Positive relationships: Ask the expert - Quick change

Some of my colleagues have been saying that I take too long when changing nappies, which is worrying me. We have a key person system in place where one of us takes charge of planning, observations and liaising with the parents of our small group. The daily routine includes nappy changing times in the morning when they arrive, and before lunch. We don't always "do" our key children. There seems to be a pressure to get through feeding, snack and meal times quickly, and now it seems as if changing nappies is more rushed - almost like a competition at times.'

What a shame! You obviously feel stressed at the atmosphere that exists in your setting, where the 'care' part of 'daycare' appears to be getting lost.

It sounds as if the key person system has fallen into the trap of becoming a more administrative role, rather than its original intention of the key person being the one who provides a 'safe haven' for her group of children. Of course, a vital part of the key person role is to think about her children and, following careful observations, to adapt, promote and provide activities supportive to their individual needs. Deepening the relationship with parents is also crucial. This supports consistency and stability for the child and ensures that parents do not feel 'usurped'.

However, a weakening of the key person role into one where the relationship with the child and their parents is not the hub of daily practice may lead to specific caring aspects of daily life becoming 'mechanical' - with stress being on 'getting the job done' rather than appreciating the significance of the act of feeding a child, or the wealth of experiences associated with the routine procedure of changing a nappy.

Thankfully, the value of meal times is increasingly noticed because of the emphasis on healthy eating and because people have taken the opportunity to reflect on the wealth of social interaction involved, as well as the opportunities for 'natural' learning about number (how many knives, forks and spoons do we need), correspondence (which cup goes with which plate), quantity and mathematical language (how much, more, less, full).

Consistent care

To turn to nappy changing, Elinor Goldschmied said in her seminal work People Under Three, 'So much of the subtle communication for children who do not yet have command of language comes through touch and handling' (p40). Such touch and handling obviously occurs not only when a child is being held, comforted, lifted and carried, but also when being changed.

I hope we are a very long way from the situation described by Goldschmied where a child 'was put on a pot by one nurse, wiped by another and had his pants pulled up by a third'. Such impersonal care should have no part in any setting. What may linger is the idea that this is something to be 'got through'. The practice may still exist in some settings of a rota for different staff to change nappies, or the importance of consistency for the child is not always realised. This is not to say that a child should never be changed by another member of staff. There should, if possible, be a 'buddy system' where another person who the child also knows well can take over in the key person's absence.

Why is it necessary for the child to have a consistent, caring person who carries out this process in an unhurried, caring way? What is so important about changing a wet or soiled nappy? The key lies in the intimacy of the act - we are cleaning an intimate part of the child's body. We have several types of touch receptor all over our bodies that respond to gentle pressure, deep pressure, sustained pressure and vibration. We also have two major pathways for touch from all those receptors through the spinal cord and up to the brain. One of these pathways carries 'messages of pain, temperature, itch, tickle, sexual sensation, crude touch (the one that tells you if you have banged your knee) and sensual touch' - this latter relates to stroking and massage (Blakeslee & Blakeslee, 2007). Please note, the reference to 'sexual sensation' is identifying what types of touch this pathway accommodates - babies and children do not have 'sexual' feelings in the adult sense.

Washing, wiping, patting and stroking during nappy changing will provide a soothing experience for the baby, who may previously have been experiencing feelings of coldness or wetness as a result of their bodily functions. Some babies are sensitive to changes in temperature, so removing clothing can be distressing. The feel of the changing mat may also be pleasant to some babies and unpleasant to others. It is so important that practitioners recognise that each baby will have an individual response to this process., and that parents will have a very familiar changing routine. Most parents will have their own way of undressing their baby - how they clean, talk and interact - which is going to be the pathway laid down of 'how my nappy is changed'. Then in daycare, someone else carries out this process. s a key person, getting to know how the parents usually carry out nappy changing can help baby make the transition from home to daycare.

Quality of interaction

Uncaring, rapid and task-driven attitudes to these everyday routines carry far more implications than their very ordinariness may suggest. As well as the impact on their sensory/touch systems, children will also be aware of the quality of the interaction between themselves and the carer involving facial expression, tone of voice, quality of handling and so on.

Nappy changing is a task and sometimes can be unpleasant. Whatever the state of the nappy, it is how the adult responds that turns this experience into one that is positive or negative for the child. A young child will not evaluate the quality of care, but what will be integrated into the most subtle aspects of how they feel about themselves will be the impact of their daily experiences and how it felt for them.

- Maria Robinson is an early years consultant and author of From Birth to One and Child Development from Birth to Eight: A journey through the early years (Open University Press). Her Nursery World series on child development can be bought online at: www.nurseryworld.co.uk/Books

REFERENCES

- Blakeslee, S, Blakeslee, M, (2007) The Body Has a Mind of Its Own. New York, Random House Publishers

- Goldschmied E, Jackson, S (1994) People Under Three. London, Routledge

- I am using the feminine terms here as (sadly) the vast majority of daycare practitioners are female, so apologies to the male practitioners who may be reading this!

- However, we must also carefully note that self-touch of the genital area can be comforting and many young children will do so for this reason.