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Know

Maintaining Hygiene

Toileting and diapering are a major source of contamination and unsanitary practices can put staff members, children, and youth at risk for illness and infection. It is critical to keep diapering areas and restrooms clean in child development and school-age programs. Make sure:

• Toilets are flushed.
• Floors, doors, walls, and changing surfaces are clean.
• Paper towels and other trash are thrown away properly.
• Running water, liquid soap, paper towels, plastic bags for soiled clothing, and toilet paper are available.
• Adults always wash hands after changing a diaper, helping a child use the toilet, assisting with soiled clothing, or touching contaminated surfaces.
• Children wash their hands after using toileting or having their diaper changed.
• All children and adults wash their hands properly.

Handwashing and Diapering

Proper handwashing procedures are essential when diapering and toileting. It is important to follow the order of handwashing steps to prevent contamination. There are two times adults must wash their hands during diapering. Adults must wash their hands first before they gather diaper supplies and again during the final step after they have put cleaning and sanitizing solutions away. Infants and toddlers must wash their hands or have their hands washed after a clean diaper is put on them and they are fully dressed. More on handwashing is addressed in Lesson Two.

Toileting Procedures

Toileting, as with diapering, has procedures that must be followed to reduce the spread of germs. Toileting has additional health considerations as toddlers are learning self-help skills and are actively participating in their toileting routine. As a result, the chances of contamination are increased.

Have Supplies Stocked and Accessible

Having all necessary items available when staff need them is essential for both safety and health. It’s awful to realize, in the middle of a diaper change, that someone used the last pair of gloves. Or, when showing a toddler how to wash their hands, you notice the soap dispenser is empty. Work with staff to have systems in place. Someone should check that all supplies are well-stocked at the beginning of the day to ensure that staff members always have what they need, when they need it. This could be a duty of the opening staff member in each room or program.

Glove Procedures

Gloves, though recommended and required by many programs, do not automatically protect infants, toddlers and adults from exposure to germs. Adults often feel a false sense of protection when they wear gloves. Wearing gloves merely involves protecting your hands; germs that touch a glove can unknowingly be spread to the next surface the glove touches.

The following Gloving Procedure, from , illustrates correct general use of gloves (a visual of the procedure is provided on page 460). This procedure should be used anytime you are treating an infant or toddler with an injury or using them during diapering routines.

1. Wash hands prior to using gloves if hands are visibly soiled.
2. Put on a clean pair of gloves.
3. Provide appropriate care.
4. Remove each glove carefully. Grab the first glove at the palm and strip the glove off. Touch dirty surfaces only to dirty surfaces.
5. Ball up the dirty glove in the palm of the other gloved hand.
6. With the clean hand, strip the glove off from underneath at the wrist, turning the glove inside out. Touch dirty surfaces only to dirty surfaces.
7. Discard the dirty gloves immediately in a step can. Wash your hands.

Remember, wearing gloves does not take the place of handwashing!

Potty Training

Many staff members who work with infants and toddlers, or young preschoolers, will need guidance in potty training issues. Potty training is an important milestone for children and one that staff members must approach sensitively. You can help teachers and staff members learn:

• When children are typically ready to begin potty training
• How to tell if a particular child is ready for potty training
• How to help children potty train successfully
• How to help children (including preschool and school-age children) respond to accidents
• How to work with and stay sensitive to families’ concerns and input about potty training.

Watch this video for other ways you can support toilet training in your setting.

Staff members who work with preschoolers or school-age children may also need support around promoting independent toileting. For most children, potty training is a distant memory by kindergarten. That doesn’t mean that there won’t be an occasional accident. It also doesn’t mean that they won’t need some support around their growing independence. Here are some things to keep in mind when supporting staff who work with school-age children and older preschoolers.

• Accidents happen and they can be humiliating for the child. Make sure staff respond sensitively and make it a point to protect the child’s privacy. Help staff members think about ways to minimize attention toward the accident and ways they can subtly help children find clean clothes. It’s also important that staff members help children “save face” when they re-enter the program area after an accident.
• Promote independence in young school-agers. In most school-age programs, children do not need adult permission to use the restroom, but this might be a new and difficult idea for young children transitioning into the program. Help staff remain patient and support children as they learn to recognize their own needs and take care of them independently.
• Plan ahead. Changes in routine or exciting special events can make children forget to take care of their needs. This means staff should remind preschool and school-age children to use the restroom before field trips or long bus rides.

