I N  S I C K N E S S  &  H E A L T H

Diapering FAQs

An individual child will need 5,000-6,000 diaper changes before being fully potty trained. It is hardly surprising, then, that caregivers have many questions regarding diapering. It is a daily challenge to manage diapering chores in a sanitary way that prevents the spread of diseases by germs left on surfaces, the caregiver's hands, or the child's hands. Close attention to diapering details also can reduce episodes of upset stomachs, diarrhea, and even more serious illness such as Hepatitis A.

Here are a few "FAQs" (frequently asked questions) and general answers regarding diapering practices. Keep in mind that your childcare licensing or certifying agency may have specific rules or guidelines that also apply.

Q. Which are better: cloth or disposable diapers?
A. For childcare centers and family childcare homes, disposable "paper" diapers and disposable training pants are much easier to use while still maintaining a safe and clean environment. Guidelines from the American Academy of Pediatrics (AAP) and the American Public Health Association (APHA) require that soiled cloth diapers be stored in labeled containers with tightfitting lids provided by an accredited commercial diaper service, stored in a location inaccessible to children, and sent home with the child at the end of the day. Disposable diapers require less handling by a caregiver than cloth diapers, and, therefore, offer less chance for contamination of other items in the environment. This is particularly important when considering the many other tasks performed by caregivers, such as preparing and/or serving food, washing faces, wiping noses, and handling personal care items and toys. Infants who wear disposable diapers generally develop fewer diaper rashes; but changing diapers often reduces diaper rash regardless of the kind of diaper used.

In the rare situation where a satisfactory disposable diaper cannot be found for an individual child, careful planning is required to manage cloth diapers and their waterproof covers. A cloth diaper with waterproof covering and front closure system is preferred to a cloth diaper with pull-on plastic panties. Both the diaper and waterproof covering should be replaced at each diaper change. Agreement with parents regarding who will provide diapers and covers (and how many and how often) and related supplies must be clearly defined. Strategies for storage and daily removal of used cloth diapers and waterproof coverings must be considered.

If you have concerns about the effects of disposable diapers on our environment, there is good news. Manufacturers of disposable diapers are working to increase the biodegradeability of disposable diapers, which represent about two percent of the waste in our landfills.

Q. What should be done with dirty diapers?
A. Whether you use cloth or disposable diapers, you should never wash or rinse diapers or clothes soiled with fecal material in the childcare setting. Because of splashing, and the potential for contamination of hands, sinks, and bathroom surfaces, rinsing increases the risk that you, other providers, and children will be exposed to germs that cause infection. You may dispose of any bulk stool in a toilet and flush away. Gather the disposable diaper with the absorbent side inward, and use the tapes to securely close it before placing in the used-diaper pail. Cloth diapers and soiled clothing should be put into a sealed plastic bag or container with a tightly fitting lid to be sent home with the child without rinsing. You should tell parents about this procedure and why it is important. Always keep bags or containers of used diapers away from children's areas and out of cubbies or diaper bags used to transport bottles, food or other clean items.

Q. What is barrier paper and why should it be used?
A. An ideal barrier paper is non-absorbent and disposable, such as examination table paper used in doctors' offices which is placed on the surface where the child's bottom will be during changing. It is discarded along with the dirty diaper, used wipes, and caregiver's gloves before re-diapering and dressing the child. Use of barrier paper reduces soiling of the diaper-changing surface and makes cleaning and sanitizing efforts more effective. Providers should, however, check with their state licensing agencies because some states do not allow use of paper barriers.

Q: What about using gloves for diaper changing?
A. Two different diaper-changing methods may be used to minimize the risk of transmitting infection from one child to another or to a provider. One method involves the use of gloves and the other does not. The method you select should be used consistently in your childcare setting. Some people object to the impersonal nature of gloves when handling infants and toddlers and fear that the gloves send a message of disgust or disapproval to the child. On the other hand, many caregivers routinely wear gloves for diaper changing and many regulatory agencies require that latex or vinyl gloves be used at every diaper change.

The following recommended procedure notes additional steps to be included when using gloves:

  • Caregivers should keep their fingernails trimmed to no more than fingertip length. Using a soft nail brush to clean under the nails during hand washing will remove soil under the nails.
  • When gloves are worn, they should be removed after the child's bottom is clean. The diaper, wipes, and barrier paper are discarded before putting on the clean diaper and dressing the child.
  • If gloves are not worn, use soap and warm water for at least 10 seconds to clean your hands.
  • Engaging the child with a smiling face and cheerful words will make the diapering experience positive regardless of whether gloves are worn. Always maintain a pleasant attitude while changing a child's diaper. Never show disgust or scold a child who has had a loose stool.

Q. What is the best way to clean the diaper area of baby girls?
A. Gently lift her legs, remove the soiled diaper, and wipe her backside. Lower the baby to the barrier paper. Using a wipe or wet paper towel use long strokes to clean the genitals front to back paying attention to folds and creases. Using the front to back motion will decrease contamination of the urinary opening with stool. It is not necessary to separate the inner labia and clean inside.

Q. How is an uncircumcised baby boy cleaned?
A. Gently lift his legs, remove the soiled diaper, and wipe his backside. Lower the baby to the barrier paper. Using a wipe or wet paper towel gently move the testicles aside and clean underneath them. Wipe under the penis and over the testicles toward the rectum. In the first few months of life or even longer, the foreskin may adhere to the head of the penis (the glans) and does not need to be forcefully retracted. The child's pediatrician or health care provider will give guidance to the parent as the boy ages and the foreskin separates from the glans. Remind parents to keep you informed of changes in his care.

Q. Is it ok to clean the child's hands with a wipe before returning him or her to the crib or the play area?
A. While a wipe will remove some dirt and germs, it does not replace hand washing. Carry the child to a sink and wash the hands with soap and warm running water for at least 10 seconds. Children are never too young to begin to associate toileting activities and hand washing, and since they are not usually involved in a lot of "messy play" we sometimes forget to wash their hands.

By Kathi Ford, BSN, Early Childhood Nurse Consultant,
Pima County Health Dept., Tucson, AZ


National Health and Safety Performance Standards nrc.uchsc.edu

American Academy of Family Physicians (Diaper Rash) familydoctor.org/healthfacts/051

Just for fun! History of the diaper www.gpoabs.com.mx/cricher/history.htm

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