TRAINING COURSE

Diaper Changing

When changing diapers, caregivers must follow the following steps:

• Promptly change soiled or wet diapers.
• Thoroughly cleanse children with individual cloths or disposable towels. You must discard the disposable towels after use and launder any cloths before using them again.
• Ensure that the children are dry before placing a new diaper on the child. If the child must be dried, you must use a clean, individual cloth or disposable towel to dry the child. You must discard the disposable towel after use and launder any cloth before using it again.
• Caregivers must not apply powders, creams, ointments or lotions without the parents written permission. If the parent supplies these items, permission is implicit. However, you are encouraged to still get written permission in these cases.
• You must label powders, creams, ointments, or lotions with the individual child's name. It is also recommended that you label the items with the date that the parent provided these items, if applicable.
• Keep all diaper-changing supplies out of the reach of children.

A pleasant attitude while changing a child's diaper, even if a child had a loose stool, helps develop a child's positive sense of self. Wipes are helpful in removing residue, such as food off a baby's face or feces from a baby's bottom during diaper change. Parents need to give permission before over-the-counter creams or powders are used. A parent should address whether the child has a skin allergy or if a child's health care provider does not recommend use of topical products when diapering. Caregivers must be proactive when it comes to skin irritations. Caregivers must seek written permission to use these products before the need arises.

Diaper Changing Equipment

• You must have a diaper-changing table or surface that is smooth, non-absorbent, and easy to clean.
• You must not use areas that children come in close contact with during play or eating, such as dining tables, sofas, or floor play areas, for diaper changing.
• To prevent a child from falling, a diaper-changing surface that is above floor level must have a safety mechanism, such as safety straps or raised sides that is used at all times when the child is on the surface, or the caregiver's hand must remain on the child at all times when the child is on the surface.
• You must have a hand-washing sink in the diaper-changing area.

A separate area used for diaper changing and/or changing soiled underwear reduces contamination of other parts of the child-care environment. 

Preventing the spread of germs when diapering children.

• Caregivers must wash their hands before and after a diaper change.
• Infant's hands must be washed after each diaper change.
• If you are using disposable gloves, you must discard them after each diaper change and wash your hands with soap and running water.
• Caregivers with open wounds and/or any injury that inhibits hand washing, such as casts, bandages, or brace, must not change diapers.
• You must sanitize the diaper-changing surface after each use. However, if you are changing diapers on a number of children consecutively, you may cover the surface with a non-absorbent paper liner that is disposed of between each diaper change.
• You must cover containers used for soiled diapers or keep them in a sanitary manner, such as placing soiled diapers in individual sealed bags.

Assembling all of the supplies necessary for a diaper change before bringing the child to the changing table ensures the protection of the child. If the hand-washing sink is not adjacent to the diapering area, wipes may ne used, as a temporary measure only, to clean the caregiver's and child's hands while supervising the child on the changing table.  Proper hand washing is still required once the child is removed from the diaper changing surface.

During diaper changing, a child's hands often stray into the area of the child's body covered by the diaper. Germs are contained in human waste and body fluids are present on the skin and the diaper even if they cannot be seen. Washing an infant's hands after each diaper change helps reduce the spread of germs.

Because of the risk of splashing, and gross contamination of hands, sinks, and bathroom surfaces, rinsing diapers or clothes soiled with fecal material in the setting increases the risk that you, other caregivers and the children would be exposed to germs that cause infection.

Rotating 2 changing mats throughout the day, using one while another is sanitized and dries, provides an alternative to waiting between diaper changes. 

Supplies that are recommended in the diaper changing area

• Clean diapers
• Paper liners
• Wipes
• Disposable gloves
• Diaper cream
• Plastic bags

Steps to changing a diaper

1. Lay the infant on his back. Remove any clothing that inhibits access to the diaper.
2. Remove the soiled diaper.
3. Lift the infant up gently so you can scoot the diaper out from under his bottom.
4. Use wipes to clean the infant's diaper region. Always wipe from front to back to avoid infection, especially for girls
5. If the area is red or inflamed, soothe it with diaper ointment.
6. Wait for the infant's skin to dry before putting on a fresh diaper.
7. Take a fresh diaper and place it under the infant. Bring the front part up on the infant's stomach and fasten the tabs to secure the diaper on his waist.
8. Replace any clothing over the new diaper.

How to prevent diaper rash

• Check the infant's diaper often (every two hours) and change it promptly
• Clean the infant's diaper region thoroughly during changes.
• Do not use scented wipes or soaps on the infant's diaper region.
• Pat, do not scrub, an infant's bottom when drying the infant.
• Look out for skin marks, which indicates that the diaper is too tight.

Daily Reports

Caregivers must provide a daily written or electronic report to the child's parent when the child is picked up from the child-care center. The report must contain:

• Times the child slept.
• Times and amount of food consumed.
• Times of diaper changes.
• Child's general mood for the day.
• A brief summary of the activities in which the child participated.

Because infants are not able to communicate essential information to the parents, it is important that the caregiver do so. In child-care centers, several caregivers may care for an infant or there may be shift change. A report for each parent will allow the parent to know how their infant spent the day, so the parent can supplement the infant's activities, meals and so on at home, based on the child's activities. This is a very good way of creating solid communication and healthy relationships with parents, and it enhances the protection and well-being of infants.