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    Objectives
    • Describe the importance of maintaining hygienic conditions in restrooms and changing areas.
    • Consistently implement general hygiene practices to cut down the spread of infectious diseases.
    • Promote children’s self-care skills and independence while assisting with toileting and clean-up.
    • Demonstrate ways to diaper and toilet correctly.

    Learn

    Learn

    Know

    In your family child care program, some children may still wear diapers, some children may just be learning to use the toilet, and others may have already mastered toileting. Family child care providers must know how to safely change a child’s diaper, how to patiently and respectfully help a young child learn how to use the toilet, and how to respond sensitively to toileting accidents. Children are fascinated by their bodies and all the things their bodies can do. They may also be fascinated—and sometimes fearful—of the restrooms they use every day. They approach the restroom the same way they learn about other things: by exploring. They might love to flush the toilets, turn faucets on and off, watch toilet paper unroll, and explore the sounds their voices make in the restroom. Unfortunately, all of this learning can come at a price. Restrooms are full of bacteria and as a caregiver, you must be prepared to promote learning and healthy hygiene.

    It is critical to keep restrooms and changing areas clean in your child care program. Diapering and toileting are major sources of contamination. Unsanitary practices can put you and children at risk for illness and infection. This lesson will focus on general practices for maintaining hygienic diapering and toileting practices and procedures for helping a child who has had an accident.

    At some point, you will likely help a young child learn how to use the toilet. Toileting accidents are a typical part of the “potty training” process for many children, as it may take time for them appropriately recognize and respond to the signals in their bodies. The best way to prevent accidents is to maintain regular toileting routines and carefully watch for signs that a child needs to use the restroom. Holding the genital area, squirming, or moving uncomfortably could all mean a child needs to use the restroom.

    You should diaper young children or encourage them to try using the restroom at least every two hours. For toilet-trained children, be sure to remind them to use the restroom before you go outside, go on a field trip, or begin any new activity that involves leaving your family child care home. These are also important times to diaper children who are not yet toilet trained.

    Diapering Procedures

    Diapering and toileting procedures are designed to reduce contamination of surfaces, including hands, equipment, materials and floors. Following approved procedures will help to eliminate contamination and recontamination of surfaces.

    Diapering procedures involve many steps; each is important and must be followed to reduce the risk of contamination. For cloth diapers, be sure to follow your licensing agency or Service specific guidelines. The following Diapering Procedure, recommended by Caring for Our Children (2015), depicts eight steps, each step consisting of several tasks. As always, adhere to your Service’s diapering procedures.

