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    Objectives
    • Identify general hygiene practices related to diapering and toileting for children.
    • Deepen your understanding of what matters most when it comes to potty training.
    • Provide management practices to support your staff as they implement your Service’s requirements for potty training.
    • Ensure staff know how to sensitively and hygienically respond to toileting accidents.

    Learn

    Learn

    Know

    Maintaining Hygiene

    It is critical to keep diapering areas and restrooms clean in child development and school-age programs. Toileting and diapering are a major source of contamination and unsanitary practices can put staff members, children, and youth at risk for illness and infection. Sanitary conditions must be maintained in all diapering areas and restrooms. Make sure:

    • Toilets are flushed.
    • Floors, doors, walls, and changing surfaces are clean.
    • Paper towels and other trash are thrown away properly.
    • Running water, soap, paper towels, plastic bags for soiled clothing, and toilet paper are available.
    • Adults always wash hands after changing a diaper, helping a child use the toilet, assisting with soiled clothing, or touching contaminated surfaces.
    • All children and adults wash their hands properly.

    Handwashing and Diapering

    Proper handwashing procedures are essential during diapering and toileting. 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. 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. More on handwashing is addressed in Lesson Two.

    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 are learning self-help skills and are actively participating in their toileting routine. As a result, the chances of contamination are increased.

    Have Supplies Stocked and Accessible

    Having all necessary items available when staff need them is essential for both safety and health. It's awful to realize, in the middle of a diaper change, that someone used the last pair of gloves. Or, when showing a toddler how to wash their hands, you notice the soap dispenser is empty. Work with staff to have systems in place; someone should check that all supplies are well stocked at the beginning of the day to ensure that staff members always have what they need when they need it. This could be a duty of the opening staff member in each room or program.

    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. Wearing gloves merely involves protecting your hands; germs that touch a glove can unknowingly 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 an infant or toddler with an injury or using them during diapering routines.

    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! Lesson Two provides a visual handout on the procedure for removing gloves that you can share with staff.

    Potty Training

    Many staff members who work with infants and toddlers, or young preschoolers, will need guidance in potty training issues. Potty training is an important milestone for children and one that staff members must approach sensitively. You can help teachers and staff members learn:

    • When children are typically ready to begin potty training
    • How to tell if a particular child is ready for potty training
    • How to help children potty train successfully
    • How to help children (including preschool and school-age children) respond to accidents
    • How to work with and stay sensitive to families concerns and input about potty training.

    Watch this video for other ways you can support toilet training in your setting.

    Supervise & Support

    Toilet Training Toddlers

    Follow best practices in Toilet Training toddlers.

    You should also remember that staff members who work with preschoolers or school-age children may also need support around promoting independent toileting. For most children, potty training is a distant memory by kindergarten. That doesn't mean that there won't be an occasional accident. It also doesn't mean that they won't need some support around their growing independence. Here are some things to keep in mind when supporting staff who work with school-age children and older preschoolers.

    • Accidents happen and they can be humiliating for the child. Make sure staff respond sensitively and make it a point to protect the child's privacy. Help staff members think about ways to minimize attention toward the accident and ways they can subtly help children find clean clothes. It's also important that staff members help children "save face" when they re-enter the program area after an accident. 
    • Promote independence in young school-agers. In most school-age programs, children do not need adult permission to use the restroom, but this might be a new and difficult idea for young children transitioning into the program. Help staff remain patient and support children as they learn to recognize their own needs and take care of them independently.
    • Plan ahead. Changes in routine or exciting special events can make children forget to take care of their needs. This means staff should remind preschool and school-age children to use the restroom before field trips or long bus rides.

    In addition to these points, remember that accidents must be handled appropriately to limit contamination and the spread of germs. Attached, find the steps that a staff member should follow in the event a toddler, preschooler or school-age child has an accident. With trainers and coaches, talk through different case scenarios so staff members feel prepared to handle accidents sensitively and with proper hygiene practices.

    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 to use the toilet may involve families emotionally letting go of their baby and embracing that their child is now 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 this process.
    • Cultural expectations vary. A common expectation in the United States holds that children will be potty-trained by their third year; around age 2 years for girls and 2½ years for boys. Other cultures may promote that children should be potty-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 new sibling has 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.

    Program Supports

    Families take the lead in potty training. Your staff should consult with the families, share ideas about readiness signs and decide together how to best work with the child. Your staff should openly work with families whose cultural beliefs and values create different expectations for when and how potty training is conducted. Communicating ideas and expectations is the best way to provide care that is in the best interests of the child.

    Toilet training is typically easier for children when they can feel the effects of "accidents" and can take an active role in changing to dry clothing. You should adhere to your Service's or program's policies on what kinds of clothing should be worn when potty training and be sure to have your staff communicate with the families about these policies.

    Families and staff should agree on the appropriate words to use. Most programs use the accepted names of bodily functions and body parts (bowel movement, urine, etc.). Discussion is needed with families so that the same words are used if possible by the families and your staff.

    Expectations align when communication remains open and all members of the team are ready and work together. Appropriate praise and positive reinforcement by staff is important in encouraging children to transition to potty use. Being specific in the praise ("You stayed dry," "You went in the potty all by yourself!") helps keep the feedback specific and authentic.

