Standing Nappy Changes: Why & How

Montessori Standing Nappy Changes: Why & How

You may have heard that Montessori environments promote a "standing" nappy change for toddlers, rather than placing the child in a lying position in a change table/mat.

The "standing change" is a technique that I use in my own Montessori classroom and it is an effective, successful experience for me and the children in my care. It is something that feels quite natural to me and I do not personally find it to be more 'difficult' than a traditional nappy change (on a table/mat). The children in my care seem equally comfortable and happy with this method - particularly because it is often quicker than a traditional change, thus allowing them to get back to 'work' more quickly, and also because it is a dignified and respectful experience for them. 

I offer the following information to help explain why I make this choice as a professional (and why I will continue to use the method when I'm a parent) and also to outline how I actually move through the practicalities of it.

This information is not meant to suggest that this is the "right" way or the "only" way to change a child respectfully. Each parent has the right to decide what feels comfortable for their family just as each school/centre has the right to define their own philosophy on the matter. 

If the points made below resonate with you then you might choose to try the standing change technique yourself. If you find yourself disagreeing with the points below, or you have your own equally strong reasons for preferring the traditional technique, then I absolutely respect your right to engage in parenting/caring in the manner that feels right to you! This is not a prescription, just an open sharing of information. There is absolutely no judgement implicit in these words - I don't think that a teacher/parent who uses standing changes is "better" or "worse" than one who uses traditional nappy changes, because we are not in competition against each other but are instead on the same team (team 'Child'!).  I just want to share my own feelings on the subject and I hope they might be helpful to some, while I know they won't be right for all. 

WHY:

  • First and foremost, it shows respect for the dignity of the child.
    As the child becomes more cognitively and physically mature it makes sense to change our interactions to respect the child’s actual level of ability. A beautiful nappy change on a table is absolutely perfect for an infant, but making a mobile toddler lie on their back for the change renders them artificially immobile and regresses them to a previous stage of development. If children were born with the ability to stand, such as a foal can do soon after its birth, then it is unlikely that we would instinctively make them lie down to change a nappy. It is something we do out of necessity for a newborn, because there is no alternative when a child’s legs are incapable of supporting their standing weight. That does not necessarily make it the right thing for an older child. We need to look at the ‘standing toddler’ as a unique creature and decide what is the most respectful and appropriate method for their physical, social, emotional and cognitive needs. A standing nappy change respects their physical needs by incorporating their motor coordination, rather than ignoring it. It respects their social and emotional needs by maintaining a close, connected interaction between adult and child while also promoting a gradual step towards increased independence. It also respects their cognitive needs by providing a more stimulating experience where the child can watch what is happening, or observe the environment, rather than looking straight up at an empty ceiling.

  • It allows a child to be more aware of what is happening during the process.
    He/she can more easily look down to observe – this allows the child to see actions such as the unbuttoning of pants, the opening of the nappy tabs and so forth. The child feels more empowered by this knowledge and can also use these observations to start taking ownership for the routine. He/she can unbutton and take down the pants independently, or ‘step into’ a pull up (the way that he/she will do with underpants soon), rather than lying back passively while the adult does these things to the child.

  • It promotes toilet learning by allowing a child to associate the ‘change’ process with the environment and dynamics of using the toilet.
    The standing change can occur beside the toilet, and the child might even like to sit on the toilet in the middle of the change to see if there is ‘more’ to come, and the child starts to cognitively identify that a change or progression is happening from the ‘babyhood’ of nappies on the change table to the childhood of standing to approach the toilet. It is a huge – and potentially daunting or scary – movement from “change table” to “toilet” but a much milder and smoother step from “standing next to the toilet to get changed” and “using the toilet”.

  • In a home environment the standing change also allows the process to occur without interrupting the child.
    Children often resist nappy changes if they are engaged – but the adult can be unwilling to wait until later due to the smell or concerns about hygiene/discomfort. A standing nappy change at home means that the child does not have to cease activity because a parent can perform a standing nappy change while the child continues to engage.
    (If you're a parent with a toddler outside the house, and you need to use a public bathroom, the standing change also means you don't have to worry about making your child lie down on an unhygienic surface because he/she can keep his/her shoes on and remain standing on the bathroom floor). 

