7.2: Caregiving Routines

Caregiving Routines

In chapter 1 we looked at theorist Magda Gerber and learned that caregiving routines are a very important part of the environment for infants and toddlers. A routine is a consistent, predictable event that helps young children understand the nature of the childcare environment and feel secure there. Caregivers should be focused on routines that meet the needs of the child as well as incorporate interactions with the child.

A well-planned regular routine:

• enables children to reduce anxiety by knowing what is coming next
• encourages children’s positive behavior by meeting their basic needs
  • eating and sleeping,
  • active and quiet play
  • time alone and time with other children

A routine activity is an excellent time to practice the serve and return speech that is so important to brain development. The most common infant and toddler routines are feeding, napping and diapering/toileting.

State Regulations

Child care licensing is a process where state governments set minimum health and safety requirements that child care programs must meet to legally operate. These requirements help ensure your child is healthy and safe in a child care program. Licensing requires that child care programs are monitored to ensure they continue to meet those requirements.

Wisconsin State Child Care Licensing

The state of Wisconsin regulates healthy, safe and nutritious practices that licensed care settings must follow. These regulations do not necessarily relate to higher quality care but are to ensure minimum safety requirements. There are many general regulations and some additional ones specifically for infants and toddlers. Here are a few related to caregiving routines.

• Prior to admission, the licensee shall obtain written information from a child’s parent or guardian to individualize the program of care for the child.
• Childcare workers shall use the information obtained from the parents to provide care to the child.
• Information shall include the following:
  • Schedule of meals and feeding.
  • Types of food introduced and timetable for new foods.
  • Toileting and diapering procedures.
  • Sleep and nap schedule.
  • The child’s way of communicating and being comforted.
  • Developmental and health history.
• Childcare workers shall document changes in a child’s development and routines every 3 months based on discussion with the parent.
• Childcare workers shall respond promptly to a crying child’s needs.
• Emphasis in activities shall be given to play as a learning and growth experience.
• Throughout the day each infant and each toddler shall receive physical contact and attention such as being held, rocked, talked to, sung to and taken on walks inside and outside the center.
• Routines relating to activities such as taking a nap, eating, diapering and toileting shall be used as occasions for language development and other learning experiences.
• When a non-mobile child is awake, the childcare worker shall change the child’s body position and location in the room periodically. Non-mobile children who are awake shall be placed on their stomach occasionally throughout the day.

Napping

• Each infant and each toddler shall be allowed to form and follow his or her own pattern of sleeping and waking.

Feeding

• Childcare workers shall do all the following: Feed each infant and each toddler on the child’s own feeding schedule. Ensure that food, breast milk, and formula brought from home are labeled with the child’s name and the date and are refrigerated, if required.
• Hold a child who is unable to hold a bottle whenever a bottle is given.
• Bottles may not be propped.
• Hold or place a child too young to sit in a highchair in an infant seat during feeding.
• Wide based highchairs, hook-on chairs or infant seats with safety straps shall be provided for children who are not developmentally able to sit at tables and chairs.
• Encourage children to experiment with self-feeding with their hands and spoons.
• Eating utensils and cups shall be scaled to the size and developmental level of the children.

Diapering and Toileting

• Childcare workers shall do all the following:
  • Plan toilet training in cooperation with the parent so that a child’s toilet routine is consistent between the center and home.
• Universal Precautions
  • All bodily secretions are potentially infectious
  • All staff exposed to bodily secretions shall wear single use, disposable gloves, hands will be washed after gloves are removed
  • Child’s hands will be washed with soap and warm running water after diapering.
  • Infant’s hands may be washed with single use soapy cloth.
  • Children one and over must use running water
  • Hand sanitizer may not replace hand washing

