Los Angeles Valley College Infant and Toddlers Education Paper

Enhancing the Diapering Routine: Caring, Communication, and Development

by Deborah E. Laurin, Carla B. Goble

• Standing on the changing table, 19-month-old Lilly smiles at Ms. Ute,  her caregiver. Lilly’s tiny hands hold on to the support rail to help  her keep her balance as she responds to Ms. Ute’s words and gestures.  Both child and caregiver engage in a choreographed routine as Ms. Ute  undresses Lilly for her diaper change. The routine is a responsive  partnership, with each person respectfully communicating and  cooperating. Lilly lifts her legs one at a time as Ms. Ute removes  Lilly’s overalls. Ms. Ute talks softly, moving slowly, pausing, and  allowing time for Lilly’s participation.

Ms. Ute says, “Kaki” (Hungarian for poo), and Lilly  repeats it several times as she looks curiously at the diaper that Ms.  Ute has just removed. As she washes Lilly, Ms. Ute explains her actions  and describes the diaper rash cream she is about to use. Lilly shows  keen interest in the cream. Ms. Ute dips her fingers into the cream and  holds her fingers out for Lilly to see. Unhurriedly and with care, Ms.  Ute applies the cream to Lilly’s rash. Lilly helps spread some of the  cream herself.

“Now it’s time to put on a clean diaper,” Ms. Ute says as she holds  up two diapers for Lilly to choose from. Lilly points to the one she  wants and says, “Mama.” Ms. Ute responds, “Yes, Mama diapers Lilly too.”  Ms. Ute carefully puts the diaper on Lilly, front to back, following  Lilly’s movements as Ms. Ute closes the diaper’s sticky tabs. Lilly  gazes at Ms. Ute’s shirt and reaches out to touch the buttons. Seeing  Lilly’s curiosity, Ms. Ute talks to her about the buttons’ color and  texture.

Lilly shifts her attention to getting dressed, assisting Ms. Ute by  stepping into her overalls. She adjusts her hands on the rail for  support. Lilly watches intently while Ms. Ute closes the snaps on the  overalls’ shoulder straps. As Lilly playfully pulls the snaps apart, Ms.  Ute says, “I can see that you know how to unsnap your overalls.” Lilly  is learning, trying, and doing some things herself. Ms. Ute finishes and  offers a cloth to Lilly, who takes it and wipes her hands. Ms. Ute  carefully wipes Lilly’s hands one last time before lifting her from the  changing table. Ready to return to the play area, Lilly retrieves a toy  she placed on the nearby shelf before her diaper change.

This vignette is an observation of an actual diapering at Lóczy, the  early care and education program at the Emmi Pikler Day Care Center, or  Pikler House, in Budapest, Hungary. Some of these practices may differ  from those typically used in US programs serving infants and toddlers.  For example, toys or other objects are not used as distractions during  diapering. Instead, they are set aside to ensure that children and  caregivers fully engage in the diapering relationship. Another  difference is that Lilly stands up and holds on to a rail during the  diaper change, which enables her to move and participate.

• Diapering offers reoccurring opportunities to support learning  through relationship-based interactions, cooperation, and communication.

The pace is slow and relaxed, with ongoing communication between the  caregiver and Lilly. This helps Lilly anticipate each step in the  process. She makes decisions and is an active partner in undressing and  dressing herself. While participating in the diaper-changing routine,  Lilly is learning language and self-help skills, and developing  autonomy, self-regulation, and other capabilities.

Diapering and responsive care

Infants and toddlers experience an average of 5,000 diaper changes in  their young lives (Gerber 2000; Lally 2013). In most programs and  homes, diapering occurs at a fast pace, with the emphasis on speedy  completion. For children, this results in missed opportunities for  one-on-one interactions, language experiences, and involvement in their  bodily care and sense of agency.

The intimate nature of diapering, both in center care and at home,  offers reoccurring opportunities to support young children’s learning  and development through relationship-based interactions, cooperation,  and communication between caregivers and babies. These early diapering  experiences also powerfully influence how babies begin to feel about  their bodies and bodily functions. When a caregiver takes time to tune  in to each child’s individuality and interacts patiently and gently, the  child perceives that the caregiver enjoys their time together, which  builds a strong, supportive relationship between them (Tardos 1994,  2016).

Research on best practices emphasizes the importance of  individualized infant and toddler care for building relationships,  assessing development, and embedding learning opportunities for young  children in everyday routines (Gonzalez-Mena & Eyer 2007; Tanyel  & Knopf 2011). However, research reveals that less caregiver  involvement and less elaborate communication with children takes place  during diapering routines than during play (Wilcox-Herzog & Ward  2004; Degotardi & Davis 2008; Degotardi 2010).

Developmentally appropriate practice for infants and toddlers calls  for a warm, close relationship between a caregiver and child: “Treated  as a personal, one-on-one interaction—where the caregiver seeks the  baby’s attention and cooperation—diapering builds a sense of teamwork,  and their relationship grows as a result” (Copple et al. 2013, 62).

Diapering at the Pikler House

Do you remember when you first learned to change a diaper? It may  have been a difficult, awkward, tense, and even fearful experience. With  practice, you became efficient. But diapering is about more than  gaining efficiency; it requires developing self-awareness about how to  observe and respond to a child’s signals. Knowing diapering hygienic  protocols is important, but that knowledge should coexist with the  caregiver–child relationship. (See “Using Elements of the Pikler Approach for Diapering (Links to an external site.).”)

A caregiver at the Emmi Pikler Day Care Center noted, “You have to  remember to think like you are the child.” By doing so, a diapering  routine becomes an opportunity for understanding each other’s intent and  different mental and emotional states (Gaffan et al. 2010; Colombo et  al. 2012). ) The most critical element is the different types of talk a  caregiver uses with a child during the diapering process so the child  knows, is ready for, and can participate in what occurs.

