The purpose of this procedure is to provide guidelines to further enhance the safety and security regarding personal care for toddler, preschool, pre-kindergarten, and school-aged children by Prince George’s County Public Schools (PGCPS) employees, and enable students who require assistance with self-care to obtain it in an appropriate manner while reducing the risk of spreading germs and disease within the school environment.
Children who are not toilet trained cannot be excluded from pre- kindergarten (ages three or four). Further, Maryland law requires that all students who are five (5) years old by September 1st of the current school year must be admitted to kindergarten. Mastery of self-care skills, including toilet training, cannot be a precondition for student enrollment.
Toileting is a skill that must be learned by the child and is not a skill developed overnight. Educators should include the family in developing a plan that supports the child using the toilet independently.
In addition to toileting, self-care includes all of the activities students are expected to be able to do in order to meet their basic needs, such as eating/feeding, bathing, dressing, grooming and teeth brushing. While students entering school for the first time are expected to be able to manage most self-care needs, some students may require additional assistance and adult support for various reasons.
When students require assistance with self-care, consider the extent to which they require adult assistance while promoting and teaching independence and protecting students’ privacy. Discuss self-care needs with students outside of the presence of other students.
Additional guidelines are provided in the PGCPS Special Education Department Personal Care Management Guidance for students with significant cognitive and physical disabilities who require adult support to address their personal care needs at school and during Community-Based Instruction (CBI).
Students may require help with adaptive skills, as well as other activities of daily living such as eating, drinking, cleansing, dressing, and toileting.
Personal care tasks specifically identified as relevant include:
dressing and undressing (including undergarments, diapers, and pull-ups);
assisting children with changing undergarments, diapers and pull-ups, and cleaning of body parts as needed based on toileting needs;
helping children to sit on the toilet using a step stool and/or lifting the child up (cleaning urine and/or feces);
helping the child with clothing management, including diaper and/or pull-up changes; and
washing body parts.
Guidelines For Implementing The Management Of Personal Care Needs:
Parental Consent:
For general education students with personal care needs, a permission form is included in Appendix F for parents to complete, which addresses PGCPS staff assistance with their child’s toileting and personal care needs. If a parent does not wish for school staff to assist with this need, the school must promptly notify the parent or an emergency contact who will be asked to come to the school and attend to the child’s needs without delay.
For students with disabilities whose personal care needs are documented in an IEP or 504 plan, no additional parental consent is required for staff assistance.
Documentation of Student Need:
A student who may have an occasional accident would not have a medical plan. However, if a student has repeated toileting difficulties, staff should consult with the Principal and meet with the parent(s)/guardian(s). Appendix D & E: Risk Assessment and Individual Personal Care Management Plan should be used to create a temporary personal care plan.
All teachers shall provide their principal with name(s) of the student(s) who may require adult support with personal care needs using Appendix C, Personal Care Management Classroom Record. This document should be used whether or not a student has an IEP/504 plan in place.
Teachers must submit copies of the classroom record at the beginning of each quarter to the Principal. Copies shall be maintained confidentially in a LAF file for each student.
It is imperative this information stay current as the school year progresses, if there are personnel changes and student status changes. In many schools, staff members (administrative, instructional, and support staff) are responsible for providing personal care to students daily.
If a student has an IEP/504 and needs personal care assistance due to a medical condition, the school nurse (RN) will develop a written Individualized Health Care Plan (IHCP). Staff should review the IHCP with the nurse and document in the comment section of Appendix C (Personal Care Management Classroom Record) what is required for the student.
Best Practice and Guidance in Personal Care:
This requires great trust and responsibility. When providing personal care, administrative, instructional, and support staff members must attend to the safety and comfort of the students, and ensure they are treated with dignity and respect. There is a balance struck between maintaining privacy and dignity for children alongside protection of the student and staff member(s).
It is important for each school to ensure the following practices are in place to manage the personal care needs of students. It is important that staff members be knowledgeable of best practices and supporting development of adaptive skills including feeding, dressing, undressing, and toileting skills.
At no time should student(s) personal care needs related to toileting be managed in the instructional setting or in the presence/view of other students.
All adults assisting with personal care should be employees of the PGCPS, including substitute teachers.
All parties should know and understand the personal care needs of the student. Personal care needs should be reviewed on a regular basis by the classroom team members and reviewed during SIT/SST, 504 Plan and/or IEP meetings, as appropriate.
Staff members assigned to support a student(s) with personal care needs shall notify other staff members and request coverage, if needed, when they are taking the student out of the classroom to another destination to take care of personal care needs.
There must be two adult staff members present to support students who have personal care needs, regardless of gender. The staff should assist by coaching and encouraging the student on how to take care of his/her personal needs.
Staff should also ensure proper supervision for any remaining students within the classroom or vicinity when a student may need assistance with personal care needs.
Staff members should utilize the student’s communication system to facilitate independence in meeting the adaptive needs.
Staff Members Who Provide Personal Care Should:
Escort the child to the restroom upon request and without unnecessary delay, and periodically check in with the child to avoid toileting accidents.
Encourage the child to undertake as much of the procedure for themselves as possible, including washing of body parts and dressing/undressing.
Encourage and praise students for the use of appropriate adaptive skills for personal care and avoid chastising or using negative reinforcement or punishment.
Know and have available a student’s system of communication.
Have knowledge of and respect for any cultural or religious sensitivity related to aspects of personal care.
Speak to the child by name and ensure they are aware of the focus of the activity.
