2 Diapering

For many families, changing a child’s diaper becomes a major battle. This routine is one that is often not as scheduled or predictable as other activities. It is often unpleasant for adults and not an activity that the young child enjoys. As your child grows older and becomes more mobile and interested in interacting with his world, diaper changing might become even more difficult. While it can be challenging, it is also an opportunity for building a positive, nurturing and responsive relationship with your child. Several proven strategies can help to make diapering a positive and relationship building experience for both of you.

Prepare Child

Prepare the child for the diaper change. Develop a predictable routine for diapering that can change as the child grows and becomes more mobile and independent. A routine helps the child understand what will happen and what to expect. While changing your child, give your child your undivided and unrushed attention. The calmness in your voice and manner will most likely calm him and encourage his cooperation. Respond to his sounds and interactions with gentle touch, nuzzles with your nose under his chin, eye contact, soothing sounds and words. Respond in soothing ways that you know comfort him and you both enjoy. Babies and toddlers thrive on predictability and learn from repetition. They like and need to know what is going to happen next. The following are strategies that will help your child learn to cooperate with the diaper changing routine.

Provide a Transition Warning

Most young children need help in transitioning from one activity to another especially if they are engaged in an activity that is enjoyable. It’s difficult for a child to move from an activity he really enjoys to one that he does not like.

• You might try giving him a verbal warning and say, “Tommy, I think it is time to change your diaper. We’ll change it in five minutes. Okay?”
• Another transition strategy is to set a timer and when the timer rings, it’s time to change the diaper. For example, you can set the timer for 5 minutes and warn your child when the bell rings it will be time to change his diaper. Remind him as the time gets closer. You might say, “Look, Mason, 2 more minutes, then we change your diaper.” You can use a kitchen timer to help your child or purchase a visual timer that shows the time counting down (your child’s teacher or therapist would be able to tell you more about where to purchase a visual timer).
• You might use a countdown or count up strategy and make a game of the transition. You might say, “Hmm, someone has a poopy diaper. Who can it be? I think it is Sammy. Let’s change your diaper. 5, 4, 3, 2, 1. Diaper change.”

Provide Choices

Provide Choices Whenever Possible. Providing limited choices to your child is a powerful strategy for the prevention of challenging behaviour. Limited choices that can be offered during diaper change might be about what toy to bring to the changing table, where to do the diaper change, turning the lamp on or off. This gives your child a feeling of control, supports your child’s communication, and encourages your child to cooperate with your requests. Offering limited choices (2 or 3) versus many prevents your child from engaging in a game where you keep offering different things and your child keeps saying “not that one.” Your child could choose who might change him (Daddy or Nana), where to be changed (on the floor or on the couch), or what to hold (diaper, wipe, or pacifier). You can communicate the choices for your child with words, pictures, or by showing your child an object. When you offer choices by presenting objects, pictures, or using sign language, say what the options are in addition to showing the child the choices (even if your child has a hearing loss).

Empathize

Empathize with your child’s feelings. If your child pouts, says “not now, Mommy,” ignores you, screams, or runs away, provide a label for how he might be feeling and follow through with the diapering. You might say, “You look sad (angry). I know you want to go out and play. Here, hold your blanket. First, change your diaper. Then we can go out and play.” Your empathy will help your child understand that you respect how he feels but that it is still necessary to change his diaper.

• Use or allow your child to choose (with limited options) a transition object.
• This is something (e.g., diaper, book, blanket, bottle, etc.,) that the child can take with him and hold or suck (e.g., pacifier, bottle) during the diapering process.

Smooth Transitions

Ensure that the transition is smooth and encourage your child’s cooperation by letting him know what will happen after you change his diaper with the use of a “First…, Then…” statement. You might say, “First we change Micah’s diaper. Then we can go outside to play.”

Many parents have found success with using a picture for each step of the routine using photos or clip art. The steps might look something like what is listed below for changing Micah’s diaper. For each step, the underlined word would be represented with a photo or picture. Not only does this explain the process for your child, but it also ensures that others (e.g., grandparents, babysitters, etc.) will conduct the routine in a similar and predictable way. For children who can’t see a picture, you might use an object or your words to guide your child through each step.

Child as Helper

Encourage your child to be a helper in the routine. Active participation in the process builds your child’s self confidence, independence, and problem solving abilities. You might say, “Shelby, time to change your diaper. Please help me find what we need. Hmm. Where do we keep the diapers? (wait) Oh yeah. Thank you. Now we need the wipes. You are such a big helper. Thank you.”

Minimize unwanted movement.

Some children become very active during diaper changing. When they wiggle around or resist, it places them at danger of falling off the changing table and it makes it difficult for the adult to complete the routine. The following strategies are suggested for keeping your child from wiggling all over the place.

• Reduce distractions in the diapering area. A pet or others running around the child only makes him want to get up and join the fun.
• Describe what you are doing in a fun way. You could do this in song. You might sing, “This is the way we take off your diaper” (to the tune of “This is the way we wash the clothes”) or use some other melody that’s bouncy. You could use “First…Then” statements. You could say, “First we take off you overalls. Then I take off the wet diaper…” and so on.
• Let your child help as much as possible. You can ask your child to help such as “Can you hold your legs up high? Hold the diaper for Mommy? Open the powder for me?”
• Use interesting distractions. Laugh and comment on these as you are diapering your child.
  • You might play peek-a-boo, sing his favourite song or a do favourite finger play (e.g., “itsy, bitsy, spider”).
  • Use a toy (e.g., binoculars, stuffed animal, etc.).
  • Use stickers – one on each of the child’s hands.
• Plan a preferred activity or event to follow diapering.

Celebrate Successes

Celebrate you and your child’s successes along the way. Children need to hear in concrete ways what they have done well. You might say, “Thanks for being such a ‘big boy.’ You really helped me diaper you.” or “No more poopy diaper. We did it!” For older children, use natural consequences, such as, “Now your bottom will be clean and not feel sore!” Or “Now you can put on pants and go outside, because you are all dry!”.

Chapter Attribution

This page is adapted from Making Life Easier: Diapering by Pamelazita Buschbacher, illustrations by Sarah I. Perez. The resources is in the open domain, published on The National Center for Pyramid Model Innovations (NCPMI) website.