Safe Diapering in Childcare

15 min read Training Guide

Change diapers in a sequence that keeps the child safe and stops germs from spreading.

Table of contents

You may change hundreds of diapers in a month. It is one of the most common tasks in infant and toddler care, and also one of the main ways stomach bugs spread through a room. Germs such as norovirus, Shigella and Cryptosporidium travel on hands, surfaces and toys, and a single change done out of order can spread them. Doing the same steps the same way every time protects the child, you and everyone else in the room.

The steps below follow the Centers for Disease Control and Prevention (CDC) diaper changing steps for childcare settings. Your state licensing rule and your program's posted procedure may add detail, and those rules come first. Procedures should be posted in every diapering area, so follow the poster on your wall.

What You Will Be Able to Do

  • Set up a diapering station so that you never have to walk away from a child
  • Follow the seven CDC steps in the correct order
  • Keep clean and dirty items apart during a change
  • Handle soiled clothing, creams and cloth diapers correctly
  • Support toddlers who are learning to use the toilet

Setting Up the Station

A safe diapering area is set up long before the first change of the day.

  • The changing surface is firm, washable, free of cracks and not used for anything else.
  • The surface has a raised edge or sides.
  • A sink with soap and paper towels is close by, and it is not the one used for food.
  • A hands-free trash can with a lid and liner is within reach.
  • Disinfectant is stored out of children's reach and is ready to use.
  • The station is well away from where food is prepared or served.

Staff who change diapers should not prepare food for children during that shift, according to CDC guidance. If your program has only one or two adults in a room, find out how your director handles this, and be strict about handwashing.

Warning: Keep a hand on the child at all times on a raised surface, and never walk away, even for a second. A straps-only setup does not replace your hand. If you forgot something, take the child with you.

The Seven Steps

Wash your hands and the child's hands before you start, if your program's procedure calls for it. Then follow these steps.

Step 1: Prepare

  1. Cover the changing surface with a disposable liner.
  2. If you use diaper cream, squeeze some onto a tissue now, so you never have to touch the tube with soiled hands.
  3. Bring everything to the station: a clean diaper, wipes, clean clothes, a plastic bag for soiled clothing, and gloves.
  4. Put on gloves.

Step 2: Clean the Child

  1. Place the child on the surface. Keep one hand on them.
  2. Take off clothing that could get soiled, and bag any that already is.
  3. Unfasten the diaper, but leave it under the child for now.
  4. Clean the diaper area with disposable wipes. Wipe from front to back, and use a fresh wipe each time. This helps keep stool away from the urinary opening, which matters most for girls.

Step 3: Remove Trash

  1. Put used wipes into the soiled diaper.
  2. Fold the diaper closed and drop it into the lined, covered can.
  3. Take off your gloves and throw them away.

Step 4: Replace the Diaper

  1. Slide a fresh diaper under the child.
  2. Apply diaper cream if needed, using the tissue you prepared. Never dip a finger or a used tissue back into the jar.
  3. Fasten the diaper and dress the child.

Step 5: Wash the Child's Hands

Use soap and water. Help the child rub for at least 20 seconds, rinse and dry with a paper towel. Then take the child to a supervised area. For a young baby who cannot stand at a sink, use your program's method for cleaning their hands.

Step 6: Clean Up the Station

  1. Remove the liner and throw it away.
  2. Wipe away any visible soil.
  3. Wet the whole surface with a disinfectant that is right for that surface.
  4. Leave it wet for the full contact time on the label, then let it air dry or wipe it, as the label says.

Cleaning comes first, because disinfectant does not work well on a dirty surface. Never mix chemicals, and follow the Safety Data Sheet for the product. Only use products your program approves.

Step 7: Wash Your Hands

Wash with soap and water after cleaning up, even if you wore gloves. Gloves can tear, and hands can pick up germs when you take them off. Then record the change in the child's daily log if your program uses one.