    Diapering Procedure

    1. Get organized. WASH your hands and gather all the necessary items for a diaper change.
      • Non-absorbent paper liner large enough to cover the changing surface from the child's shoulders to beyond the child's feet.
      • Fresh diaper and clean clothes (if needed).
      • Disposable wipes.
      • Plastic bag for soiled clothes or cloth diapers (if needed).
      • Plastic gloves.
      • Diaper cream, removed from a container and placed on a disposable tissue.
    2. Put on gloves.  Carry the child to the diapering area.  ALWAYS KEEP A HAND ON THE CHILD.
      • Gently place child on diapering surface, always keeping a hand on the child.
      • Remove child's clothes, socks and shoes if needed so the child does not contaminate these surfaces with stool or urine during the diaper change.
      • If clothes are soiled, place them in a secured bag to go home. Do not rinse the clothes.
    3. Clean the child's diaper area.
      • Unfasten diaper but leave the soiled diaper under the child.
      • Clean the child with wipes, wiping from front to back to remove urine and stool, using each wipe only once.
      • Lift the child's legs as needed to use disposable wipes to clean the skin on the child's genitalia and buttocks.
      • Put the soiled wipes into the soiled diaper or directly into a plastic-lined, hands-free covered can.
      • Use fresh wipe or damp paper towel with each cleaning.
    4. Remove the soiled diaper.
      • Immediately place soiled diaper in a plastic-lined, hands-free covered trash can.
      • For cloth diapers, place the cloth diaper and its contents (without rinsing or emptying) in a sealable plastic bag or in a plastic-lined, hands-free covered can to give to parents or laundry service.
      • Remove gloves and dispose of them immediately.
      • Clean your own hands and the child's hands with a disposable wipe.
      • Dispose of the wipes immediately.
    5. Put a clean diaper on the child and dress the child.
      • Slide fresh diaper under the child.
      • If diaper cream is needed, use tissue to apply the cream and then discard the unused amount.
      • Adjust and fasten diaper
      • Finish clothing the child
    6. Wash the child's hands.
      • Take the child to the sink and WASH their hands with soap and water.
      • Return the child to a supervised area.
    7. Clean, rinse and disinfect the diapering area.
      • If paper liner is used, dispose of liner in a plastic-lined, hands-free covered trash can.
      • Clean any visible soil with detergent and water and sanitize the changing surface.
      • If a pad is used, spray both sides of the pad and the changing table surface with detergent solution. Rinse with water.
      • Wet the entire changing surface with the disinfecting solution
      • Spray both sides of the pad and the changing table surface with a disinfecting solution.
      • If the recommended bleach dilution is sprayed as a disinfectant on the surface, leave it in contact with the surface for at least 2 minutes.
      • The surface can be left to air dry or can be wiped dry after 2 minutes of contact with the bleach solution.
    8. Wash your own hands.
      • Put cleaning and disinfecting solutions away and WASH your hands.
      • Record the diaper change, diaper contents and problems in your daily log.

    For more information on the use of cloth diapers, see the Handling Cloth Diapers resource in the Learn Activities section of this lesson.

    Handwashing and Diapering

    Proper handwashing procedures are essential during diapering. The order in which handwashing is completed during the diapering procedure is critical for the environment to be free of contamination. There are two times adults must wash their hands during diapering. Adults must wash their hands first before they gather diaper supplies and again during the final step after they have put cleaning and sanitizing solutions away (See Step 1 and Step 8 on the above Diapering Procedure chart). Children must wash their hands or have their hands washed after a clean diaper is put on them and they are fully dressed (Step 6 of the procedure).

    Reading how to complete a proper diapering procedure is much easier than actually changing a diaper! Whether this is your initial training on diapering or you’ve changed 500 diapers, it is important to review each step to assess if you are still conducting the procedure correctly.

    Toileting Procedures

    Toileting, as with diapering, has procedures that must be followed to reduce the spread of germs. Toileting has additional health considerations as young children are learning self-help skills and are participating in their toileting routine. The Do section below outlines some general hygiene practices to remember with regard to toileting.

    Also, infants and toddlers could drown in toilet bowls; they may play and explore in the restroom, contacting contaminated items or surfaces or otherwise injure themselves. For this reason, infants and toddlers should always be supervised in the restroom by both sight and sound.

    Help Children with Self-Care and Hygiene

    When you oversee young children’s toileting, whether they are still learning or have already mastered toilet training, it’s important to make sure they complete their toileting routine in the most hygienic way possible. For example, teach girls to wipe front to back, so that they can keep germs that may cause urinary infections away from their vaginal area. You may also need to help young children gauge the amount of toilet paper they need to adequately cover their hand and wipe themselves, but also not clog the toilet. In addition, although you will help young children take increasing responsibility for wiping their bottoms independently, in the early phases of toileting you may need to offer assistance in wiping to ensure children’s bottoms are free of fecal matter. Remember to put on gloves to help with this process and to follow the glove procedure outline below. Most importantly, make sure all children follow appropriate handwashing procedures (see Lesson Two) after using the restroom.