Diapering Area

• Must be cleaned and disinfected after each use
  • Cleaning – soap and water
  • Disinfectant (bodily fluids) – bleach formula (one Tablespoon bleach to one- quart water) or other approved (like quat), for bodily fluids (diaper table, bodily fluid clean-up) – stronger chemical …. versus….more diluted for common germs
  • Both only good for 24 hours, must be made every day
  • Sanitizer (anything a child can lick – toys/counters)
• Diaper changing pads – more sanitary to remove and use changing table surface
  • Place so that caregiver can see other children in room
  • If surface is above floor lever – provide a barrier to prevent failing
  • YoungStar always requires keeping a hand on the child
• Must have sink with hot/cold running water.
• Kitchen sink may not be used
• Shall be a ready supply of dry and clean clothing and diapers to meet needs of all the children

Medication

• Need parent permission in writing for diaper cream, lotions, powder, salves
  • update every 6 months
  • Should be in original container and labeled with child’s name
• Directions for use should be posted in diapering area
• Application should be recorded on daily sheet, not in medical log
• Medication should be kept out of reach of children
• Medication may not be expired

Glove Use and Removal

Fig. 7 1. Chart describing removal of gloves.

The 6-step process to use and remove gloves

1. pinch and hold the outside of the glove near the wrist area
2. peel downwards away from the wrist, turning the glove inside-out
3. pull the glove away until it is removed from the hand, holding the inside-out glove with the gloved hand
4. with ungloved hand, slide fingers under the wrist f the remain glove. D
   • do not touch the outer surface of the glove
5. peel downwards, away from the wrist, turning the glove inside out
6. continue to pull the glove down and over the inside-out glove being held in the gloved hand

Garbage

• Must be rigid, covered and emptied daily
• Diapering pail (diaper/gloves/wipes) needs to have a foot activated cover and be plastic lined
  • Container is washed and disinfected daily
• Place parent-supplied soiled cloth diapers in labeled plastic bags kept separate from other cleaning

Timeliness

• Staff checks children for signs that they are wet or soiled on a regular basis according to each child’s personal schedule.
• Diapers will be changed as soon as possible once discovered or at a maximum of every 2 hours.
• Diapering should be used for language development and other learning experiences

Toilet Learning

• Plan toilet learning in cooperation with the parent so that a consistent routine is followed
• No toileting may happen under 18 months
• Child under age 30 months do not need to be counted in determining the number of toilets, but must have at least one
• If potty chairs are used for children under 30 months, the chairs will be provided in a ratio of 1 chair per 4 children
• Steps or blocks shall be provided if the sink and toilets are not proportioned to the size of the child
• A child may not be punished for a lapse in toilet learning
• Children in the process of learning to use the toilet will be encouraged to be as independent as is developmentally appropriate, easy on/off clothing

Steps for Diapering a Child based on Licensing and YoungStar Recommendations

_____ 1. Ready all supplies ~ diaper /wipe ~ may need more than one /gloves / medications

_____ 2. Wash your hands for 20 seconds

_____ 3. Bring child to the changing area. Remember to prep the child for the activity and TALK to them throughout the process. Always keep one hand on child while on the changing table.

_____ 4. Put on latex glove – if necessary

_____ 5. Remove child’s bottom clothing and open soiled diaper

_____ 6. Wipe front to back using a single use diaper wipe~ one swipe per wipe

_____ 7. Remove soiled diaper and gloves, putting them into a plastic bag

_____ 8. Apply any ointments/creams as directed by parents; secure dry diaper; dress child, but do not stand them on the ‘dirty’ table surface.

_____ 9. Wash hands and assist child in washing hands

_____ 10. Place child in a safe area where he/she will have access to learning materials.

_____ 11. Wet/soiled clothes should be bagged/double bagged and labeled with the child’s name

_____ 12. Wash your hands for 20 seconds

_____ 13. Clean changing table surface by washing with soap and water, then spray disinfectant; let air dry for at least 2 minutes

_____ 14. Wash your hands for 20 seconds

_____ 15. Record child’s diapering on the diaper log and for the family

Sources

• Licensing Rules for Group Child Care Centers and Child Care Programs Established or Contracted for by School Boards. Wisconsin Administrative Code DCF 251. Wisconsin Department of Families and Children. March 2023.
• YoungStar. Wisconsin Department of Families and Children.