Objectives

Identify general hygiene practices related to diapering and toileting for children.
Use strategies for training staff about how to help toddlers learn to use the toilet.
Teach, model, observe, and provide feedback on general hygiene practices.

Learn

Teach

It is critical to keep restrooms clean in child care and school-age programs, as toileting and diapering are a major source of contamination. Unsanitary practices can put staff members, children, and youth at risk for illness and infection. This lesson focuses on ways you can help staff members maintain hygienic diapering and toileting practices. It also includes information on working with staff members who are in contact with potty-training toddlers.

At a minimum, sanitary conditions must be maintained in all diapering areas and restrooms. Make sure:

Toilets are flushed.
Floors, doors, walls, and changing surfaces are clean.
Paper towels and other trash are thrown away properly.
Running water, 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.
All children and adults wash their hands properly.

Many staff members who work with infants and toddlers need guidance in toilet training issues. Toilet 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 toilet training
How to tell if a particular child is ready for toilet training
How to help children toilet train successfully
How to work with families in the toilet training process
How to help children (including preschool and school-age children) respond to accidents

Consider using this video to teach toddler staff members about toilet training.

Click here to watch Toilet Training Toddlers

Follow best practices in toilet training toddlers.

Remember that staff members who work with preschoolers or school-age children may also need support around promoting independent toileting. For most children, toilet training is a distant memory by kindergarten. That doesn’t mean there won’t be an occasional accident, though. 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. Help them think of responses school-age children can give when others ask what happened or why they changed clothes.
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.
Make sure restrooms are physically and emotionally healthy. For many children and youth, multi-stall restrooms can be intimidating. Gender-fluid or gender-diverse youth are particularly at risk. Watch for signs of bullying and ensure restrooms are adequately supervised. Make a plan for offering all children and youth the option of single-stall or gender neutral restrooms. See the Creating Gender Safe Spaces focused topic for more ideas.
Plan ahead. Changes in routine or exciting special events can make children forget to take care of their needs. This means you should remind school-age children to use the restroom before field trips or long bus rides.

Model

You can model talking positively to toddlers about the toilet. Join in congratulating children who “go potty.”

Help staff members identify ways to organize the diapering and toileting areas so that supplies are always accessible and hygiene is maintained. Set up opportunities for teachers or caregivers in infant programs to visit each other’s classrooms for ideas.

Talk to school-age program staff about how to teach children and youth to maintain sanitary conditions. Regularly inspect the restrooms to make sure they are clean. If you see a problem, talk to staff members right away and make a plan to fix it.

Observe

Watch how the staff member in the following video prepares the changing area in an infant classroom. All staff members should know and follow required cleaning procedures every time.

Cleaning Diaper Changing Stations

This video shows high- quality practices for cleaning changing stations.

Take a few minutes to think about the range of restroom conditions you might encounter in infant through school-age settings. Read this chart and think about which scenarios might be most likely in your settings. How might you respond?

Age Setting Scenarios

Scenario	You saw: A staff member changing diapers without gloves
You Say	What you might say: “Gloves are a major way you can protect yourself and the children.”
You Do	What you might do: Offer training on glove-wearing procedures Discuss the benefits of wearing gloves Make sure a variety of glove sizes are available

Scenario	You saw: A staff member finishes a diaper change, cleans the mat, and writes on the child’s log. Then she washes her hands.
You Say	What you might say: “The pen that you used for the log is contaminated. Let’s disinfect that pen and talk about the steps for cleaning…”
You Do	What you might do: Suggest moving the diaper log slightly further away from the changing area as a physical reminder that it is a separate step and that hands must be washed Put a sticker on the pen that says, “Clean” as a reminder to wash hands first

Scenario	You saw: You walk through the classroom mid-day and see paper towels on the floor and little puddles beside the toilets.
You Say	What you might say: “I know you make sure your restrooms are clean everyday at opening and closing, but we’ve also got to make sure we stay on top of it all day…”
You Do	What you might do: Make a plan with the staff about monitoring the restrooms hourly Continue to do “spot checks” on your classroom visits Model healthy habits when you’re in the room: encourage children to throw away their own towels, etc. Talk to supervisor if staff members do not implement hygiene practices and this becomes a performance issue

Scenario	You saw: You see a pair of underwear hanging over the stall door. The staff member says the child’s mother asked them to rinse dirty underwear before sending them home if the child had an accident.
You Say	What you might say: “I understand where his mom is coming from, but rinsing the underwear introduces germs into our sinks and increases the risk of contamination. Would you like me to come this afternoon and help talk to her?”
You Do	What you might do: Arrange to be in the classroom when the mother picks up, if the staff member requests it Provide information on the program’s policies for helping children with accidents and preventing the spread of bacteria