    Young children who are learning how to use the toilet or who have recently mastered potty training likely still need assistance with toileting and dressing— this is especially true if they have just had an accident in the restroom. Accidents can be embarrassing for children. It is important to help the child clean up, get dressed, and return to the learning environment safely. You must also work to prevent the spread of germs and contaminants during the clean-up. Proper hygiene is important for you and the children in your program. Many illnesses can be spread through fecal matter.

    When accidents happen, prepare yourself to help the child clean up and change clothes. A space for changing the child is important. You must be sure to keep the changing space, the child, and yourself clean. Follow these steps:

    1. Wash your hands.
    2. Bring supplies over. You will need clean clothing, wipes, plastic bags, paper liner for the child to stand or lie on, a wet cloth or paper towel, and disposable gloves.
    3. Follow the procedures described in Caring for Our Children (2015). These procedures are provided in the attachment called Changing Soiled Clothes in the Apply section.

    Consider the following scenario while thinking about the information shared above. What would you do to address this situation?

    Several children in your program are finishing breakfast. One of your toddlers refused to use the restroom when she came in this morning. She said she did not need to go, washed her hands, and sat down for breakfast. Now as you walk to the kitchen to start cleaning up, you notice a puddle on the floor behind her seat. You think she spilled her drink, but you notice that her cup is full. You ask her to stand up so you can clean the puddle. You see then that her pants are all wet, and you suspect she had an accident.

    You should do the following:

    Make sure all children are safe and block off the soiled area. Wash your hands and gather supplies. Ask the child who had the accident to go into the restroom area while you gather supplies. Put on gloves and follow changing procedures (see Apply section of this lesson) to help the child remove soiled clothing and clean herself. Put soiled clothing in a sealed plastic bag to be sent home. Clean your hands and the child’s hands with fresh disposable wipes. Help the child get dressed in clean clothing. Wash your hands and make sure the child washes her hands thoroughly. Then let her return to play in a supervised area. Clean and disinfect the changing area. Wash your hands. Clean and disinfect the soiled area of your family child care program. Wash your hands again.

    Having Supplies Stocked and Accessible

    Having all necessary items available when you need them is essential for both safety and health. You don’t want to be in the middle of a diaper change or helping a child clean up after an accident to find someone used the last pair of gloves. Similarly, you don’t want to show a toddler how to wash their hands and find the soap dispenser empty. Checking that all supplies are well-stocked at the beginning of your day helps ensure you have what you need when you need it.

    Glove Procedures

    Gloves, though recommended and required by many programs, do not automatically protect children and adults from exposure to germs. Adults often feel a false sense of protection when they wear gloves. Wearing gloves does not merely involve protecting your hands. Germs that touch a glove can be spread to the next surface the glove touches.

    The following Gloving Procedure, from Caring for Our Children (2015), illustrates correct general use of gloves, whether you are treating a child with an injury or using them during diapering routines. On the Diapering Procedure chart above, see Step 1 on when to put on gloves and Step 4 on when to dispose of gloves during the diapering process.

    1. Wash hands prior to using gloves if hands are visibly soiled.
    2. Put on a clean pair of gloves.
    3. Provide appropriate care.
    4. Remove each glove carefully. Grab the first glove at the palm and strip the glove off. Touch dirty surfaces only to dirty surfaces.
    5. Ball up the dirty glove in the palm of the other gloved hand.
    6. With the non-gloved hand, strip the glove off the other hand from underneath at the wrist, turning the glove inside out. Touch dirty surfaces only to dirty surfaces.
    7. Discard the dirty gloves immediately in a hands-free or step trash can. Wash your hands.

    Remember, wearing gloves does not take the place of handwashing!

    Toilet Training

    Most children begin toilet or potty training, and many will master it, during the toddler years. It is important to take some time to consider the potential barriers to toilet training and each child’s unique development and situation. Considering these barriers will help you determine if the timing is right for the child, family, and caregivers to begin the toilet training process.

