Diapering - Safety and Sanitation

When thinking of infant care in a childcare setting, one of the first things that comes to mind is changing diapers. This is sometimes a messy job, and proper hygiene and diapering are very important for an infant's well-being. Understanding the sanitation and safety needs for diapering can help make the job a bit easier as well as safer.

Parents may choose to use either cloth or disposable diapers or sometimes both. This is a personal decision based on experiences, preferences, and even finances. Some childcare providers require disposable diapers for sanitation purposes. There are advantages and disadvantages to either cloth or disposable diapers. Disposable diapers are more convenient simply because they can be bought in bulk and thrown away when soiled. In addition, because of the materials used, disposable diapers feel drier than cloth diapers when the baby wets.

Some babies may show sensitivity to certain brands of disposable diapers. Signs of sensitivity include redness and irritation in the diaper area that goes away when a different type of diaper is used. If sensitivity to a particular brand of diaper develops, that brand of diaper should be avoided.

Cloth diapers may be either more economical for parents (if they wash them themselves) or more expensive but easier (if they are cleaned by a diaper service). In childcare, plastic pants should be used over cloth diapers to prevent wetness from spreading. Cloth diapers will feel wetter to the infant than disposable diapers, and need to be changed quickly after the baby wets to prevent irritation to the baby's sensitive skin.

Changing Diapers

Infant diapers should be checked for wetness and feces at least hourly. When changing diapers, you should wash your hands before and after each infant. Germs are spread primarily by direct contact, so frequent hand washing is necessary. Latex-free gloves also are recommended, but remember--gloves are no substitute for thorough hand washing.

Prior to taking the infant to the changing table, gather all supplies: paper liner, clean diaper, gloves, and wipes. Lay the infant on a firm surface, and stay at her side; keep one hand on the infant at all times. Never leave an infant unattended on a changing table, even for a second! Unfasten the dirty diaper and fold inward to prevent contamination. If there is stool in the diaper, clean the infant's diapered area with baby wipes or a wet wash cloth. A baby girl should be wiped from front to back to prevent infection. When the dirty diaper is removed, quickly replace it with a clean diaper, especially with little boys, or you may get sprayed!

Apply diaper rash ointment, if requested by the parent. Wash the child's hands and return him to the supervised area. Dispose of the dirty diaper and dirty gloves into a covered garbage can or pail; and make sure the garbage container is out of the babies' reach. Place soiled clothes in a plastic bag to send home. Wash your hands and record the diaper change in the child's daily log.

What Dirty Diapers Can Tell You

Diapers sometimes can tell you about the baby's health. After about one week of age, an infant should have six-eight wet diapers per day. A baby who is having fewer than six wet diapers per day could be dehydrated. Dehydration could be due to vomiting, diarrhea, or not getting enough formula or breast milk. In addition to decreased urination, signs of dehydration include dry, tacky mouth; sunken fontanel (soft spot); and crying with few tears. If dehydration is suspected, a doctor should be consulted immediately. If a baby is irritable, has a fever, and the urine is foul smelling, this could indicate a urinary tract infection, and a doctor should be consulted. A doctor also should be called if there is blood present in urine.

How many dirty diapers or bowel movements should a baby have? Each baby will have his or her unique routine. Some babies have several "dirties" a day, while others may have one dirty diaper every three days. However, changes in a baby's normal bowel movement routine could indicate problems. If a baby goes more than three days without a stool, is fussy, or has a distended abdomen, he or she may be constipated. The parents should consult their pediatrician for advice on what to do. Never give home remedies for constipation! As an infant gets older, changes in the stool will be noticed. When solid foods and juices are added to the diet, expect to see changes in the stools, such as texture, color, and consistency.

Sometimes babies have diarrhea, watery stools, or more than one episode of stool that is looser than normal for that individual baby. Diarrhea may be caused by viral illnesses, infections, food contamination, antibiotics and other medications, dietary changes, and fruit juices. A doctor should be consulted the same day if an infant has more than three episodes of diarrhea. If blood or mucus is present in the stool or a baby has frequent, watery stools, a doctor also should be consulted.

Diaper Rash

Occasionally an infant will develop diaper rash. This is redness, bumps, or broken down skin (sores) in the diaper area. Diaper rash most commonly develops when diapers are not changed often enough, so prevention is the best treatment. The wetness or stool next to the skin is an irritant, and diapers must be changed promptly. If an infant has diarrhea or frequent loose stools, frequent changing of diapers may not be enough to prevent diaper rash.

When this occurs, let the diaper area air dry completely at each diaper change. A diaper rash ointment, which will coat and protect the skin, can be used at the parent's request. Several brands of ointment are available, and some babies may be sensitive to various ointments; parents should consult their doctor or pharmacist for recommendations. As with any medication, caregivers should not apply any ointment or cream unless the parent has requested and provided it specifically for their child. A physician also may prescribe a special ointment, particularly if over-the-counter brands are not effective.

If a baby has red bumps that will not go away, a yeast infection may be present. A doctor may recommend an antifungal cream to use in the diaper area. Occasionally, a baby will have a diaper rash so bad that his or her bottom bleeds. This usually occurs with frequent diarrhea, and a doctor should be consulted. The doctor may recommend warm baths, leaving the diaper area open, and a prescription paste or cream to protect the infant's bottom. Baby powder is not recommended because it will get in the air and the baby may inhale it.

Safe and sanitary diapering can help reduce the spread of illnesses in your childcare program and can provide an opportunity for enjoyable interaction time with the child.

CHANGING AREA: In larger childcare programs, the diapering area might be in a separate room or space while family settings may use a changing table in the play area. The diapering surface should be cleaned before and after each change using a disinfectant such as bleach solution. Supplies such as baby wipes, ointments, diaper pins, and disinfectants should be kept out of the child's reach but easy to access with one hand (the other hand is always on the child). The diaper pail should be frequently emptied and cleaned. Plastic pail liners make clean up easier.

RESOURCES

Caring For Our Children: National Health and Safety Performance Standards has information on diapering in the childcare setting. The text can be viewed online, nrc.uchsc.edu or ordered through American Academy of Pediatrics, PO Box 747, Elk Grove Village, IL 60009-0747; 888-227-1770.

Child Health Information and Prevention Resources has available a Newborn and Infant Care training package for childcare providers; 205-663-7402; www.childhealthonline.org

INTERNET RESOURCES

Diaper Posters:
www.mi4c.org/programs/health/env/sanitation/diapering.html