Types of talk

During diapering at the Pikler House, the caregiver uses several  types of talk to describe, explain, and communicate actions in an  unfolding back-and-forth process similar to adult conversations (Bodrova  & Leong 2007). Back-and-forth, or serve-and-return, exchanges are  meaningful: the caregiver returns the child’s serves with  relevant information by responding to the child’s interest and actions,  following the child’s gaze or gesture, or responding to the child’s  vocalizations and babble. This tuning in to each other (sometimes  referred to as mentalization), which can take place during diapering routines, forms the foundation for infant brain development (Shonkoff 2017).

Diapering requires developing self-awareness about how to observe and respond to a child’s signals.

Using expressive and responsive language strategies during diapering  promotes infant and toddler language, social, emotional, motor, and  cognitive development (Wittmer & Petersen 2010). The types of talk  used during diapering routines should be individualized to the  developmental capabilities of each infant and toddler. (For descriptions  of several types of talk, with examples of how they may be used in the  diapering process, see “Using Different Types of Caregiver Talk during  Diapering,” below.)

Diapering routines allow caregivers to engage with each child,  ideally in the child’s home language. Reaching out to family members,  caregivers can learn a few words in each child’s home language; as a  reminder, they can create and hang a poster near the changing area with  simple phrases in the various languages. (To support pronunciation,  consider writing each word twice: correctly and phonetically.) Using a  child’s home language demonstrates its importance and helps bridge the  home and care environments. Encouraging families to continue speaking  their home language contributes to linguistic continuity, which supports  infants and toddlers in their identity formation (Sánchez & Thorp  1998a, 1998b; Thorp & Sánchez 1998; De Houwer 1999).

Caregiver dialogue should be personal, rich, and warm. Infants and  toddlers cooperating with caregivers are motivated by a sense of  pleasure and agency (Vincze 1994). At times, the child may playfully  depart from the caregivers’ request, instead following other interests;  but that, too, supports language development and relationship building.  For instance, when Lilly lightheartedly pulled her overall snaps apart,  she broke from the choreography of dressing to explore this clothing  element. Instead of scolding her, Ms. Ute followed Lilly’s lead and  narrated using parallel talk:“I can see that you know how to unsnap your  overalls.” After pausing and having her new skill acknowledged, Lilly  was ready to finish dressing.
 

Using Elements of the Pikler Approach for Diapering

Speak to the infant or toddler. Before picking the child up, address the child, pause, and wait for eye contact

Approach the child from the front and show your hands, palms facing  up. “I’m going to change your diaper. Are you ready?” “Now I am going to  pick you up.” “I see you’re ready for your diaper change.” (Tardos  2011, 88). Talking about what’s going to happen reduces the likelihood  of startling the child. Infants are developing their first sense of  self, safety, and trust through contact with others and with their  caregivers (Lally 2009).

Give the child time to process.Allow the infant or toddler time to absorb and prepare for what is going to happen. 

Let the child transition from his activity to diapering. Tell him,  “Soon it will be time to change your diaper.” If the child resists,  leave him for a short while and change another child, or all the  children, before returning to him. Inform the child, “After you play a  little while, I will return to diaper you.” 

With an infant, first touch the child gently before carefully placing  your hands under his head and body, pausing before lifting. “I am  lifting you in my arms now and will place you here on the change table”  (Tardos 2011, 88). 

For older infants and toddlers, offering two diapers for the child to  choose from engages the child in the diapering process. Inviting the  child to decide between the diapers, pointing to the diaper patterns,  and describing the images, colors, or shapes gives the child time to  adjust to the diapering and respond to the choice, slowing the process  down so it doesn’t feel tense or rushed. The child is often happy during  the next diaper change if the caregiver tries to remember his diaper  preference and says, “I remember that you liked this diaper before”  (Tardos 2016).
 

Describe what is happening.Talk with the child, describing what you are doing and preparing her for what will happen next. 

A child benefits when caregiver communication occurs in a  conversational style rich with different types of talk. Communicate in a  variety of ways, pausing frequently to allow the child to process and  respond to your words and actions. When you talk about the clothes the  child is going to wear, what part of the body you are touching or  cleaning with the wipes, and what you are going to do next, the child  absorbs information about herself and the diapering process. Speak  positively about the diapering experience and avoid facial expressions  that show distaste or comments referring to smelliness, messiness, or  dirtiness. 

Tardos (2011, 86) offers a simple example: “Now, I am going to take  off your diaper to see if there is anything in it. I am going to wipe  your skin; lift your bottom, please. Will you allow me to do that? Now I  am going to put this coat on you. You see how pretty it is? Your  grandmother made it for you. First I am pulling up one arm, then the  other. I have to lift you up a little bit. It’s not very easy, but we  have made it. Thank you.”
 

Listen and observe. Pay close attention to the child to notice and interpret her actions and responses. 

The conversational content of the relationship will grow when a  caregiver responds to the child’s interest and expressions. For example,  a caregiver may remark, “I can see that you like this nice warm coat.  Yes, I see you are sleepy now. You have just yawned. I am going to put  you in your bed real soon. Here we are, I am going to put you down in  your bed. And now I am covering you. Sweet dreams!” (Tardos 2016).

ASSIGNMENT 2 

This is in a Chapter you have already read before this week….a scavenger hunt!

Using your textbook, answer these two questions:

1. What are the four roles of the adult in infant-toddler education?

(Make sure you find the four roles not the longer list, safety is not on this list)

2. What does this have to do with facilitating problem solving ability in infants and toddlers?

(How do these roles help us allow children to help solve their own problems?).