As a parent in the neonatal intensive care unit (NICU), you may have to reach into a plastic box and change a diaper the size of a credit card. You may be worried about your baby’s fragile skin, messing up, afraid of all the tubes and medical interventions, nervous to lift your baby’s legs. It’s a lot! Here are 5 tips I have learned as a NICU occupational therapist for changing a baby’s diaper while they are in an isolette. I hope they help boost your confidence!

As a neonatal occupational therapist, I spend a lot of time thinking about and changing diapers.

A diaper change is one of a baby’s major occupations, and for premature babies, it is part of their big event…their assessment.

If you are a parent with a baby in the neonatal intensive care unit (NICU), then you may have experienced the full depth of emotions that come with the thought or act of changing your baby’s diaper—fear, excitement, apprehension, stress, confusion, happiness, and probably one hundred other emotions.

For parents of babies in the NICU, you find yourself in a different place. Many nurses will ask “Do you want to change her diaper?”…and it’s not at all like you were expecting.

There’s no changing table, no diaper station set up, wires, tubes, and a nurse seemingly looking over your shoulder.

I want you to know that however you feel as you approach your baby’s bedside is valid!

The NICU is a scary place and doing new things in a new environment can be very intimidating. Whether you have been changing diapers for months or mustering up the courage to do it for the first time, I am glad you are here.

Changing the diaper of a baby in an isolette is no easy task.

To get comfortable, the best thing to do is just start changing diapers. Practice, Practice, Practice.

Get in there, and ask your baby’s nurse or a neonatal therapist for help and support.

And if you want to know how to stop fumbling around in the isolette during a diaper change, or how to prevent your baby from peeing or stooling all over themselves and their bedding… or even how to prevent your own physical discomfort while changing your baby’s diaper at the isolette…keep reading!

I want to share with you 5 of the best tips and tricks I have learned when changing a baby’s diaper in the isolette.

I hope they make that diaper change easier for you and more enjoyable for your baby.

1. MAKE SURE THE ISOLETTE IS AT THE CORRECT height

If your baby is going to be comfortable, you need to make sure you are comfortable and taking care of your own body too. You definitely don’t need to add back pain to the list of things in your life right now.

Every isolette has a mechanism that will lower or raise it to a certain height. Most isolettes have a foot pedal near the floor that you press to make the isolette go up or down depending on how tall you are.

Make sure you are able to reach your arms through the arm holes comfortably without squatting or standing on your tip toes. Check to be sure your shoulders are relaxed and you are not having difficulty reaching your baby.

Release the tension from your own body.

Don’t be scared to make an adjustment to the isolette height—just ask the nurse how to move it, so it best fits you.ar

2. FOLD OVER THE TABS OF THE DIRTY DIAPER ON THEMSELVES BEFORE TAKING IT OUT FROM UNDER YOUR BABY

You guys, those tiny little tabs on your baby’s diaper are STICKY.

When I first started in the NICU and had to adjust to changing diapers in an isolette, I found myself trying to get the dirty diaper out from under the baby only to have the tabs stick to their bedding or positioning device constantly.

This caused me to have to maneuver around the baby, worry about getting the diaper’s contents on the baby or the bed, and it made me feel FLUSTERED.

Then, I learned a trick (#praisehands).

After you unattach the dirty diaper’s tabs, fold the little tabs over so they stick to the used diaper. Only after you do that should you pull the diaper out without fear that it is going to stick to anything and cause unnecessary handling or frustration.

I have included a picture below of what it looks like to first have undone the diaper tabs and then to fold the tab of the dirty diaper over so it doesn’t stick before you pull it out

3. PLACE A CLEAN DIAPER UNDER YOUR BABY FIRST BEFORE TAKING OFF THE OLD ONE

Now this is an oldie but a goodie– and it may be something you’ve noticed your nurses do, if you have seen them change a diaper.

It may be something you did with your previous babies.

Open and place a clean diaper under the diaper your baby is wearing first before undoing the dirty one.

You guys, this has saved me SO many times.

You don’t want to have just taken your baby’s dirty diaper off, try and put the new one on and then have your little babe poop or pee all over their bed before you have gotten the new diaper on.

There have been times when I think I am super therapist and can make it happen—and that’s when the little babe puts me in my place (#facepalm). I did this with my newborn at home too after I thought I was super mom, so it may be a good idea to carry this practice over after discharge.

4. KEEP YOUR BABY’S ARMS SWADDLED BY THEIR FACE, AND ONLY EXPOSE THEIR DIAPER AND LEGS

Does your baby rest or get positioned in a positioning device or swaddle?

There are a lot of different positioning devices on the market including (but not limited to) the Dandlewrap, Z-Flo, Bendy Bumper, and Snuggle Up. If you’re curious about how this applies to your baby, leave me a note in the comments or shoot me an e-mail, and I am happy to help.

Lots of parents tell me the hardest part of changing their baby’s diaper in the isolette is that their little one’s arms and legs start going crazy, and it is hard to keep their hands out of their business “down below”.

Also, many babys show signs of stress during a diaper change, so it can be helpful to provide some calming input for them to support their self-regulation attempts (ability to stay calm and organized) while they are participating in this activity.

This next trick addresses both…it helps you as the parent get what you need done, but it also keeps your baby happy and content in the process. WIN WIN.

Now, if the diaper change is the first part of your baby’s assessment, it can be helpful not to undo their positioning device all the way.

Before undoing their swaddle or positioning device and releasing their arms so they wave around freely, only unstrap/unzip/open the lower portion of the device, so you only have access to their legs while keeping their arms swaddled by their face. You will have access to their legs and diaper while they stay swaddled above.

There’s is one thing you should do before you jump in and start changing your baby’s diaper. Check out…

ONE THING I TEACH EVERY NICU PARENT TO DO WITH THEIR BABY—A HAND HUG!

Watch your baby after you apply this technique, and let me know how it goes. 

Did your baby’s face look calm and content? Were they comfortable? Did they stay asleep during the process? Was it easier for you?

5. MAKE SURE YOU HAVE EVERYTHING YOU NEED WITHIN REACH BEFORE DISTURBING YOUR BABY

Before you reach your hands into the isolette to get started, make sure you have access to what you need…the right size diaper, wipes, and diaper ointment (if your baby uses them).

You don’t want to be in the middle of taking the dirty diaper off only to realize there are no more diapers in the drawer, or you left the wipes on the counter.

Prep everything ahead of time.

You can even keep the baby wipes inside the isolette at the bottom so they are warmer when you use them on your baby’s skin. BUT, make sure to ask your nurse if that is okay.

Some NICUs may not allow additional items in the incubator.

Whew! There you have it…5 tips to make changing your baby’s diaper in the isolette easier for you and more enjoyable for your baby!

1. Make sure the isolette is at the correct height.
2. Fold over the tabs on the dirty diaper first.
3. Place a clean diaper under the dirty one before pulling it out.
4. Keep arms swaddled and only expose the hips and legs.
5. Make sure you have everything you need within reach before starting.

Only someone who loves babies as much as I do could write 1,500 words about a diaper change 🙂

I hope you are encouraged to take one of these tips into your baby’s unit today, discuss it with your nurse, and/or apply it to your time with your sweet little one.

Leave me a comment or shoot me an e-mail to let me know how using these tips went.

I can’t wait to hear your stories!

You got this.