In addition to these points, remember that accidents must be handled appropriately to limit contamination and the spread of germs. Below, find the steps that a staff member should follow in the event a toddler, preschooler or school-age child has an accident. With trainers and coaches, talk through different case scenarios so staff members feel prepared to handle accidents sensitively and with proper hygiene practices.

Barriers to Potty Training

• Children are not yet ready. Sometimes toddlers are pushed into potty training before their bodies are ready. It is not impossible to help a child who is not ready to learn to use the potty, but it is definitely more of a challenge.
• Families are not yet ready. For families to be ready to make the commitment, they must be ready to help the child with potty training at home, bring all of the supplies needed, and work as a team with the teaching staff so the child has consistent reinforcement. Transitioning to use the toilet may involve families emotionally letting go of their baby and embracing that their child is now a preschooler. This may be a process for some families to work through; in fact, they may not even be aware that they are feeling ambivalent about this process.
• Cultural expectations vary. A common expectation in the United States holds that children will be potty-trained by their third year; around age 2 years for girls and 2½ years for boys. Other cultures may promote that children should be potty-trained within an earlier or later time frame. As with all decisions, staff should consult with families to understand their expectations.
• Timing is a factor. A child may be physically but not emotionally ready for potty training. Perhaps a new sibling has arrived, a parent is deployed, the family has moved, or other family changes make potty training an additional stressor rather than a welcome task. It is best in these circumstances to delay potty training until the child or family has made it through most of the emotional upheaval in the transition.

Program �Թ���s

Families take the lead in potty training. Your staff should consult with the families, share ideas about readiness signs and decide together how to best work with the child. Your staff should openly work with families whose cultural beliefs and values create different expectations for when and how potty training is conducted. Communicating ideas and expectations is the best way to provide care that is in the best interests of the child.

Toilet training is typically easier for children when they can feel the effects of “accidents” and can take an active role in changing to dry clothing. You should adhere to your ����Dz�������’s policies on what kinds of clothing should be worn when potty training and be sure to have your staff communicate with the families about these policies.

Families and staff should agree on the appropriate words to use. Most programs use the accepted names of bodily functions and body parts (bowel movement, urine, etc.). Discussion is needed with families so that the same words are used if possible by the families and your staff.

Expectations align when communication remains open and all members of the team are ready and work together. Appropriate praise and positive reinforcement by staff is important in encouraging children to transition to potty use. Being specific in the praise (“You stayed dry,” “You went in the potty all by yourself!”) helps keep the feedback specific and authentic.

Diapering and Toileting Is a Time for Learning

Diapering and toileting is an opportunity to engage in nurturing interactions that support all domains of development; it is so much more than taking care of a child’s physical needs. While diapering and toileting, infants and toddlers:

• Learn self-help skills.
• Acquire language and communication skills through listening and verbalizing (cooing, babbling, talking) with staff during routine care.
• Develop a sense of competence when they are helpful.
• Practice small and large muscle skills, including grasping their pants to push down and pull up during toileting and holding their legs up and returning to a sitting position during diapering.
• Develop their emotional attachment to staff, which helps them feel secure and supports their development and learning.

The Importance of Documentation

Recording when infants and toddlers are diapered or when they use the bathroom is important information to both staff and their families. Changes in these bodily functions of infants can be an indication that something is wrong and needs to be addressed. For toddlers, documentation helps potty training when staff can identify toileting patterns. It is important to document diapering and toileting records immediately. If staff put off documentation, something will likely come up and they will have to rely on their memory rather than recording it accurately.

Supervise & �Թ���

Management Practices That �Թ��� Appropriate Potty Training and Toilet Hygiene

The chart below summarizes your key responsibilities when it comes to ensuring that your Service’s ����Dz�������’s requirements for potty training are met.