The Community-Led Total Sanitation (CLTS) approach is said to have radically revolutionized a poorly performing sanitation sector. The claims of CLTS programmes successfully stopping practices of open defecation have only recently begun to be critically reviewed: scholars and practitioners are questioning the sustainability and scrutinizing the participatory nature of this approach. This article builds on these analyses to draw attention to the School-Led Total Sanitation (SLTS) programme which promotes the role of children as sanitation change agents to ‘trigger’ a shift of behaviour in their peers and elders in school and surrounding environments. The article reviews the active role of children in SLTS in the context of how ‘participation’ is structured in demand-led sanitation approaches, as well as in relation to children's rights to participation in developmental projects in general. Reviewing the arguments supporting SLTS in practitioner literature and drawing on observations from SLTS case studies in Ghana, the authors notice a significant contradiction in the concept of children's participation as premised in SLTS initiatives and as outlined in the child rights agenda. These findings expose inherent tensions in SLTS between children's rights, participation and the role of children as sanitation change agents. They build on existing critiques of participation as coercion within demand-led sanitation approaches that have ‘gone global’.