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Respectful care in Early Years – Exploring the Pikler Approach to nappy changing

  • Respectful care in Early Years – Exploring the Pikler Approach to nappy changing

Dorothy Marlen explores the Pikler approach to the care of infants and young children…

You may not have heard her name, but the genius of Dr Emmi Pikler (1902–1984) and ongoing exemplary childcare at the Pikler Institute in Budapest, Hungary, is finally beginning to gain attention in the UK.

The Pikler approach has for many years influenced early childhood care in countries in Europe and beyond, and was taken to the USA and developed as Resources for Infant Educarers (RIE) by a woman called Magda Gerber, but it has been slow to reach these shores.

Dr Pikler’s contribution to our understanding of young children and how to care for them now needs to be placed beside other important early years educationalists.

What was discovered, and is still practised, at the Pikler Institute can offer a new benchmark of care that is fully in line with recent neuroscience and attachment theory research.

Aims and principles

Pikler’s aim was to assure physical and psychic health in infants and young children. She recognised (in the 1930s) that the key to achieving this was through creating secure attachment.

She saw that giving respectful care, particularly during times of personal care, was one of the main tools for achieving this.

She also saw the importance of allowing children’s self-initiated activity and its deep influence on children – including on self-image, self-control and many other things.

These understandings and others were developed by Dr Pikler first in her work as a family paediatrician in Budapest, then in the orphanage there that ran for over 65 years, and now in the daycare groups that are still run from the same premises on Lóczy Street.

Among the many factors that contributed to her success in improving children’s lives in families and in residential care was the quality of care given and the understanding of the importance of self-initiated movement and play.

Respectful care

I thought I knew what respectful care meant until I observed carers at the Pikler Institute.

It was a profound experience to see the level of trust, enjoyment and gentle cooperation that is possible between carer and child.

The care approach is highly skilled, complex and multilayered. As well as the care practice, it includes ongoing consideration of key worker roles, observation and team discussion.

Here are a few pointers to what this approach to childcare entails, with the single example of nappy changing.

“World peace starts on the changing table”

I heard this simple but profound phrase while training at the Pikler Institute, and it informed me that what we do in the routine, repetitive tasks of infancy, undertaken several times a day over several years, ripples into adult life.

These repeated care moments will be, without exception, unconsciously taken in on a bodily and emotional core level by children. Whether the care is rough and rushed or calm and gentle will have consequences for how the ‘other’ as well as ‘self’ is experienced, perhaps for life.

Nappy changing is the most delicate of care times. It involves touch in the most intimate parts of the body and requires total vulnerability on the part of the child.

With the child, not to the child

At the Pikler Institute this time of bodily care is treated with the utmost respect and is seen as one of the primary times when trust and relationship can be developed.

It is not acceptable to commit any form of ‘microviolence’ to children during this (or indeed any) time. The use of adult force is not acceptable.

What this means is that all the aspects of the care activity are carried out with the child’s cooperation, not to the child.

The child is invited to take part in every step and nothing is carried out without the child’s consent – this is true for even the youngest baby.

Calm, gentle, with no distractions

The nappy-changing is carried out slowly and calmly with the carer fully present to, and engaged with, the child. This is a special time with this particular child.

Full attention, as we know from attachment theory, is crucial to creating trust. In the Pikler daycare, each child has special times each day alone with their key worker during nappy-changing, at mealtimes and preparing for and after nap-time, depending on their age.

In the residential nursery these one-to-one times happened during feeding, bathing, sleeping and dressing activities, several times a day, and were central to maintaining good attachments and a calm environment with contented and active children.

The child’s interests

The carer’s attention is not just concerned with the task but is open to the child’s interests in the care-giving activity and other things in the vicinity too.

The carer is attentive to all cues from the child and the activity becomes a dance. The care-giver is always the leader of this dance, guiding, allowing the conversation, adapting to the child, yet always coming back to the nappy-changing task.

At the Pikler Institute, children are not given something to play with while carrying out nappy-changing. The child is invited to be fully engaged, rather than risk a dissociation from what is happening to their body.

This time is an invitation for an intimate and cooperative shared endeavour.

Learning language

Even an infant can understand what their carer is requesting, and can respond and initiate.

As the child gets older, conversation includes past, present and future interests, and over time this creates a deep sense in the child of being held ‘in mind’ by their particular carer throughout the day, creating a natural doorway to language learning and practice.

Adapting to the child’s movements

A perhaps startling aspect of the care routine is that the carer adapts to the movements of the child, allowing the child to roll onto her tummy, or later stand in the nappy-changing activity if this is what they want.

Special changing tables make this ‘freedom of movement’ absolutely possible. So rather than the carer trying to keep the child on their backs (which risks the use of force), the infant or toddler’s need to move can be adjusted to by the adult.

It makes for a much happier and engaged child. With practice this works! (read Being with Infants and Toddlers by Beverly Kovach, Susan Patrick, Laura Briley).


If nappy-changing is carried out to this level of mastery then there are several important consequences for children and the day-to-day relationship between a child and their carer.

The child is filled up emotionally by this special time with the carer and slowly internalises the full, calm and gentle attention given. Rather than rushing through the care moments, the child has rich moments of one-to-one relationship, and this is a key to achieving secure attachment and the emergence of self-initiated exploration and play.

The high art of care as practised at the Pikler Institute works, but it takes training, time and practice like any art.

It necessitates an ongoing process of observation, self-reflection and team support. Those of us who have undertaken this training have experienced many uncomfortable realisations of our own unconscious cultural habits as carers (and parents) of children.

But isn’t this an essential journey anyway for those who wish to work with our youngest children?

Find out more

Read Dorothy’s article on nurturing babies’ physical development with the Pikler approach.

Download SIGNAL, Vol 18 no. 3–4.

Read Bringing Up and Providing Care for Infants and Toddlers in an Institution).

Dorothy Marlen is a freelance early childhood workshop leader, trainer and consultant with a specialisation in the Pikler approach, and is the author of The Parent and Child Group Handbook – A Steiner/Waldorf Approach (Hawthorn Press).