Unique Child: Practice in pictures - With care

NAPPY CHANGING

Ava has been in nursery for some time and has a good relationship with Claire, her key person, who sees to most of her care routines. While she is changing Ava's nappy, Claire takes time to play a game with her and the two of them enjoy the closeness and physical intimacy of the interaction.

When the nappy is changed and Ava dressed, Claire gently pulls Ava up towards her, and this time Ava turns the action into a game and Claire responds. It is clear that Claire is not rushing Ava and that both of them are relaxed and enjoying being with each other.

Then Ava tells Claire that she wants to go to the toilet. Because Claire knows Ava well, she is aware that this is an important step in her toilet training, as Ava is obviously becoming more aware of herself and her physical feelings.

While Claire helps her, Ava chats happily about her mum, Molly. It is important for Ava to be able to think and talk about her mum while she is apart from her. Claire knows this and responds warmly. Ava hugs Claire and her words suggest that she is comfortable and happy to have Claire with her, when her mother isn't available to her.

The pleasure and contentment on Ava's face confirm that Claire is providing the reassurance and support that Ava needs to help her cope with the essentially routine, but potentially unsettling, experience of having her nappy changed or going to the toilet. They then go off to wash hands together, with Ava proudly declaring that she can do it herself.

GOOD PRACTICE

1. It can be all too easy for early years practitioners to think that changing nappies and toileting children is a mundane and relatively unimportant part of the routine of childcare.

However, when we are changing a child's nappies we are not just dealing with the child's physical needs. It is also a valuable time for warm interactions and playfulness, and for making sure that children feel emotionally comfortable and secure as they develop greater awareness of their bodily functions.

Try and imagine, or remember a time, perhaps when you were ill or in hospital, when you were physically dependent on the care of others:

- Were you handled roughly, or with gentleness?

- Were you looked after by the same people, or did they change constantly?

- Did your carers explain what they were doing to you?

- Did they focus on you or seem to have their minds on other things?

- Were you listened to and empathised with?

- How did the experience make you feel about yourself? Did you feel cared for, or powerless and a nuisance?

Now think about how this relates to the children who are dependent on you for their physical care. Do you:

- operate a key person approach so that the same one or two people carry out a child's care routines?

- handle the child gently, but confidently, talking through the process?

- find out from parents what special words, signs or signals they use to talk about toilet needs?

- make going to the bathroom, or having a nappy changed, into an interesting and enjoyable experience?

- take plenty of time so that the experience is relaxed and unhurried?

2. As children can be quick to pick up on an adult's feelings of disgust or tension, provide help and support to staff who may be inexperienced or uncomfortable with nappy changing.

Make sure you have a separate nappy changing area that is a private, warm, cheerful space. It needs to be comfortable for the child and the adult.

- Provide a stool so that older toddlers can be helped to climb up to changing tables for themselves.

- Make sure that everything you need is easy to reach.

- Agree procedures for disposal of soiled nappies.

- Consider using reusable nappies and support parents to see the benefits of them.

3. As a child's key person, it is very important that you make the most of this special time every day for:

- affectionate physical contact between you and the child, with tickles, cuddles and spontaneous play

- focusing on the child and the interaction between the two of you

- conversation and one-to-one communication

- opportunities for developing independence and self-help skills.

4. As children become more competent at using a potty or the toilet, it is still important for them to be supported by their key person, who is likely to be tuned in to the way the child behaves when they need to go to the toilet.

- Talk to the family and make sure that you adopt the same approach to toilet training as the child's parents or carers, so that a similar routine is followed at home and at the setting.

- Remind parents to dress children in clothes that can be quickly and easily pulled up and down, so that children can be as independent as possible.

5. It's common practice for children to be sent to the toilet in groups. Consider whether this is the best way to manage toileting.

Being rushed, worried about privacy and not feeling ready to go can make children anxious about using the toilet and lead to problems. Individual attention from their key person, who knows whether they are better suited to a potty, a toilet booster seat or a step stool will help to make sure that toilet training is relaxed and unstressful for a child. Further information: - The stills are taken from Siren Films' 'Life at Two - Attachments, Key People and Development', a DVD tracking the life and development of two-year-old Ava, at home and in the nursery. For more information, visit Siren Films at www.sirenfilms.co.uk or call 0191 232 7900

LINKS TO EYFS GUIDANCE

- UC 1.4 Health and Well-being - emotional well-being

- PR 2.4 Key Person

REFERENCES

- Key Times - A framework for developing high quality provision for children under three years old by Camden Early Years Under Threes Development Group

- Every Day a Good Day - Establishing routines in your early years setting by Stephanie Shimmin and Hilary White (Paul Chapman)

- People Under Three - Young children in day care by Elinor Goldschmeid & Sonia Jackson (Routledge)

- www.realnappycampaign.com.