I regularly field questions about this problem from the parents of children I treat. If your 8 to 24-month old is fussy during diaper changes and you know it isn’t from diaper rash, keep reading. I have some information and ideas for you.
Parents of kids with sensory processing issues or developmental delays often assume that this is the source of their child’s diaper drama. Parents who lack confidence or parents who spend a lot of time online with “Dr. Google” think that it could be sign of autism or of poor attachment.
At least, not usually.
If your young child is suddenly giving you the business, even though they really need a diaper change, there are a few things to think about before you run to a developmental pediatrician (or any pediatrician):
- Your child may have been busy exploring, and they are unhappy that they were interrupted with a task they find boring. Getting a fresh diaper isn’t much fun after those first few months of face-gazing and smiles. Once a child can really play, they have better things to do. Parents can be surprised that their gurgling infant that loved diaper changes is now resisting, or even fighting, to get off the changing table.
- If your child is one of the 15-20% of kids that Dr. Harvey Karp identifies as having a “spirited” temperament, then you are going to get a strong reaction to almost any action they didn’t initiate. Bedtimes, leaving to go to the park, leaving the park to go home, etc. Spirited kids are going to give you oversized reactions in both directions; super happy, super sad, super angry.
- Kids with limited receptive language aren’t sure exactly what is going on when you pick them up. Receptive language means understanding the words another person is using. Your child doesn’t have to be delayed; they could simply not have enough language skills to understand what you are saying.
- Your child has decided to use diapering as their “line in the sand” to express their independence and test your limits. Testing limits is normal, and I believe that nature intended this to start early. By the time parents are experiencing limit testing with a teen, they have been practicing for a while. Young children that feel that they are being controlled will test more and with more energy. This doesn’t mean that their parents are actually more controlling. Perception is reality, and if a child feels micro-managed, then they react whether or not they are indeed highly controlled. This could happen when they spend a lot of time with babysitters instead of parents, or if they have had many recent changes in caregivers, new sibling, new home, etc.
What works to reduce diaper drama?
- Use routines to improve language comprehension and manage expectations. Kids that get a regular diaper check/change know what you are doing and where they are going.
- Shorten your phrases and use the same words for the same events. See above.
- Try not to over-react to an overreaction. Spirited kids don’t need more fuel for the fire, and neither do tired, sick, or hungry children.
- Give your child more chances to control other situations in their life. Manufacture the situations if you have to. This means that they get to decide of the doll goes in the cradle or the car, or if the blue car goes down the ramp first, or if it is the red car that leads. Dr. Karp’s “give it in fantasy” strategies Give (Some of) Your Power Away To Your Defiant Toddler And Create Calmness and all of his positive “time-ins” are excellent ideas to build a child’s sense of fairness and autonomy.
- Offer the 8-24 month old child something interesting to hold and look at during the diaper change. It could be a new soft toy, but it might be better to give them a tiny collapsible colander to examine. The novelty factor should buy you enough time to do the deed. Remember to change it up regularly. They need to learn to expect that this could be more fun than drama.
- Older kids with the language skills to understand the negotiation could be asked “Do you want your diaper change NOW or in one minute?” It doesn’t have to be 60 seconds later. The idea is that you have given them a choice. You have to stick to the agreement. If they still balk after the minute is up, don’t use this again right away. You will be teaching them that their protests work to avoid following your directions. Oops.
The truth is that most children know that you are going to change their diaper regardless of their protests, and they can handle it if you help them a little bit.