    Barriers to Potty Training

    • Children are not yet ready. Sometimes toddlers are pushed into potty training before their bodies are ready. It is not impossible to help a child who is not ready to learn to use the potty, but it is definitely more of a challenge.
    • Families are not yet ready. For families to be ready to make the commitment, they must be ready to help the child with potty training at home, bring all of the supplies needed, and to work as a team with you so the child has consistent reinforcement. Transitioning to using the toilet may involve families emotionally letting go of the baby and embracing the child becoming a preschooler. This may be a process for some families to work through; in fact, they may not even be aware that they are feeling ambivalent about the process.
    • Cultural expectations vary. The dominant culture in the United States holds the expectation that children will be potty trained by their third year. This is generally thought to be the age of 2 years for girls and the age of 2½ years for boys. Other cultures may believe that children should be potty trained within an earlier or later time frame. As with all decisions, you should consult with families to understand their expectations.
    • Timing is a factor. A child may be physically but not emotionally ready for potty training. Perhaps a sibling has newly arrived, a parent is deployed, the family has moved, or other family changes make potty training an additional stressor rather than a welcome task. It is best in these circumstances to delay potty training until the child or family has made it through most of the emotional upheaval in the transition.

    Child Readiness Signs

    The child:

    • Has understanding of the concept of cause and effect
    • Has an ability to communicate, including sign language—he or she may use words or gestures to indicated the need to use the toilet
    • Can remain dry for at least two hours at a time during the day or is dry at naptime
    • Has bowel movements on a regular and predictable schedule
    • Can follow simple directions
    • Can sit on the toilet and can feel and understand the sense of elimination
    • Shows discomfort over wet or soiled diaper
    • Shows some interest in going to the potty and being more autonomous
    • Is able to pull down and pull up his or her own pants

    Readiness for Children with Special Needs

    When children have developmental delays or disabilities, they may potty train much later than typically developing children. You should work with the child’s family and other resources, such as intervention specialists, to ensure the most inclusive practices when it comes to potty training strategies, timing, and readiness factors. For more information on inclusive practices and toileting training for children with special needs, visit: https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/Toilet-Training-Children-with-Special-Needs.aspx

    The Importance of Documentation

    Recording when young children, especially infants and toddlers are diapered or when they use the bathroom is important information to both you and their families. Changes in these bodily functions of babies can be an indication that something is wrong and needs to be addressed. For toddlers, documentation can help you identify patterns that can assist with potty training. It is important to document diapering and toileting records immediately for each child, after you’ve washed your hands. If you put off documentation, something will likely come up and you will have to rely on your memory rather than having recorded it accurately.

    Diapering and Toileting Is a Time for Learning

    Diapering and toileting is an opportunity to engage in nurturing interactions that support all the domains of development; it is so much more than taking care of a child’s physical needs. While diapering and toileting, young children:

    • Learn self-help skills needed for formal school.
    • Acquire language and communication skills through listening and verbalizing (cooing, babbling, talking) with you during routine care.
    • Develop a sense of competence when they are helpful.
    • Practice small- and large-muscle skills, including grasping their pants to push down and pull up during toileting and holding their legs up and returning to a sitting position during diapering.
    • Develop their emotional attachment to you, which helps them feel secure and supports their development and learning.

    See

    Watch this example of diapering and notice how safety procedures are followed and the caregiver capitalizes on the one-on-one experience to deepen her relationship with the child and provide language and learning opportunities.

    Proper Hygiene While Diapering

    Diapering Properly Step By Step

    Watch these providers describe how to help children after toileting accidents.

    Helping Children after Accidents

    Watch these providers describes how to help children after an accident.