Why the Order Matters

Each step is placed to keep clean things away from dirty ones. These are the points people most often get wrong:

Point Why it matters
Set up before the child is on the table You never have to leave the child
Gloves come off before the clean diaper Soiled gloves would contaminate the fresh diaper and clothes
Child's hands get washed before you clean up Babies touch their diaper area, then their mouths
Surface is disinfected every time The next child's skin and hands will touch it
Your hands get washed last They have touched the most surfaces

Soiled Clothes and Cloth Diapers

Do not rinse soiled clothing in a classroom sink. Rinsing splashes germs around the room and onto the person doing it. Put soiled items into a plastic bag, tie it and store it out of children's reach until pickup, then tell the family.

If your program allows cloth diapers, follow its written rules. Cloth diapers usually need a waterproof cover and a separate lidded container, and they go home in a sealed bag without rinsing. Families should supply what you need.

Checking on the Child's Skin

Every change is a chance to notice how the child is doing. Look for:

  • Diaper rash, broken skin or sores
  • Stool that has blood or mucus, or that is very watery
  • Fewer wet diapers than normal, which can be a sign of dehydration in a baby
  • Bruises or marks that have no clear explanation

Note what you see, and tell your lead teacher and the family. Cream for diaper rash often counts as medication under licensing rules, so most programs need written permission from the family before you use it. Marks that worry you may fall under your duties as a mandated reporter.

Respect During Diaper Changes

A diaper change is also time with a child. Tell the child what you are doing, and keep your voice warm: "I'm going to lift your legs now." Talk, sing and make eye contact. It builds trust and language. Keep the child's body covered from others as much as you can. Never show disgust or make comments about smell or mess. As children get older, offer small choices, such as which foot goes first.

Toileting

Toddlers learn to use the toilet at different ages, and readiness matters more than age. Never rush it, punish a child for an accident or force a child to sit on the toilet. Work with the family so that the routine at home and in care match.

  • Watch for signs of readiness, such as staying dry for longer, telling you when they have gone, or showing interest in the toilet.
  • Help children wipe. Teach girls to wipe from front to back.
  • Have every child wash their hands afterward, with soap and water, and supervise it. Young children need help to do it well.
  • Clean and disinfect toilet seats and handles on your program's schedule. Potty chairs are harder to keep clean, and many states discourage or ban them in group care. If yours are allowed, empty and disinfect them after each use, using a sink set aside for that.
  • Keep clean spare clothes for each child, and handle accidents calmly and privately. Follow the same steps for bagging soiled clothes.

Common Mistakes

Mistake What it costs
Stepping away to get wipes A child can fall in seconds
Touching the cream jar with soiled hands Germs get into the whole jar
Using the same gloves for the fresh diaper Clean items are contaminated
Wiping the table but not disinfecting The next child is exposed to germs
Rinsing soiled clothes in the sink Germs spread across the room
Skipping the child's handwash Germs go straight from hands to mouth

Check Your Understanding

1. You have started a change and find that you are out of clean diapers. They are on a shelf across the room. What do you do?

Pick the child up and take them with you, or call another adult to bring one. Never leave a child on the table, and do not rely on a strap or a raised edge.

2. You have just thrown the soiled diaper away and you are still wearing gloves. What comes next?

Take off the gloves and throw them away, then put the fresh diaper on the child. Soiled gloves should not touch clean items.

3. A child's pants are soaked with diarrhea. A coworker suggests rinsing them in the sink so that they do not smell. What do you do?

Do not rinse them. Put the clothes in a sealed plastic bag out of reach, send them home, and tell the family what you saw. Check your illness policy too, because diarrhea that a diaper cannot contain may be a reason for the child to go home.

4. You finish the change and the child toddles off to play. You wipe the surface with a disinfectant wipe and move on. What did you skip?

You skipped washing the child's hands before they went to play, and possibly the disinfectant's full contact time. You also need to wash your own hands.

Key Takeaways

  • Use the seven steps, in order, for every change
  • Set up first, and keep a hand on the child at all times
  • Take off gloves before you touch the clean diaper
  • Wash the child's hands, disinfect the surface, then wash your own hands
  • Never rinse soiled clothing, so bag it and send it home
  • Keep diapering and food preparation apart