    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 staff 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 staff, which helps them feel secure and supports their development and learning.

    The Importance of Documentation

    Recording when infants and toddlers are diapered or when they use the bathroom is important information to both staff and their families. Changes in these bodily functions of infants can be an indication that something is wrong and needs to be addressed. For toddlers, documentation helps potty training when staff can identify toileting patterns. It is important to document diapering and toileting records immediately. If staff put off documentation, something will likely come up and they will have to rely on their memory rather than recording it accurately.

    Management Practices That Support Appropriate Potty Training and Toilet Hygiene

    The chart below summarizes your key responsibilities when it comes to ensuring that your Service's requirements for potty training are met.

    Management Practices

     

    Staff Practices

    I should always…

    To ensure

    Staff never…

    Make certain that staff are trained on our Service's requirements and best practices for potty training

     
    • Fail to follow proper procedures for diapering and potty training
    • Start the potty training process without first meeting with the family to discuss readiness, expectations and term agreement
    • Pressure families or children to use the potty before they are ready
    • Stigmatize families or children who delay potty training due to cultural beliefs
    • Forget to track progress and communicate that progress daily to families

    Provide the equipment and supplies staff need for potty training

     
    • Forgo proper diapering or toileting procedures due to a lack of supplies

    Keep family and staff handbooks up to date about our program's philosophy when it comes to potty training

     
    • Fail to follow our program's policies and philosophy when it comes to potty training

    Ensure staff are trained on how to appropriately respond to toileting accidents

     
    • Respond insensitively to a child's toilet accident or fail to address the accident with proper hygienic procedures

    Conduct program walk-throughs in restroom or changing areas, and/or provide checklist, supplies and other tools to assure toileting and changing areas are kept clean

     
    • Leave restrooms or changing areas in unsanitary conditions
    • Fail to have the materials they need to uphold sanitary toileting and diapering practices

    Explore

    Explore

    It is not uncommon for children that are potty training or children who have been fully potty trained to experience potty training regression. You might observe toileting regressions in children when they have been sick; during changes in the household, such as the arrival of a new baby or a death in the family; or any other situation that is out of the norm and causes stress for the child. Spend some time reading the articles below on regression and emotional issues with potty training. Use the Potty Training and Regression Activity to answer the questions based on these articles.

    Regression – http://www.healthychildren.org/English/ages-stages/toddler/toilet-training/pages/Regression.aspx

    Emotional Issues and Bathroom Problems - http://www.healthychildren.org/English/ages-stages/toddler/toilet-training/pages/Emotional-Issues-and-Bathroom-Problems.aspx

    Apply

    Apply

    Taking time to assess your program’s practices around potty training and considering whether they are aligned to your program’s policies is important to ensure everyone is on the same page when it comes to supporting this very important developmental milestone. Complete the Partnering for Potty Training Activity, and use the information to determine what additional staff development might be useful.

    In addition, use the Restroom and Diapering Environment Best Practices Checklist for restrooms and diapering to ensure staff use best practices that align with program policies. With help from your trainers and coaches, you can use it help focus your observation in each classroom or program. Provide constructive feedback to the staff members about what you observed. In addition, as a manager, you can look for patterns across classrooms or programs that may benefit from being addressed in a wider staff training.

    Glossary

    TermDescription
    ReadinessIn the context of toilet learning, the biological and developmental signs of readiness for potty training

    Demonstrate

    Demonstrate
    Assessment

    Q1

    True or False? The use of gloves fully protects from germs and replaces handwashing.

    Q2

    What do infants and toddlers learn during the diapering and toileting experience?

    Q3

    You are doing a walk-through of the program space and hear a school-age staff member say, “You’re a big kid. You should not be having accidents at your age.” How do you respond?

    References & Resources

    American Academy of Family Physicians (2010). Toilet Training you Child. Retrieved from http://familydoctor.org/familydoctor/en/kids/toileting/toilet-training-your-child.html 

    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

    Bredekamp, S. and C. Copple, eds. (1997). Developmentally appropriate practice in early childhood programs , revised edition. Washington D.C.: National Association for the Education of Young Children.

    Gonzales-Mena, J. (1993) Multicultural Issues in Child Care. California: Mayfield Publishing.

    Harms, T., D. Cryer and R.M. Clifford. (2006). Infant/Toddler Environment Rating Scale, revised edition. New York: Teachers College Press.

    Mayo Clinic. (2015). Infant and Toddler Health: Potty Training: How to Get the Job Done. Mayo Foundation for Medical Education and Research. Retrieved from http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/potty-training/art-20045230

    Medline Plus. (2015). Toilet Training. U.S. National Library of Medicine: Bethesda, MD. Retrieved from http://www.nlm.nih.gov/medlineplus/toilettraining.html

    Pike, Lynn. (2004). Toilet Training. University of Missouri Extension. Retrieved from http://extension.missouri.edu/p/GH6128

    Toilet Training Toddlers: A Guide for Caregivers Adapted from Oesterreich, Holt, & Karas (1995)