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    Objectives
    • Describe the importance of maintaining hygienic conditions in restrooms and changing areas and of following correct diaper and toileting procedures.
    • Consistently implement general hygiene practices to cut down the spread of infectious diseases.
    • For toddlers, 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

    Infant and toddler caregivers 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. Remember that young children are often fascinated by their bodies and all the things their bodies can do. They may also be fascinated by--and sometimes fearful of--the restrooms they use every day. They approach the restroom the same way they learn about other things: through exploration. Young toddlers 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 come at a price. Restrooms are full of bacteria; as a caregiver, you must be prepared to promote learning and healthy hygiene.

    It is critical to keep restrooms and changing areas clean in child care programs. 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 to appropriately recognize and respond to their bodies' signals. The best way to prevent accidents is to maintain regular toileting routines and carefully watching 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.

    Diaper infants or toddlers or encourage them to try using the restroom at least every two hours. For toilet-trained toddlers, be sure to remind them to use the restroom before you go outside, go on a field trip, get in the car to go home, or begin any new activity that involves leaving the classroom. These are also important times to diaper children who are not yet potty-trained.

    Diapering Procedures

    Diapering and toileting procedures are designed to reduce contamination of surfaces, including hands, equipment, materials and floors. There is also the possibility of re-contamination when a clean surface is soiled again. Follow approved procedures to eliminate contamination and re-contamination of surfaces.

    Diapering procedures involve many steps; each is important and must be followed to reduce the risk of contamination. 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 program'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 (if needed).
      • Plastic gloves.
      • Diaper cream, removed from a container and placed on a disposable tissue.
      • Put on gloves.
    2. 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 changing.
      • 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 plastic-lined, hands-free cover trash can.
      • 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 sanitize 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 sanitizing 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 sanitizer 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 sanitizing solutions away and WASH your hands.
      • Record the diaper change, diaper contents and problems in your daily log.

    To see an illustrated guide of the above (with photos courtesy of Healthy Child Care North Carolina), see the Diapering Procedure resource from the Iowa Department of Public Health located below in the Learn Activities section.

    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. First, adults must wash their hands first before they gather diaper supplies and then again during the final step after they have put cleaning and sanitizing solutions away (see steps 1 and 8 above on the Diapering Procedure chart). Infants and toddlers must wash their hands or have their hands washed after a clean diaper is put on them and they are fully dressed (see step 6 above).

    Reading the 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 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 toddlers learn self-help skills and participate in their toileting routine. The Do section below outlines some general hygiene practices to remember with regards to toileting.

    Infants and toddlers could also drown in toilet bowls; they may play and explore in the restroom, contacting contaminated items or surfaces or otherwise injuring 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 toddler's toileting, whether they are still learning or have already mastered potty-training, it's important to assure they complete their toileting routine in the most hygienic way possible. For example, teach girls to wipe front to back, to prevent germs that can cause unitary infections away from their vaginas. You may also need to help young children gauge the amount of toilet paper they need to adequately cover their hand to wipe themselves, but also not clog the toilet. In addition, although you will help toddlers take on more responsibility for wiping their bottoms independently, in the early phases of toileting you may need to offer assistance in wiping to assure children's bottoms are free of fecal matter. Remember to put on gloves to help with this process and to follow the glove procedure outlined below. Most importantly, it's important that you ensure all children follow appropriate handwashing procedures (see Lesson Two) after using the restroom.

    As previously mentioned, toddlers, who are learning how to use the toilet or who have recently mastered toilet training, likely still need assistance with toileting and dressing. But this is especially true if they have just had a toileting accident. Accidents can be embarrassing for young 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 clean-up. Proper hygiene is important for you and the children in your classroom. Many illnesses can spread through fecal matter.

    Once you know an accident has happened, 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 lay on, 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 Changing Soiled Clothes resource in the Apply section below.

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

    Several children in your class 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 breakfast cart 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 supervised 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 the classroom. Wash your hands again.

    See this teacher describe how she helps children after an accident.

