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, get in the car to go home, 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 (2019), depicts eight steps, each step consisting of several tasks. As always, adhere to your Service’s diapering procedures.

For more information on the use of cloth diapers, see the Diapering Procedure and Handling Cloth Diapers resources 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 (2019). 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?

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. Shaming or otherwise telling the child that she should have gone to the restroom when you asked her is not necessary. Accidents happen and young children are still learning about their bodies and natural consequences are just as important as following directions. 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 (2019), 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.

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. Your relationship with the families will be important to help the family to work through this process; 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.

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

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.