  • The standing nappy change is also one of the first ways that we can promote ‘protective behaviours’ for the child.
    Trusted adults should strive to teach children that they have ownership of their own bodies and that each individual has the right to remain in control of what happens to their body. Placing a child in an immobile, prone position (lying on their back on a change table) and then doing the nappy change routine to them while they are unable to even see what is going on sends a potentially troubling message that it is “okay” for an adult to render you powerless over your body while touching you in intimate areas. Yes the child has ‘consented’ to the nappy change but their autonomy and control is then removed by the dynamic of the situation. The child is passive and powerless, the adult is active and in control. By allowing the child to remain standing during the change we are returning the control and active decision making to the child. The child can step back if they are made to feel uncomfortable (eg. If the wipe is too cold, or the adult’s movements too rough). The child can choose positions that feel physically and emotionally comfortable – eg. One child might happily bend over to reveal their bottom, while another might feel uncomfortable with this and will instead ‘squat’ so that the bottom cheeks remain ‘closed’ but the thigh areas are easier to access. The child who is standing can also start to perform the actions independently – taking a wipe and cleaning his own penis, or her own vagina, rather than having to lie back while an adult touches these areas. The standing change can be one of the earliest opportunities for the child to start retaining ownership of his/her body and rights. 

  

  

HOW:

  1. Be vigilant: The earlier that the change occurs, the easier it will be. If a child has been sitting in a full nappy for a long period then any faeces will have started to harden/stick to the skin and will have also been ‘squashed’ into more areas. If a nappy can be addressed quickly then the faecal matter is often still in one ‘piece’.
  2. Plan ahead: Place a disposable change mat (or paper towels) on the floor if you’re changing a nappy with a significant bowel motion. Have all of your materials easily accessible. When you actually remove the nappy think about the motion you will do this in so that you can contain the majority of matter and provide the initial wipe. By removing the side tabs (or breaking the sides of a ‘pull up’) you can then hold the bottom middle of the nappy with one hand and take it just low enough for it to stop touching the child’s body, then slide it backwards past the bottom (wiping a little along the way with the dry part at the very top front of the nappy). Pulling the nappy forward would potentially put faecal matter onto the vagina/scrotum while pulling it downwards (such as with a pull up) can drag faeces/urine down the legs. Taking it backwards helps prevent the spread of faeces and holding it from the bottom middle section helps to prevent spillage.
  3. Promote a connection with the ‘toilet’ process: Arranging the change near the toilet allows the child to start building a connection between the expulsion of faeces/urine and the toilet. The toilet is no longer a foreign, distant idea but a relevant and realistic goal. This can be enhanced by;
    1. Asking the child the sit on the toilet if they feel that there might be “more” urine/faeces. This is particularly relevant if the nappy change is being performed immediately after the wee/bowel motion as sometimes a vigilant adult might have noticed the expulsion in the middle of the process, meaning there is more to come if the child is given the opportunity to try.
    2. Allowing the child to try wiping his/her own bottom.
    3. Using toilet paper (instead of or as well as wipes) so that the child can place these (or watch as the adult places these) in the toilet to flush them. This introduces one part of the toilet routine but also helps the child feel comfortable with the ‘flush’, which is important since children can sometimes be nervous/fearful about ‘flushing’. 
  1. Ensure safety: Ask the child to hold onto a stable surface to maintain their balance. Often the easiest available surface is the sink in a classroom setting (where the sinks are low) – the child can hold the edge of the sink with one, or both hands, to maintain balance and to comfortably get into the poses that allow access (see point #6). 
  1. Communicate: Tell the child what you are going to do before you do it and ask the child to help with the process (either by actively engaging or by adopting poses that allow easier access – see point #6). Take advantage of the child’s cognitive abilities by explaining what is happening and why.
  2. Ensure hygiene: It is important to still get into all the ‘nooks and crannies’ to remove faecal matter. When the child is simply standing normally you may be unable to see hidden faecal matter, so it is important that you do make an active effort to check.
    There are several strategies to help ensure that you can observe and access difficult areas;
    1. Ask the child to bend forward gently. This does not have to be an undignified “touch your toes” type of bend, just a gentle angle of bending forward so that the bottom cheeks are a little more open and visible.
    2. Ask the child to ‘squat’. Placing their legs far apart and bending slightly opens all of the areas that need to be accessed (including bottom, inner thighs and scrotal/vaginal area).
    3. Ask the child to lift one leg at a time. By lifting one leg up you can more easily see and access the inner thigh areas.
      You can help the child to understand these poses by demonstrating them yourself! This shows the child the physical positions that you need them to adopt, but it also helps the child to feel comfortable with doing so because they see you role-modelling it.
  1. Involve the child: Just as a three year old might wipe his/her own bottom after using the toilet, it is appropriate for the two year old to do the same during a change. Provide the two year old with a wet wipe or toilet paper and offer instructions about how to reach back to ‘wipe’ (initially it is best to do this only after the adult has removed the majority of the matter).
  2. Pack up hygienically: Ensure that you follow the same types of steps that you would with a change table. In a classroom setting this would be a routine such as using detergent and water to ‘wash’ the area (including the floor under the child as well as any surfaces touched during the change) and disposing safely of the bagged nappy, wipes and gloves. Ensure that the child washes his/her hands thoroughly and that the adult does the same.
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