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Young children occasionally need assistance with toileting and dressing, especially if the child has had an accident in the restroom. Once you know an accident has happened, prepare yourself to help the child clean up and change clothes. First, wash your hands. Then, bring supplies over. You will need clean clothing, wipes, plastic bags, a paper liner for the child to lie on, wet cloth or paper towel, and disposable gloves.

The book Caring for Our Children (2019) offers these steps for the changing process:

Step 1: Get Organized

• Consider whether to change the child lying down or sitting.
• If the child is standing, it may cause the clothing, shoes and socks to become soiled. Remove any clothing that may become soiled in the cleaning process.
• To avoid contaminating the child’s clothes, have the child hold their shirt, sweater, etc. up above their waist during the change. This keeps the child’s hands busy and you know where the child’s hands are during the changing process.
• If the child is wearing disposable pull-ups, pull the sides apart, rather than sliding the garment down the child’s legs. If underwear is being changed, remove the soiled underwear and any soiled clothing, doing your best to avoid contaminating surfaces.
• To avoid contaminating the environment and spreading germs to the other children in the room, do not rinse the soiled clothing in the toilet or elsewhere. Place all soiled garments in a plastic-lined, hands-free plastic bag to be cleaned at the child’s home.
• If the child’s shoes are soiled, wash and sanitize them before putting them back on the child. It is a good idea to request a few extra pair of socks and shoes from the parent/caregiver to be kept at the facility in case these items become soiled.
• Check for spills under the child. If there are any, use the paper that extends under the child’s feet to fold over the soiled area so a fresh, unsoiled paper surface is now under the child’s buttocks.

Step 2: Avoid Contact with Soiled Items and Put them in an Individual Plastic Bag.

• Lift the child’s legs as needed to use disposable wipes to clean the skin on the child’s genitalia and buttocks. Remove stool and urine from front to back and use a fresh wipe each time you wipe. Put the soiled wipes into the soiled pull-up or directly into a plastic-lined, hands-free covered can.
• If gloves were used, remove them using the proper technique (see Apply Section) and put them into a plastic-lined, hands-free covered can.
• Whether or not gloves are used, clean your own hands and the child’s hands with a disposable wipe. Dispose of the wipes before proceeding.

Step 3: Put on a clean pull-up or underwear and clothing, if necessary.

• Assist the child, as needed, in putting on a clean disposable pull-up or underwear, then in re-dressing.
• Note and plan to report any skin problems such as redness, skin cracks, or bleeding.
• Put the child’s socks and shoes back on if they were removed during the changing procedure.

Step 4: Wash your hands and the child’s hands and return the child to a supervised area.

Step 5: Clean and disinfect the changing surface.

• Dispose of the disposable paper liner used on the changing surface in a plastic-lined, hands-free covered can.
• If clothing was soiled, securely tie the plastic bag used to store the clothing and send home.
• Clean the changing surface with soapy water.
• Disinfect the changing surface with bleach water, allowing to air dry for 2 minutes.
• Put away the disinfectant. Some types of disinfectants may require rinsing the change table surface with fresh water afterwards.

Step 6: Perform hand hygiene and record the change in the child’s daily log

• Handwashing is the final and most important step of toilet hygiene. Be sure to wash your hands after you use the toilet, help any child use the toilet, change soiled clothing or clean a child’s accident space.