child develops differently," she said. "Childhood isn't a race."

Rachel, a mother-of-two from Nottinghamshire, is one of Lu-Quee's clients. She tried to toilet-train her son when he was three but he had problems with withholding stools.

She works as a teacher but said being on the other side of the problem as a parent was very different.

"I'd say as a teacher, I feel I'm quite an informed parent in this area," she said. "So I was thinking, 'I know what's going on but I don't know what to do'.

"It's not the parent, it's not being lazy; it's hard and it's a lot of effort," she added.

She was told she would not be able to access funded support for her child until he was five, and it was not until the end of his reception year that the family received help.

Now aged eight, her son is awaiting an assessment for ADHD, which Rachel believes could have affected aspects of his development despite going unnoticed in his early years.

"Withholding can be trauma-informed and it can be because of passing something that has hurt at some point or someone has reacted badly to them having an accident," she said, adding she believed embarrassment and shame had contributed to her son's difficulties after he had an accident at nursery.

Helen Davies, a health visitor and children's nurse based in Stafford, said children who repeatedly had accidents may be frightened of the toilet, leading to constipation.

"A child who is struggling may be frightened of the toilet, withholding poo or experiencing constipation. Repeated accidents should prompt curiosity about what is getting in the way rather than an assumption that parents have not tried hard enough," she said.

Annamaria Bailey, 37, a mother-of-two from Wolverhampton, said toilet-training her two-year-old involved taking four days off from her job as an independent travel agent.

"I'm a stay-at-home mum," she said. "I don't know how I would block out four consecutive days of work."

She said helping children with skills such as toileting and communication could be a particular challenge for families where both parents worked full time.

"There's no longer that time to sit and play with your children now as much as you would like," she said. "I just genuinely don't think it's the parents' fault."

Lu-Quee highlighted that older generations are working later too, meaning some families "don't have the village like they used to have".

Kindred Squared said the West Midlands had seen one of the biggest declines in school readiness in the country, with the number of children lacking skills such as toileting increasing year on year.

Solihull Council said it had "had reports locally of a higher proportion of children arriving at school in nappies or pull-ups in comparison to a few years ago", adding that its new potty-training scheme would form part of its wider Best Start in Life programme.

Bailey, a former reception teacher and early years lead, said she had worked in "deprived and affluent areas" and had seen inequalities in school readiness.

"It comes down to income," she said. While some parents were able to buy parenting books, she said those on lower incomes had less access to information.

"Books are quite expensive," she added, suggesting families could be given free toilet-training resources when their children turned two.

Davies, who provides one-to-one guidance through her company Essential Parenting, said families may not be getting "timely, consistent support before difficulties become entrenched".

She said financial pressure, parental stress, limited opportunities for play and difficulty accessing early years provision and professional advice could make preparing for school harder.

"Public services are essential, particularly for families who cannot afford private support," she said.

For teachers, the issue is tangible. A reception teacher dealing with several children who need help with toileting has to balance that against the needs of the rest of the class.

"It's really, really difficult for schools to be able to facilitate supporting that alongside teaching," said Lu-Quee. "Teachers are undoubtedly reporting that children are arriving in school with much broader, wider ranging needs but I think we need to be really careful that we're not just jumping to blaming parents."

Anna Nijjar, a governor at St Nicholas CE First School in Codsall, Staffordshire, said responsibility for children's development fell to schools as well as parents: "The role of school, particularly at that age, is to help children develop into young people and to learn the right skills."

She called for more funding for schools to help them meet increased demands: "We should support parents but we should also be supporting schools. Schools are absolutely desperate for resources and are having to make the best decisions with the money they have. We should be making sure our schools are ready for children."

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