    Do

    General Hygiene Procedures for Toileting

    There are many ways to maintain a healthy environment throughout your family child care program. The restroom is an important place to start. Follow these steps to create healthy habits for yourself and the children in your care:

    • Check the restroom regularly to make sure toilets are flushed.
    • Check to make sure floors, doors, and walls are clean.
    • Make sure paper towels and other trash are thrown away properly.
    • Make sure running water, soap, paper towels, plastic bags for soiled clothing, and toilet paper are available.
    • Make sure you put disposable gloves on before handling soiled clothing or diapers. Remove gloves before handling clean clothing and diapers.
    • If possible, use a separate sink for general use versus handwashing after toileting. If you must use the same sink, disinfect it before using it for general or food-related use.
    • Always wash your hands after helping children use the toilet, assisting with soiled clothing, or touching contaminated surfaces. Even if you wear disposable gloves, you must wash your hands.
    • Make sure all children and adults wash their hands properly.

     In addition, when it comes to diapering and toileting, always do the following:

    • Follow correct diapering and toileting procedures.
    • Ensure that all diapering and toileting supplies are well-stocked and accessible.
    • Involve young children in the diapering and toileting process (e.g., they may be able to help pull up their pants or hold the diaper); it’s something you do together not something that is done to them.
    • Use descriptive language to explain what is happening during diapering and toileting.

    Explore

    Explore

    It is important to think ahead about how you will respond when children have accidents or problems in the restroom. In the What Would You Do activity, read the scenarios and describe the steps you would take to keep children healthy. Consider healthy hygiene practices, handwashing, and modeling healthy habits. Share your responses with a trainer or coach. Then, compare your answers to the suggested responses.

    Apply

    Apply

    To help provide a healthy restroom environment, consider posting the Gloving Procedures poster from Caring for Our Children in your restroom or changing area. Save the Changing Soiled Clothing Guide as a reference.

    Glossary

    TermDescription
    AttachmentThe process of forming a close relationship with a child that leads to a sense of trust and security
    ContaminationTo infect or soil with presence of infectious microorganisms (germs) in or on the body, on environmental surfaces, on articles of clothing, or in food and water
    Fecal MatterSolid human waste or the product of a bowel movement
    Re-contaminationTo again infect or soil with presence of infectious microorganisms (germs)
    Sense of competenceAn indicator of infant and toddler emotional development; the child will recognize his or her ability to do things

    Demonstrate

    Demonstrate
    Assessment

    Q1

    Mattias had an accident on the playground. His underwear, jeans, socks, and sneakers were soiled. His family child care provider took all the children inside, directed the other children to play in an area she could easily see, prepared the changing area, and helped Mattias get cleaned up. She washed both their hands. She helped him dress in clean clothes and put his sneakers back on his feet. What did Mattias’ family care provider forget to do?

    Q2

    Which is not a way to prevent toileting-related accidents in your classroom?

    Q3

    Andrea is a family child care provider. She notices that one of the children in her program, Peeta, has wet jeans after nap time. Which of the following is the best way for Andrea to respond?

    References & Resources

    American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2015). Caring for Our Children: National health and safety performance standards; Guidelines for early care and education programs. (3rd ed.). Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Retrieved from http://nrckids.org/CFOC/TOC

    Cryer, D., Harms, T., & Riley, C. (2003). All about the ECERS-R. Kaplan Early Learning Company.

    eXtension.org (2016). Preschool Children May Have Daytime Toileting Accidents. Retrieved from: http://articles.extension.org/sites/default/files/w/5/55/JITP45-46mo.pdf

    North Carolina Child Care Health and Safety Resource Center. (n.d.). Publications and Resources. Retrieved from https://healthychildcare.unc.edu/resources/links/

    Ohio Child Care Resource and Referral Association. (2006). Ohio’s Infant & Toddler Guidelines.

    Pennsylvania Chapter of the American Academy of Pediatrics. (2010). Changing Soiled Underwear for Toddlers. Retrieved from http://www.ecels-healthychildcarepa.org/publications/fact-sheets/item/116-changing-soiled-underwear?highlight=WyJzb2lsZWQiLCJ1bmRlcndlYXIiLCJzb2lsZWQgdW5kZXJ3ZWFyIl0=