    Helping Children After Accidents

    Review steps to take to clean up after a toileting accident.

    Have Supplies Stocked and Accessible

    Having all necessary items available when you need them is essential for both safety and health. It's a pain to realize, in the middle of a diaper change, that someone used the last pair of gloves or, while showing a toddler how to wash their hands, you find the soap dispenser empty. Checking that all supplies are well-stocked at the beginning of your day helps to ensure that you always have what you need when you need it.

    Glove Procedures

    Gloves, though recommended and required by many programs, do not automatically protect infants, toddlers and adults from exposure to germs. Adults often feel a false sense of protection when they wear gloves. Think carefully during clean up as you could unknowingly spread germs that touch your glove to the next surface your glove touches.

    The following Gloving Procedure, from Caring for Our Children (2015), illustrates correct general use of gloves, whether you are treating an infant or toddler 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 clean hand strip the glove off 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 step can. Wash your hands.

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

    Toilet Training

    During the toddler years, most children begin toilet or potty training, and many will master it. It is important to take time to consider the potential barriers to toilet training and each child's unique development and situation. Consider these barriers to determine if the timing is right to begin the toilet training process, for the child, the family, and caregivers.

    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 the teaching staff so the child has consistent reinforcement. Transitioning from diapers to the toilet may involve families emotionally letting go of their 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. In the United States, many hold the expectation that children will be toilet trained by their third year. This is generally thought to be around age 2 years for girls and 2½ years for boys. Other cultures may promote that children should be toilet trained within an earlier or later time-frame. As with all decisions, staff 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, the child 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, to feel/understand the sense of elimination
    • Shows discomfort over their wet or soiled diaper
    • Shows some interest in going to the potty and being more autonomous
    • Is able to pull down and pull up their 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. Placement in a classroom should not only be contingent on potty training; development in other areas should also be considered so that the child has the best placement in the least-restrictive environment. Work with the child's family and use 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 infants and toddlers are diapered or when they use the bathroom is important information for both you and their families. In babies, changes in these bodily functions can be an indication that something is wrong and needs to be addressed. For toddlers, documentation can identify patterns that can help 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 recording it accurately.

    Diapering and Toileting Is a Time for Learning

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

    • Learn self-help skills needed for preschool.
    • 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 these examples of diapering and notice how healthy procedures are followed and the caregivers capitalize on their one-on-one interactions to deepen their relationships with children and provide language and learning opportunities.

    Diapering Correctly with Sensitive Interactions

    Diapering Properly Step By Step

    Do

    General Hygiene Procedures for Toileting

    There are many ways to maintain a healthy environment throughout your classroom. 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, walls and toilet seats 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 and handwashing after toileting. If you must use the same sink, disinfect it before use 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:

    • Follow correct diapering and toileting procedures.
    • Ensure that all diapering and toileting supplies are well-stocked and accessible.
    • Involve infants and toddlers in the diapering and toileting process; 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

    Watching others during the diapering process can provide some ideas for ways to enhance your own practices. Watch the video below, then download, print and complete the Diapering Video Activity. Share your responses with a trainer, coach, or administrator.

    Changing Diapers Supports Development

    Changing Diapers Supports Development

    Apply

    Apply

    Use these documents to help provide a healthy restroom environment. Post the Gloving Procedures poster from Caring for Our Children in your restroom or diaper changing area. Save the Changing Soiled Clothes 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
    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 their ability to do things on their own

    Demonstrate

    Demonstrate
    Assessment

    Q1

    When must adults wash their hands during the diapering process?

    Q2

    Finish this statement: Diapering and toileting are an opportunity to…

    Q3

    True or False? If gloves are used properly during diapering changes, you do not have to wash your hands.

    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

    North Carolina Child Care Health and Safety Resource Center. (2019). Retrieved from https://healthychildcare.unc.edu/

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

    North Carolina Child Care Health and Safety Resource Center. (2018). Handwashing posters for children and adults. Retrieved from http://www.healthychildcarenc.org/?page=posters