Visiting the bathroom and toilet facilities is a routine part of child caregiving, particularly when children are in the midst of toilet training. In both center-based or home care childcare settings, precautions are necessary to ensure safety and sanitation.

The first rule of safety and sanitation is supervision. Children must always be supervised when they go to the bathroom, whether they are actually using the facilities or simply washing their hands. Supervision does not end at the doorway; you must be able to see all children, whether they are in the toilet facility, waiting in the hallway, or returning to their play area.

The ideal situation is to have one adult accompany each child to the bathroom while another cares for children in the play area. However, if you are the only caregiver with several children, consider taking all children to the bathroom at the same time. Be sure to position yourself so that you can see the children using the facilities, as well as those finished and waiting to leave.

Safety and sanitation of toileting and handwashing facilities on field trips can be challenging. Again, supervision is the first step. Remember, children should never enter a public restroom alone.

Sanitation is an essential component of healthy childcare. However, young children do not have good sanitation habits. Germs may abound not only on the toilet seat and flush handle, but also on the sink, trash can lids, and door handles. Children contact germs on their hands, and then spread them from their hands to their mouths as well as to toys and other children. Many diseases such as hepatitis A, hepatitis E, typhoid fever, and giardiasis are spread through the fecal/oral route.

Proper handwashing is the first step in sanitation and disease prevention. Teach children how to wash their hands thoroughly with soap and running water. Adults also should wash their hands after assisting children with toileting.

The handwashing area is often located in or near the toilet facility; however, regardless of the location, you should always follow safety precautions.

• Running water and liquid soap should be easily accessible.
• If necessary, use a secure, non-slip step stool to help children reach the sink.
• Children should not share towels when drying their hands; instead, disposable towels stored within easy reach of the sinks are recommended.
• Position a large, covered trash can near the sink. Trash cans with a step control mechanism work best, as they allow children to dispose of trash without contaminating their just-washed hands.

Toilets, floors, and handwashing areas should be cleaned and sanitized daily, or more often if visibly soiled. If you are responsible for cleaning the bathroom area, use utility gloves designated for this purpose only and wash and dry them after each use.

Potty chairs present additional sanitation issues. The Caring for Our Children guidelines do not recommend the use of potty chairs because of the difficulty in keeping them clean and sanitized. If potty chairs are used, after each occurrence the contents must be dumped into a toilet and the chair must be cleaned in a utility sink, one that is not used for handwashing or food preparation and sanitized. The utility sink must be sanitized after each use.

Ideally, child-sized toilets should be available. If a regular size toilet is used, children may need a sturdy non-slip step stool. This also must be cleaned and sanitized after each use.

A key component of safe childcare is prevention. By being aware of the risks associated with bathroom use and tackling potential problems in advance, you can prevent most hazardous situations and injury. The following safety issues should be addressed in all childcare settings.

Prevent drowning Children can drown in as little as an inch of water. Check the facility for containers of water. Empty cleaning buckets of their contents and store them upside down, preferably out of the reach of children.

In home-based settings, consider using a toilet seat lock or an alarm that sounds when a toilet lid is lifted. Be sure bathtubs drain properly.

Prevent burns Water that feels warm to you can be painfully hot for children’s tender skin. Hot water always presents the risk of serious burns; however, the amount of time it takes to cause a serious burn varies greatly depending on just how hot the water is.

In three seconds, water at a temperature of 140° F can cause burns that require hospitalization and skin grafting. By lowering the temperature to 120° F, a child would have to be exposed for more than 15 seconds to suffer the same degree of injury.

Check the temperature of the hot water as it comes out of the tap. To do this, run the hot water into a cup for several seconds. Empty the cup and fill it with the hot water. Use a candy thermometer to determine the temperature.

Remember, if hot water is available at children’s sinks, always adjust the water before allowing a child to wash his or her hands.

Prevent falls Children often splash water on the floor when washing their hands or brushing their teeth. Young children (and adults) can slip and fall on wet floors, resulting in serious injury. Routinely check the floor for moisture and immediately clean any spills.

It also is important to avoid clutter on the floor. Floors that are littered with scraps of toilet paper, toys, or supplies can be hazardous for young children.

Prevent poisoning The easiest way to prevent poisoning is to remove toxic substances such as cleaning supplies from bathrooms to which children have access. Child safety latches are not sufficient protection, as many children can open these latches after just a few attempts. Place all hazardous or toxic items in a separate location in a locked cabinet or closet.

Toileting and handwashing areas to which children have access must be free of potentially dangerous items. This can be is especially challenging in home childcare settings, where personal items such as razors and hair dryers are used. These and any other potentially hazardous or toxic items should be stored out of reach in a locked cabinet.

Many tools are available to enhance safety measures in the bathroom, such as toilet locks, cabinet guards, door locks, non-slip mats, and temperature gauges (often in the form of plastic toys that changes color when the water temperature is too hot). Although these safety measures are helpful, caregivers must not rely on these sources alone to protect children. Constant supervision is a necessary component to preventing injury.

Diona Reeves, Freelance writer and former employee of the American Academy of Pediatrics’ Healthy Child Care America program

The American Academy of Pediatrics has developed a policy statement for water safety, including recommendations for infants through 4-year-olds; aappolicy.aappublications.org/cgi/content/full/pediatrics;112/2/437

Baby Center, www.babycentre.co.uk/refcap/402.html

Dr. Paul, www.drpaul.com/injprev/inj-bath.html

Dr. Spock, www.drspock.com/article/0,1510,5224,00.html?r=related

Caring for Our Children has printed and online resources offering recommendations for all kinds of safety-related issues in childcare settings. The resources can be obtained at the National Resource Center for Health & Safety in Child Care, UCHSC at Fitzsimons, Campus Mail Stop F541, PO Box 6508, Aurora, CO 80045-0508; 800-598-KIDS; nrc.uchsc.edu