Your Guide to Developmental Diapering

Based on a review of over 500 articles focused on developmental care, the HMAC identified an opportunity for healthcare providers to integrate, model and educate parents and caregivers about the importance of developmental care during diapering. This review is the first to consider diapering within the context of developmental care, including skin care, physical development, sensory elements and bonding. Every Change Matters™ operationalizes developmental diapering care through five areas of focus known as the “Alliterative Cs”:

• Calm & Clean™
• Change & Check™
• Comfort™
• Champion Sleep™
• Confidence & Closeness™

Applying Every Change Matters™ in practice presents an extraordinary opportunity for nurses and other healthcare professionals to integrate, model and educate parents and caregivers about the importance of developmental care in addition to skin care during diapering

Calm & Clean™

• Ensure all supplies needed for the diaper change are within reach before starting
• Wash hands and put on gloves per unit protocol
• Approach the infant calmly and with a gentle, purposeful touch while keeping the infant in a flexed position. For micro preemies(<1500g), it may be helpful for two caregivers to assist with the diaper change.

Change & Check™

Consult your Clinical Team to develop, and document a comprehensive diapering protocol for Newborn and NICU Nurseries.

• Change diapers every 2–3 hours or when soiled.¹ *Preterm Skin: Provide clustered care to minimize sleep disruption, when possible
• Perform a focused assessment of the perianal area at each change using a valid tool; note redness or irritation.¹
• Use appropriate methods to gently cleanse the diaper area based on the gestational age of the neonate. Avoid vigorous rubbing of skin in the diaper area. *Preterm skin is thinner and at higher risk for breakdown
• Conduct gentle, thorough cleaning of the genital area at every change with pH appropriate baby wipes.¹
• Use disposable diapers with super absorbent gel materials.^1-6sup>
• Ensure proper diaper fit.^2,4,5,7
• For infants at risk of developing diaper dermatitis, apply petrolatum based ointments or skin barriers containing zinc oxide at every change.¹

Comfort™

• Assess infant's cues related to stress and pain. Engage parents in learning these cues and teach them how to offer comfort and support.
• Provide comforting techniques such as non nutritive sucking or using a positioning aid to support the infant's motor and state systems

Champion Sleep™

• Use diapers with wetness indicators to avoid waking a sleeping infant if their diaper is dry during routine checks.
• Facilitate infant sleep cycles by minimizing ambient light and noise, clustering cares and fostering a quiet, calm environment.

Confidence & Closeness™

• Encourage kangaroo care, skin-to-skin contact and a gentle healing touch.
• Coach parents on reading their infant's cues and providing comforting techniques.
• Help parents become confident caregivers by performing skin assessments and engaging with their infant through talk, singing, facial expressions and intentional touch during diaper changes

For specific details on best practices for diapered skin visit AWHONN.org.

For more information, download the full resources for The Every Change Matters™ Guide for Developmental Diapering Care. This comprehensive list provides detailed information on incorporating evidence based skin care and developmental care into diapering practices.

• Every Change Matters™ — Nurse Education Program (Sign up to access the program)
• Every Change Matters™ — Monograph (PDF)
• Every Change Matters™ — Quick Reference Guide (PDF)
• Every Change Matters™ — Printable Poster (PDF)
• Every Change Matters™ — Mindful Diapering Tips (Video)