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Nappy changing

  • Changing your baby’s nappy for the first time can be a daunting task for any new parent, especially if you haven’t changed a nappy before.  On the ward you might like to begin by watching your nurse change your baby’s nappy. You can start to be involved by closing the tabs on the nappy and comforting your baby during the nappy change by offering a finger to hold or cupping their head. 

    Changing a nappy can be a two person job! Having one parent change the nappy while the other one comforts or supports the baby can be a great way for you both to learn what to do.  

    When getting ready to change your baby, have everything you need ready before you start the job – cotton wool and warm water, a new nappy, nappy cream if needed, a nappy sack to put the dirty nappy in and a change of clothes if needed.  Speak to your nurse and ask if you need to keep the nappy for weighing or inspection. 

    Steps to changing a nappy:

    1. Wash your hands
    2. Get everything you will need ready at your fingertips
    3. Let your baby know you are going to change their nappy by gently removing their covers and moving them gently into position
    4. Some babies may need to have their nappy changed in a side-lying position. This can help the baby to keep a flexed position and to regulate themselves. 
    5. Loosen baby’s clothes, remove as few clothes as possible to help keep your baby warm
    6. Open a new nappy and place it under your baby’s bottom before removing the soiled nappy
    7. Loosen the tabs of dirty nappy, fold tabs back and cover the dirty area. Gently clean your baby’s bottom and genitals, and apply barrier cream if needed (see below)
    8. Avoid lifting your baby up by the legs. Hold your baby’s feet together (sole to sole) and gently flex their legs up towards their tummy.  Lifting your baby by the legs and bottom may cause your baby to vomit, increase their breathing rate and cause their heart rate to change.  Having your baby’s feet together will help your baby remain relaxed and allows you easy access to clean the nappy area.
    9. If your baby becomes distressed you could try keeping your baby’s arms wrapped, having your partner hold their hands or feet, or putting their hands on the baby’s head or tummy.  Offering something to suck or grasp can also help your baby cope with a nappy change.
    10. Follow the cleaning recommendations regarding your baby’s sex (see below) 
    11. Dry your baby’s bottom by gently patting rather than wiping.  Wiping can be uncomfortable and provide unnecessary irritation against sensitive skin.
    12. Secure new nappy in place and redress your baby

    Things to remember:

    • Never lift a baby by their feet to raise their bottom to change a nappy.  Small babies often like to have their nappy changed while they are lying on their side. This can make it more difficult but it can help your baby to cope.
    • Nappies should usually be changed every three to four hours, or when your baby has done a poo. Nappy changes can be scheduled around other cares depending on what your baby can tolerate.
    • Disposable nappies are used on Butterfly  
    • Nappy wipes can cause irritation to a newborn baby’s skin, so should only be used on healthy looking skin
    • If your baby has any nappy rash you should clean the area with warm water and Rediwipes, or cotton wool which should be available on the ward. Ask your nurse if you are unable to find any of these items, or if you are running low.  Cleansers such as sorbolene cream, aqueous cream or olive oil can also be used to cleanse this sensitive area.

    Nappy rash

    If you notice any nappy rash that you haven’t seen before, let your nurse know.  They will check the rash to make sure that there is no infection. In the case of infections, an anti-fungal cream may need to be applied. 

    Barrier creams

    Barrier creams should be applied thickly at nappy changes if your baby has nappy rash. This cream should contain zinc oxide, such as Sudocream, or Bepanthan Nappy Ointment. It is not necessary to remove all of the barrier cream from previous applications. If the area is clean then you can just reapply another layer. Do not use talcum powder, or any cream with fragrances or additives, such as tea tree oil.

    Nappy free time

    Nappy free time is important for all babies. If possible, allow your baby to have some nappy free time each day. Encourage them to kick their legs and have some fresh air to their nappy area. Check with your nurse that this is okay. 

    Premature babies

    Babies born at less than 30 weeks gestation should only have cotton wool or Rediwipes with lukewarm water used to clean the nappy area.  Baby wipes should not be used.  

    Timing your baby’s nappy change

    Should you change your baby before or after a feed?  When is the right time? Each baby is different, and babies will often dirty themselves during or just after a feed. If your baby is often dirty after a feed, to avoid the disturbance of having to change their nappy twice it would be better to change your baby after the feed. If your baby has reflux, they may vomit if they are moved too much with a full tummy, so you might like to change them before a feed.

    Changing your baby boy’s nappy

    Boys can have great aim when you remove their nappy. Be ready to position their penis to point down to avoid spraying you, their clothes and the bed linen!  Gently cleanse the area, removing any soiling but being careful not to pull back the foreskin.

    Changing your baby girl’s nappy

    When wiping your baby girl, wipe from the front to the back, towards her bottom. This is important to avoid bacterial infection. Gently clean in all the creases and bottom but avoid spreading the labia.

    Nappy Changing image 1 COCOON - The Royal Children's Hospital
    Nappy Changing image 2 COCOON - The Royal Children's Hospital
    Nappy Changing image 3 COCOON - The Royal Children's Hospital
    Nappy Changing image 3 COCOON - The Royal Children's Hospital