Provide directions in a straightforward and reassuring way with the student using their personal mode of communication.
Give verbal, visual, and/or gestural cues that enable the child to anticipate and prepare for personal care steps the student can engage.
Provide facilities that afford privacy and modesty.
Request and maintain supplies for personal care, including clothing. All supplies should be accessible in the restroom or changing area (see Appendix A).
Attend to the child and not leave him or her unsupervised while tending to the student’s personal care needs.
Inform parents/guardians of when students have had toileting accidents at school and inform parents/guardians when additional supplies or extra clothes are needed to be maintained at school.
Request and maintain supplies for personal care for students (see Appendix A).
Wash hands thoroughly with soap and/or anti-bacterial sanitizer. Gloves should be changed between providing personal care to each child.
Report concerns about a child’s actions and/or comments while carrying out the personal care procedure immediately to the principal and nurse.
Refer to the Suspected Child Abuse and Neglect AP 5145 - Reporting Suspected Child Abuse and Neglect and follow the procedures for reporting if a situation occurs that makes the staff member suspicious during the personal care routine.
Changing Soiled Underwear, Pull-ups, and Clothing:
Step 1: Get organized. Prior to bringing the child to the changing area:
) Wash your hands thoroughly with soap and warm running water. Dry with a disposable towel.
) Put on a pair of disposable gloves and keep box within reach for the changing process.
) For children in toddler classrooms (classrooms servicing two and three year olds), when changing the child lying down use a disposable changing pad. If changing a child standing up, lay the disposable changing pad on the floor. Please confer with the physical therapy staff should there be questions about the child’s ability to maintain standing or if strategies are needed to support when changing a child.
) Store unused personal care items and keep within reach of the changing area.
) Have a small disposable bag(s) open and ready for pull-ups or clothes that have been soiled.
) If the child is standing to be changed, have the child stand on the disposable changing paper. This will help keep the floor free of contamination and make cleanup easier. Ensure that as solid waste is removed it is placed on the disposable changing paper and not on the floor.
) If changing the child standing, remove bottom clothing, socks, and shoes that risk becoming soiled during the change. To avoid soiling the child’s top clothing have the child hold it above their belly button during the change, if developmentally appropriate.
) Carefully remove the soiled underwear, diaper, or pull-up. Minimize contact between the soiled item and the rest of the child during the removal.
) For diapers/pull-ups containing feces, place the diaper/pull-up in a small disposable plastic bag. Leave the bag open until the child is completely changed. The bag should be placed on the disposable paper liner in use and not directly on the floor.
) Dispose of all waste in a sealable trash bag and appropriate receptacle, which is not located in a classroom, hallway or other common area outside of a restroom where it may be accessible to other students.
) Do not rinse soiled clothing, as it risks contaminating the environment. Place all soiled clothes in a plastic bag that can be secured and sent home to be cleaned.
) Store any soiled clothes in an area not accessible to students until they may be sent home to be cleaned.
)Using the wipes remove the urine and/or feces from front to back. Use a fresh wipe each time you clean from front to back.
) Lift the child’s legs as needed to ensure they are entirely clean.
) Place the soiled wipes into the soiled pull-up. If the child had a bowel movement, the wipes should go into the plastic bag.
) Remove your gloves using the proper technique (see Appendix B).
) Use a fresh wipe to clean your hands and another to clean the child’s hands.
Step 4: Put on clean pull-up or underwear.
) Encourage the child to put on another pull-up or underwear and re- dressing as independently as possible.
) Encourage the child to put back on their socks and shoes as independently as possible.
Step 5: Wash the child’s hands: Using soap and warm water have the child thoroughly clean and rinse their hands.
Step 6: Clean and disinfect the changing surface.
) Wash hands and put on a second pair of disposable gloves.
) Fold up and throw away the disposable paper into the designated hands-free garbage can. If there is a plastic bag with soiled pull-ups and/or wipes containing feces, be sure to securely tie the bag before throwing away.
) If clothing was soiled, securely tie the plastic bag used to hold the clothing that will be sent home.
) Using a paper towel with soap and water, remove any visible soil from the changing pad (if used) or the floor (if the child was changed standing up) and then wipe dry.
) Using a 1 to 10 water ratio with bleach solution or school supplied solution, spray the changing pad to disinfect it. Lightly spray floor if child was changed standing up. Allow to air dry.
) Remove gloves using the proper technique (see Appendix B).
Step 7: Wash your hands thoroughly with soap and warm water before returning to the classroom.
Guidelines if the early childhood bathroom is not located in the classroom:
Classroom teacher should notify the front office immediately to request assistance and/or coverage.
Teacher and staff member will take child to established area to change his or her clothing.
Follow the procedure as outlined above. However, for Step 2, bring child to an identified area or established bathroom for changing.
Monitoring and Compliance:
Appendices C-F are forms that must be used by all schools for monitoring, management, and accountability.
Teachers should submit copies of Appendix C, Personal Care Management Classroom Record, to the Principal at the beginning of each quarter. The Principal shall review the records and meet with staff, as needed, to address additional personal care and toileting needs for students.
Documents relating to student personal care needs must be kept in a LAF folder within the student’s education record.
Code of Maryland Regulations 13A.06.03; 13A.15.05.03
This Administrative Procedure is maintained by the Division of Student Services/Department of Special Education and will be updated as needed.
None. This is a new procedure.
October 22, 2018
Last Revised: October 22, 2018