Scenario	You saw: A sink is clogged and is causing water to overflow.
You Say	What you might say: “I let maintenance know that a sink is clogged. Please make sure children do not use that sink until it’s fixed.”
You Do	What you might do: Put up a wet-floor sign Help staff members monitor the area Follow-up on maintenance request Work with staff to talk to children about the issue and to make sure restrooms are monitored adequately

Scenario	You saw: A child has become suddenly ill with diarrhea, and there is a strong odor near the restroom. The other children are laughing, covering their noses, and talking loudly about the child and the smell.
You Say	What you might say: “I’ll help the sick child into the office, and I’ll get his mom’s number for you. Your team can keep business as usual in the program areas. Please check the restroom and let me know if any housekeeping issues need addressed.”
You Do	What you might do: Assist the child to a “sick area” near the office and away from other children Provide assistance as necessary with cleaning and sanitizing; call maintenance as applicable Talk to staff about what they can do with the other children and their comments in future situations like this. For example, staff might comment, “Everyone gets sick sometimes!”

Scenario	You saw: A five-year-old continually asks to use the restroom although it is always accessible.
You Say	What you might say: “It looks like Josie doesn’t quite understand how to take care of her needs independently yet. How do you think we may be able to help her remember that the restroom is always open and she doesn’t need to ask?”
You Do	What you might do: Provide the staff member with a few “reminder” phrases she can use when Josie asks to use the restroom Brainstorm strategies that Josie can use to remember to use the restroom on her own

It is important to ensure compliance with sanitary diapering and toileting areas. Use the Restrooms and Diapering Environment Best Practices Checklist in the Apply Activities section below to focus your observation on this important set of competencies. When you have finished observing, store the forms in staff members’ training files to document progress and competence with this skill.

Changing Soiled Clothes

Help staff learn exactly how to help a child who has had a toileting accident

Explore

Sometimes, staff members have a difficult time potty-training toddlers and they may use techniques that are not consistent with best practices. Read the scenarios in the activity, What Do I Say Now: Toileting Scenarios, and think of how you would respond to help staff maintain hygienic and supportive toileting practices. Compare your answers to the suggested responses.

What Do I Say Now - Toileting Scenarios

Think of best ways to support staff with toilet training practices

Apply

It can be helpful to have a library of professional resources. Use the Toilet Training Booklist as you consider purchasing titles for your program’s library so you can share them with staff members and families.

Use the Restrooms and Diapering Environment Best Practices Checklist as a focused observation tool to support staff that have completed the Healthy Environments course but may need additional support and feedback on diapering and toileting procedures. This checklist provides both an easy way to follow up on goals set around this topic and also specific feedback to the staff members about what you observed.

Toilet Training Booklist

A list of books to consider for your program’s library

Restrooms and Diapering Environment Best Practices Checklist

Use this checklist to observe and document competencies that address restroom and diapering environments

Glossary

Hygiene:

The set of practices that help keep people healthy

Soiled Clothing:

Clothes that have been contaminated with urine, feces, or other body fluids

References & Resources

Administration for Children and Families. (n.d.). Ensuring Safe and Healthy Child Care. https://childcare.gov/consumer-education/ensuring-safe-and-healthy-childcare

American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2023). CFOC Standards Online Database. Aurora, CO; National Resource Center for Health and Safety in Child Care and Early Education. https://nrckids.org/CFOC

American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2019). Caring for Our Children: National health and safety performance standards; Guidelines for early care and education programs (4th ed.). American Academy of Pediatrics; Washington, DC: American Public Health Association.

Aronson, S. S. (Ed.). (2013). Model Child Care Health Policies (5th ed.). Pennsylvania Chapter of the American Academy of Pediatrics.

Aronson, S. S. (Ed.). (2012). Healthy Young Children: A Manual for Programs (5th ed.). Washington, DC: National Association for the Education of Young Children.

Centers for Disease Control and Prevention. (n.d.). Safe and Healthy Diapering. https://www.cdc.gov/healthywater/pdf/hygiene/Diapering-procedures-childcare-508c.pdf

Childcare Aware. (n.d.). Healthy Childcare. https://www.childcareaware.org/our-issues/health-nutrition/

Extension Alliance for Better Childcare. (2019). ctiCleaning, Sanitizing, and Disinfecting in Childcare. https://childcare.extension.org/cleaning-sanitizing-and-disinfecting-in-child-care/

Learning for Justice. (2013). The Gender Spectrum. https://www.learningforjustice.org/magazine/summer-2013/the-gender-spectrum

National Resource Center For Health and Safety In Child Care and Early Education. (n.d.). https://nrckids.org/

Oesterreich, L. (1995). Guidance and discipline. In Oesterreich, L., Holt, B., & Karas, S. (Eds.), Iowa Family Child Care Handbook (pp. 242–245). Ames, IA: Iowa State University Extension.

North Carolina Child Care Health and Safety Resource Center. (n.d.). https://healthychildcare.unc.edu

Wohlraich, M. L. (2016). Guide to Toilet Training (2nd ed.). Itasca, IL: American Academy of Pediatrics.