Bathing a baby or child

In addition to the preservation of health and the prevention of infection, bath time for a small child offers an ideal opportunity for activities other than for their hygiene needs. The removal of drains, catheters, and dressings, or the passing of urine after surgery, are examples of activities that can be more easily undertaken during a bath. However, as with adults, care must be taken not to wet wounds or dressings that should be kept dry. Bath time is also an opportunity to play with and get to know the small or older child in a non-threatening environment. It also can have a calming effect on babies who are distressed by their unfamiliar environment.

The procedure for bathing a child is the same as for an adult but is usually undertaken with the use of bath toys. Toys that are used must be left to drain and thoroughly dried afterwards to prevent the growth of bacteria. The following procedure should be undertaken with newborn babies and babies up to the age of about six months. It can be modified to simply wash the baby’s face and bottom, more commonly referred to as ‘topping and tailing’.

Equipment:
The equipment needed consists of mild baby soap or baby bath solution; clean towel; non-sterile eye swabs (not cotton wool); disposable wipes; clean nappy and disposal bag for the soiled one; change of clothing if required; container of sterile water; and a baby bath. The procedures and rationales of bathing/showering in the bathroom are given below.

Procedure	Rationale
Plan activities around the baby’s daily routine and in line with other nursing activities	Promote normal routine and reduce unnecessary disturbance
Collect and prepare the equipment	Ensure all equipment is ready to use
Prepare the environment so that it is warm. Close windows	Avoids chilling the baby. Babies cannot shiver and they lose heat more quickly than an adult
Apply apron and wash hands. Apply gloves if required	Personal protection and prevention of crossinfection
Ensure that the baby bath is placed on a table or stand at a comfortable height when seated	Reduces the potential for back injury in the carer
Fill the baby bath with water that is comfortably warm. Test the temperature of the water with a bath thermometer or the elbow (approx. 30oC). Ensure that the hot and cold water is well mixed	Prevents scalding of the baby’s skin
Ensure adequate space around the cot area for equipment	Easy comfortable access and accident prevention
Remove the baby’s clothing and the nappy, placing it in a nappy disposal bag. Wipe away any faeces with a clean dry wipe if necessary. Always wipe the nappy area from front to back in girls	Faeces will contaminate the bath water if left on the skin. Faeces can enter the urethra causing urinary tract infection if wiping from back to front
Place the baby on the cot (or knees while seated) and wrap in a towel with the baby’s arms inside the towel	Patient safety. Prevents heat loss
Throughout procedure observe/assess the baby’s skin for blemishes, bruises, swelling and redness. If present report same and document in nursing records	To monitor baby’s condition and reduce the likelihood of the development of pressure sores
Clean the eyes from the middle to the outer aspect using the swabs and sterile water. Do not use the same swab for both eyes	Prevents debris being dragged into the tear ducts and cross-infection occurring between each eye. Cotton wool should not be used as fibres can scratch the cornea
Wash the rest of the face and ears with a disposable wipe and water from the baby bath, taking care not to allow water to run into the mouth. Pat dry using the towel whilst paying particular attention to the skin folds	Water entering the mouth while reclined may cause the baby to choke. Leaving the skin folds wet can cause the skin to become sore
Hold the head over the bath and wet the scalp area. Use a baby shampoo if required and rinse well. The use of shampoo is not necessary with every bath. If the baby has ‘cradle cap’ medical advice must be sought	Over-use of shampoo can cause excessive drying of the skin. ‘Cradle cap’ is a skin condition caused by over-production of skin cells and requires specific treatment
Take the baby out of the towel and place in the baby bath by holding in the crook of the arm whilst holding his/her arm furthest away from you. Use your free arm to hold the baby by the ankles until in the bath	Provides support and prevents the baby from slipping into the bath. The ankles do not need holding in the bath and the hand is required to wash the baby
Wash the baby’s body using the hand previously used to hold the baby’s ankles. Soap is only required if the nappy area was soiled	If baby bath solution is used, the use of soap as well is unnecessary and may cause drying of the delicate skin
Remove the baby from the bath using the reverse of the above holding technique, taking extra care, as the baby is now very slippery	Patient safety and comfort
Place the baby on the towel and pat dry paying particular attention to the skin folds	Leaving the skin folds wet can cause the skin to become sore
Put on a clean nappy and dress the baby in clean clothes as quickly as possible	To prevent heat loss
Remove apron and wash hands	To reduce risk of cross-infection
Document baby’s reactions to the procedure in nursing care plan and report any abnormal findings or adverse reactions. Update care plan as appropriate	Legal requirement. Facilitates good communication amongst health care staff