Q: What is the nappy changing procedure at your setting?
'We operate a keyperson system with a significant second. This enables one member of staff to be responsible for several children and for them alone to change their nappies. If they are sick or on holiday, or have a day off, then the significant second takes over. This works very well in the baby room, as there is a maximum of nine babies. However, it is more difficult in the older room because there are more children.'
'There is a written procedure on how to change nappies - for example, apron, gloves, clean the mat, get everything ready before the change - but nothing to say when to change nappies.'
'We aim for the keyworker to change the nappies whenever possible. But we are a small nursery with four members of staff, so the children are very familiar with everyone. We prefer keyworkers changing the nappies because the children have a special bond with them. It is a person that they know.'
'We trialled keyperson changing a few months ago for a week. On the whole, the keyperson found it rewarding, in a bizarre way - seeing the improvement in a child's nappy rash, for example, meant that this was able to be specifically monitored.
'The trouble we were finding was with specific policies of the setting, which include that the qualified Level 3 member of staff is to remain with the majority of the children at all times. In some circumstances, this meant that that practitioner was unable to do key person changes. Also, it is primarily the Level 3 practitioner who has key children, because unqualified members of staff or Level 2 assistants are only allocated a maximum of three.
'A way around this would be the secondary keyperson system, as recommended by the EYFS. However, our director of childcare is not keen on this approach and favours a keyperson within a key team approach.
'We are in the process of trialling keyperson changing again, but we are still encountering similar problems. We can't see this being resolved until all members of the team are qualified and key children responsibilities are then equally shared out. Then I think it would work like a dream.'
Q: Do you consider children's dignity and privacy when changing nappies?
'The keyperson system helps children feel secure because of the emotional attachment. When explaining keyperson changing, I try to give examples to staff of how as adults, 'conveyor belt' changing could affect them - for example, if they were in labour and having lots of different midwives, or building up a relationship with their GP and then going to another doctor, or when they start work and feel "lost" until they make relationships. I think the colleges have to get more focused and teach in a more modern, up-todate way.'
'We change children's nappies in the toilet area, but other children and adults are free to come in.'
'When changing nappies we try to keep the child's privacy, but at the same time the member of staff should be visible to another practitioner at all times. This is for safeguarding issues.'
'Staff always talk to the children, reassure them and make sure they are comfortable and often sing to them while changing their nappy.'
Q: When do you change the children's nappies?
'It depends on the child's needs, or the parent's requests.'
'In the baby room we used to change every three hours, roughly around 9.30am, 12.30pm and 3.30pm, with nappies being changed when needed in-between and dry nappies being recorded but not necessarily changed at those times.
'Since I have been senior I have tweaked the routine to include more nappy checks so that no nappy is missed if it needs changing but that the nappies are changed when needed so as not to "conveyor belt change".'
'We change children's nappies when they need changing, not to a set timetable like they do in some nurseries.'
Q: Is nappy changing regarded as a chore by your colleagues?
'I have not encountered any situations where nappy changes are regarded as a chore. In fact, during the keyperson trial time, it was found that people without key children felt left out or not useful because they could not change a nappy they found.
'Nappy changes were shared fairly between the team, usually being one round each during the day and changing nappies in-between, depending on who found it! We never had any issues with this from the staff or parents.'
'It is never thought of as a chore, here but in larger nurseries there is that possibility if one member of staff has had to change 10, 11 or 12 nappies in a row.'
'Yes, at first for some staff, when the keyperson changing system was introduced. They didn't think it was fair because on some days, one member was responsible for five and someone else for none. It was explained that this works for all staff on different days and on some days they would only have small numbers.'
AN EXPERT'S VIEW
Linda Keats, graduate training advisor, Early Years and Childcare, Essex
We all agree on one area of the nappy changing process - keep it positive and stress-free, for both child and practitioner. So, what works best - keyperson approach or conveyor belt?
An effective keyperson nappy changing system allows for intimate, one-to-one time. It provides an opportunity to develop a strong bond and attachment between child and practitioner. Sensitive and responsive interaction allows intimate and personal moments to be shared.
Imagine the child's delight knowing they are about to share time with their very own 'special person', someone they know and trust. A special care and attention that is just for them! They feel valued, a Unique Child as in the EYFS, not just another name on the nappy checklist.
As the link between home and setting, the key person should involve parents in shaping their child's personal care routines; this ensures a strong sense of trust, continuity and familiarity to develop.
In contrast, 'designated staff change times' ensure that all staff have their turn, and 'set time changes' can prevent nappies being forgotten and constant checking throughout the day. If nappy checks are too frequent, it becomes invasive and interrupts the flow of the child's play. The 'conveyor belt' approach, however, often means that quality interaction is minimal and rushed and care is not individualised.
With both systems, practitioners must ensure respect is shown for the child's privacy and dignity. Are you checking nappies in front of a room full of people? Does a different person change the child every day? The fewer people who change a child's nappy, the more respected and comfortable the child will feel.
Remember to involve the child. Ask their permission; a non-verbal expression is just as valid as a verbal response! Also, talk to the child throughout the process - they should be informed of what's happening and why.
Toileting is a natural part of everyone's day and children should never be made to feel negative about it. Some practitioners call out 'who's smelly or dirty?' This is disrespectful and humiliating and should not be part of any early years practice.
Don't forget that this routine can become a wonderful time for learning that covers most areas in the EYFS. I believe that every opportunity is a learning opportunity!
This precious time between practitioner and child should be valued and appreciated. Having worked in early years for my whole career, I believe the keyperson approach to be the most effective. However, alternative systems can enhance this routine and ensure that children feel comfortable, safe and secure throughout their day.
What's your opinion?
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