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How do you change a diaper without waking a baby up?

PICU   (3,809 Views 16 Comments)
by wingingit wingingit (New) New

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Hi! I"m a nursing student, and I think I want to go into pediatrics; I'm doing a clinical on a pediatric GI unit and we have a lot of kids who are ordered for Q2/Q1 diaper changes. I don't want to be waking these little guys up every time I have to do it-does anyone have any tips? Is there any way to get a diaper on a baby who's sleeping in the prone position?

Thank you so much for your help!

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meanmaryjean has 40 years experience as a DNP, RN and specializes in NICU, ICU, PICU, Academia.

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Open new diaper completely, smash the mattress down with your hand as you slide new diaper under baby. Then unfasten and pull old diaper out. (Much easier if you put the diaper on backward so the fasteners are toward their back/ upside.

HOWEVER, why in the world are hourly diaper changes ordered? That is crazy unless the kid is critically dehydrated.

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NICU Guy has 4 years experience as a BSN, RN and specializes in NICU.

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I'm doing a clinical on a pediatric GI unit and we have a lot of kids who are ordered for Q2/Q1 diaper changes.

I have never heard of scheduled Q1 or Q2 diaper changes. I have changed diapers that frequently on a myelomeningocele that had a raw butt and screamed every time she pooped which was frequently.

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meanmaryjean has 40 years experience as a DNP, RN and specializes in NICU, ICU, PICU, Academia.

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I also think whoever writes such orders should be called with the I&O after every single diaper change.

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cayenne06 has 10 years experience as a MSN, CNM and specializes in Reproductive & Public Health.

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Is there a medical reason for such frequent changes? And if so, is there any other way to meet the medical need without so much sleep interruption?

We should be doing everything possible to avoid unecessary poking and prodding at night. I would never ever suggest letting a baby sit in a soiled diaper, and I can think of various reasons why a PICU kid might need frequent changes. But most modern dipes should be able to hold a few voids before baby starts feeling wet. And for most little ones, uninterrupted sleep should be a top priority in their plan of care.

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middleagednurse has 50+ years experience and specializes in nurseline,med surg, PD.

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Why is baby sleeping prone to begin with?

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meanmaryjean has 40 years experience as a DNP, RN and specializes in NICU, ICU, PICU, Academia.

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Why is baby sleeping prone to begin with?

Because they can - I suspect the OP is not talking about newborns. Once they can turn themselves - they sleep.how they want to.

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audreysmagic has 15 years experience as a RN and specializes in Psych, Peds, Education, Infection Control.

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Open new diaper completely, smash the mattress down with your hand as you slide new diaper under baby. Then unfasten and pull old diaper out. (Much easier if you put the diaper on backward so the fasteners are toward their back/ upside.

HOWEVER, why in the world are hourly diaper changes ordered? That is crazy unless the kid is critically dehydrated.

^ Agreed with all of the above. However, I'd add steps: hold breath until you're sure you didn't wake the kid. Then: ninja-creep out of the room.

I kid. But, seriously, while I could see a Q1 for a c-diff kid...why? Hourly I&O? If the diaper is dry, it's not gonna count. And most diapers will be dry hourly. I don't doubt what you've heard, OP; I just question the order itself. (I've seen more ridiculous ones.) As other posters have mentioned, not disturbing these kids' sleep is ALSO important. For all the well-meaning and necessary interventions, I think people sometimes forget how restorative sleep is and how ill children have limited capability to deal with more physiological stress...such as sleep deprivation.

Also, even healthy children are crankier when they haven't slept, so there's that.

Good luck, OP! You'll find as you gain experience, you'll learn a lot of little tricks of the trade...and one day down the line when you slip out of a room after having done a full set of vitals without waking the little one, a nursing student will be looking at you in awe.

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KelRN215 has 10 years experience as a BSN, RN and specializes in Pedi.

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Why is baby sleeping prone to begin with?

When I worked in the hospital (peds neuro/neurosurgery) we frequently had patients, including babies, who had to be kept flat and prone for 24 hours post-op. Spinal surgery. I'm guessing that wasn't the case with OP's patient since she said Pedi GI, though.

I agree with those who said q 1 or q 2hr diaper change orders are insanity. I think we sometimes did q 2hrs for our chemo patients when I worked inpatient but we had to because they were getting so much fluid that they were soaking constantly.

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Hi! Thank you so much for your help!

I'm not sure why they're ordered for so often-I also feel like this is excessive! I don't want to have to pop in and roll these little guys over every time I come in!

The kids sleeping prone are toddlers; we put them on their backs, but they roll over and do their thing! The little guys are always on their backs.

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JadedCPN has 13 years experience as a BSN, RN and specializes in Pediatrics, Pediatric Float, PICU, NICU.

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^ Agreed with all of the above. However, I'd add steps: hold breath until you're sure you didn't wake the kid. Then: ninja-creep out of the room.

:roflmao: Spoken like a true pro!

Like others have said, I can't imagine why they actually need their diaper changed Q1H. I've had orders for Strict I&O per policy, which means we are checking for a wet diaper every hour, but that can be accomplished without actually changing the diaper or waking the patient. And I've only seen that order in rare circumstances such as certain chemos, certain renal patients, etc. It is definitely not the norm.

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cayenne06 has 10 years experience as a MSN, CNM and specializes in Reproductive & Public Health.

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Hi! Thank you so much for your help!

I'm not sure why they're ordered for so often-I also feel like this is excessive! I don't want to have to pop in and roll these little guys over every time I come in!

The first step with an unclear or dubious order, is always to ask the provider for clarification on the exact wording. If you don't understand why it was ordered for your patienty, politely ask them to explain the rationale. If you have concerns about how it might impact the patient, voice them respectfully.

A nurse is the final safety check before an order reaches your patient. You can't be an effective safeguard if you don't understand *why* you are doing whatever it is you are doing.

It sounds like this is not a new order, so HOPEFULLY whoever is taking care of the child can explain why it needs to be done.

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