Intimate care and nappy changing

Early years practice procedures

Prime times of the day make the very best of routine opportunities to promote ‘tuning-in’ to the child emotionally and to create opportunities for learning. Nappy changing times are key times in the day for being close and promoting security as well as for communication, exploration and learning.

Babies

Young children are usually changed within sight or hearing of other staff whilst maintaining their dignity and privacy at all times.
Key persons have an alarm for routine nappy changes and are checking throughout the session.
Key persons undertake changing nappies in their key groups wherever possible; back up key persons change them if the key person is absent.
Nappy changing areas are warm.
Members of staff can put on aprons before changing starts and the area is prepared, gloves are always worn for soiled nappies.
All members of staff are familiar with the hygiene procedures and carry these out when changing nappies.
Key persons ensure that nappy changing is relaxed and a happy time for the children.
Key persons never turn their back on a child or leave them unattended on a changing mat.
Key persons are gentle when changing; they allow time for communicating with the child. They allow time for play and ‘rituals’ that the child enjoys, such as saying boop boop boop when pulling out a wet wipe.
Key persons avoid pulling faces and making negative comment about the nappy contents.
Key persons do not make inappropriate comments about the child’s genitals, nor attempt to pull back a boy’s foreskin to clean unless there is a genuine need to do so for hygiene purposes.

Nappy changing records.

Key persons record whether the child passed a stool and if there was anything unusual about it e.g. hard and shiny, soft and runny or an unusual colour.
If the child does not pass a stool, or if they strain to do so, or is passing hard or shiny stools, the parents will be informed. The child may be constipated so their feed may need to be adjusted.
A stool that is an unusual colour can usually be related to the food that was eaten, so it is important that this is noted. However, a stool that is black, green, or very white indicates a problem, and the child should be taken to the doctor.
Very soft, watery stools are signs of diarrhoea; strict hygiene needs to be carried out in cleaning the changing area to prevent spread of infection. The parent should be called to inform them, and that if any further symptoms occur, they may be required to collect their child and to be absent until at least 48 hours after the last runny stool.

Sometimes a child may have a sore bottom. This may have happened at home as a result of poor care; or the child may have eaten something that, when passed, created some soreness. The child also may be allergic to a product being used. This must be noted and discussed with the parent and a plan devised and agreed to help heal the soreness. This may include use of nappy cream or leaving the child without a nappy in some circumstances. If a medicated nappy cream such as Sudocrem is used, this must be recorded as per procedure Administration of medicine.

Young children, intimate care, and toileting

Wherever possible, key persons undertake changing young children in their key groups; back-up key persons change them if the key person is absent.
Changing areas are warm, appropriately sited and there are safe areas to lay young children if they need to have their bottoms cleaned. Children are mostly changed standing up to give them more authority over their nappy changes.
Each young child has their own bag to hand with their nappies/pull ups and changing wipes.
Key persons ensure that nappy changing is relaxed and a time to promote independence in young children.
Young children are encouraged to take an interest in using the toilet; they may just want to sit on it and talk to a friend who is also using the toilet.
They are encouraged to wash their hands and have liquid soap and paper towels to hand. They should be allowed time for some play as they explore the water and the soap.
Key persons are gentle when changing and avoid pulling faces and making negative comment about the nappy contents.
Wipes are used to clean the child. Where cultural practices involve children being washed and dried with towels, staff aim to make reasonable adjustments to achieve the desired results in consultation with the child’s parents. Where this is not possible it is explained to parents the reasons why. The use of wipes achieves the same outcome whilst reducing the risk of cross infection from items such as towels that are not ‘single use’ or disposable.
Key persons do not make inappropriate comments about young children’s genitals when changing their nappies.
Older children use the toilet when needed and are encouraged to be independent.
Members of staff do not wipe older children’s bottoms unless there is a need, or unless the child has asked.
Key persons are responsible for changing where possible. Back-up key persons take over in the key person’s absence, but where it is unavoidable that other members of staff are brought in, they must be briefed as to their responsibilities towards designated children, so that no child is inadvertently overlooked and that all children’s needs continue to be met.
Parents are encouraged to provide enough changes of clothes for ‘accidents when children are potty training.
If young children are left in wet or soiled nappies/pull-ups in the setting, this may constitute neglect and will be a disciplinary matter.

Nappy changing is always done in an appropriate/designated area.