Every Change Matters™: A Quick Reference Guide to Developmental Diapering Care
This companion piece captures key takeaways from each of the guide’s 5 core focus areas, and can also be printed as an 11x17 poster for display and easy reference.
Five Areas of Focus
1. Calm and Clean
The healing environment
- Ensure all supplies needed for the diaper change, including clean diapers and wipes, are in reach before starting the diaper change.
- Before diapering, wash hands (don gloves per unit protocol).
- Approach the infant calmly, intentionally, and with a gentle, purposeful touch while keeping the infant in as flexed a position as possible. Keep one hand on the infant at all times. For micro-preemies (<1500g), it may be helpful for two caregivers to assist with the diaper change (one to gently perform the diaper change and the other to provide containment and flexion while offering other soothing, comforting techniques).
- After diapering, the changing surface should be cleaned, gloves removed and hands thoroughly washed or sanitized again.
2. Change and Check
Activities of daily living
- Change diapers every 1 to 3 hours during day and with each feeding at night (or at least once during the night) using a disposable diaper with superabsorbent gel.
- Conduct gentle, thorough cleansing of the genital area with baby wipes at every diaper change.
- During each diaper change, carry out a focused assessment of the perianal area.
Pain and stress assessment and management
- Assess infant’s cues related to stress and pain. Engage parents in learning to recognize these cues and how to offer comfort and support to their infant.
- Provide comforting techniques that support the infant’s motor and state systems such as use of a positioning aid or gently bringing extremities to midline.
- Offer non-nutritive sucking; consider swabbing pacifier with mother’s breast milk.
- During diapering activities, move the infant slowly and keep her in contact with the supporting surface or caregiver whenever possible.
4. Champion Sleep
- Use diapers with wetness indicators to avoid waking a sleeping infant if their diaper is dry during routine check.
- Employ strategies to facilitate infant sleep cycles, including minimizing ambient light exposure, avoiding direct light exposure, clustering cares to avoid disruption of sleep, minimizing noise, and fostering a quiet, calm environment.
- Encourage kangaroo care and skin-to-skin contact, gentle healing touch and massage (for older, stable infants), as well as facilitating ongoing opportunities to experience mother’s scent and voice.
5. Confidence and Closeness
- Coach parents about how to incorporate developmentally supportive measures such as reading their infant’s cues and providing comforting techniques.
- Aid parents in becoming “confident caregivers” by encouraging them to perform skin assessment and get to know their infant’s behaviors and cues.
- Encourage parents to take advantage of the diaper change as an excellent opportunity to engage with the infant through talk, singing, facial expressions and intentional touch.
- Verify that parents have an adequate supply of diapers at home and, if needed, assist parents with finding resources to obtain diapers.
Every Change Matters: A Guide to Developmental Diaper Care
Every Change Matters™: A Guide to Developmental Diapering Care was developed by the Huggies® Nursing Advisory Council (HNAC), which is made up of experts in neonatal and perinatal nursing, therapy, and education, as well as an NICU parent advocate working collaboratively to deliver the best outcomes for babies.