There are two completely different kinds of diapers in the world. One is a simple, three-panel rectangle of five to seven plies of soft and natural cotton. The other is a
tremendously complex combination of heavily treated paper pulp, polyethylene (and other plastics), glues, dyes, synthetic perfumes, and -- above all -- a super absorbent chemical, sodium
polyacrylate, that absorbs urine and holds it in a "gel" next to a baby's skin. We think that if you see things from your baby's standpoint, and apply the same standards of comfort
and health that you would for your own body, cotton is the obvious choice. But since some of the propaganda for disposables has focused on making cotton diapering appear to be a grossly inconvenient
and messy practice suited to the turn of the last century rather than this one, you understandably may want to know what's really involved in cotton diapering care.
First of All, A Word About All Diapers
When you're a first-time expectant parent, especially an expectant father, the thought of diapers tends to conjure up some pretty yucky imagery. The actual diaper
experience, though, is a lot lighter weight, and in fact supplies some of the nicest encounters between parents and babies. Healthy urine is sterile, as long as your baby doesn't have to wear a
urinated-in diaper for very long, so changing a wet diaper is no more unpleasant than discarding a wet towel. As for that other output, yes, there are some epic messes once in a while. They are just
as epic, by the way, whether the diaper is cotton or disposable, because while the "disposable" tag implies you get rid of the yuck at arm's length with the dirty diaper, the baby's
skin in the early days usually has at least as much yuck as the diaper itself. Nothing short of a diaper that vacuums your baby's bottom will ever change that. So, since the epic doesn't
happen all that often, relax and enjoy the diapering years, which we guarantee you will pass all too quickly, especially if you use cotton diapers.*
It's a matter of comfort and health. The comfort is something you know about from your own clothing. It stems both from cotton's soft touch on sensitive skin and from
its breathability -- which ventilates the skin and helps evaporate the potentially irritating ammonia that starts to form as soon as a baby wets. As for cotton's health for babies, it has
thousands of years of history behind it. Cotton is the fabric of choice for use directly on the skin. Like its comfort, its natural absorbency is the polar opposite of the combination of paper pulp,
plastics, and "superabsorbent" chemicals in disposables. We can provide A to Z testimonials from moms whose babies experienced irritation with disposables that went away immediately with
Isn't It Inconvenient?
Not if you use a diaper service and the modern, no-pins cotton diapering system (see below). With a service, all you do with a used diaper is put it -- without rinsing -- in
the hamper provided for your use. The service comes by once a week to take the used diapers and leave a fresh supply of soft, sweet-smelling cotton. It also supplies a freshener that goes in the
hamper and prevents your home from smelling "diapery."
How Does Modern, No-Pins Cotton Diapering Work?
It combines a soft, three-panel diaper (the center panel is extra-thick and absorbent) with a Velcro-fastening diaper cover. You just fold the diaper in thirds and trap it in
place under the cover. That's all. No pins needed. (For summer and other times when you might want your baby to wear a diaper with no outer cover, you can use either pins or diaper clips. The
slight added effort for these few occasions is balanced by the fact that disposables don't ever allow you the option of shedding the outer plastic covering for your baby's summer comfort.)
If I Want To Fold A Cotton Diaper The Traditional Way, How Do I?
It's easy with today's three-panel diaper, which is a far cry from the big, gauzy rectangle of yesteryear. Just follow these simple instructions:
1. Fold the diaper in thirds.
2. Open overlapping back section. Place baby on diaper with the wide top section centered at the baby's legs. Close in between the legs.
3. Bring the wide back ends of the diaper over the baby's hips and pin to the front section. Ease the pad section wider as necessary to comfortably encircle the baby
below the navel. While pinning the diaper, insert your finger between the baby and diaper for baby's protection. Pin out as the picture shows.
Again, using a modern diaper cover over the diaper eliminates the need for pinning.
What if my baby has large thighs? Are there other traditional alternatives?
You might want to try a "bikini twist" fold. Again, just follow these simple instructions:
1. Lay the diaper flat.
2. Twist the diaper in the middle.
3. Bring the back ends of the diaper over the baby's hips and pin to the front section. Ease the pad section wider as necessary to comfortably encircle the baby below the
navel. While pinning the diaper, insert your finger between the baby and diaper for baby's protection. Pin out as the picture shows.
Again, using a modern diaper cover over the diaper eliminates the need for pinning.
How Does A Diaper Service Work?
The service essentially rents you the use of the diapers your baby needs, sized for the baby's age. It comes once a week, at the same time, to pick up the used diapers
and leave a fresh supply. (It also sells diaper covers for your use.) Diaper services launder diapers to rigorous public-health standards that you couldn't possibly match at home, with thirteen
changes of water and high-temperature drying that eliminates bacteria.
Anything Else I Should Know About Using Cotton?
A couple of things:
Babies Diapered With Cloth Generally Toilet Train A Year Earlier Than Babies Diapered With Single-Use Diapers
You can probably expect your baby to toilet train a year earlier in cotton diapers than she or he would in disposables. This not only has obvious implications for your budget
and convenience, but it is highly significant for your baby's development. Toilet training is an important step on the way to increased competence, confidence, and sense of self.
Cloth diapers have a clear advantage over singleuse diapers when it comes to toilet training. We believe that babies diapered with cloth tend to toilet train more
quickly because they know when they are wet. With the advent of single-use pullups, it's not uncommon to see four- and five-year-old children who still aren't completely potty
trained. This late potty training has an obvious negative impact on a child's selfesteem.
In 1999, The New York Times reported that 92% of children in 1957 were toilet trained by 18 months of age.1
Maria Smith, Business Manager of Baby Fresh USA, maker of diaper wipes, was quoted in The Wall Street Journal saying "The products (wipes) are also benefiting from the
fact that children now wear diapers until they are 36 to 42 months old, some six months longer than when Baby Fresh was introduced 16 years ago (1977)." 2
And, the Other Thing (Far More Important Than You Can Imagine!)
A cotton diaper isn't just a diaper. It's a burp shield for a parent's shoulder, a wash cloth, a light sheet in summer for an infant, a cushion under a baby on a
rug or in a crib, a sunshade, a bib, a changing pad, a hand towel, and lots of other things that will give you nice memories of your child's babyhood.
Reusable Cloth Diapers vs. Single use Disposable Diapers
The battle between reusable cloth diapers and single-use diapers is heating up once again. In the 1955 virtually every baby in the United States was diapered using
cloth diapers. In 1961, Proctor & Gamble introduced Pampers, a singleuse diaper. In 1991, approximately 90% of babies in the United States were diapered using single-use
diapers. Coincidentally, the occurrence of diaper rash has increased from 7% in 1955 to 78% in 1991.3
Many parents are taking a hard look at the many health and developmental, environmental, and economic advantages cloth diapering has over single-use diapers. This
section provides information which supports the position that cloth diapering is clearly superior to singleuse diapering in each of these areas. Additionally, this section discusses other
considerations such as convenience and practicality.
Health and Developmental Issues
"Dry" does not mean "clean"
The multinational corporations who manufacture singleuse diapers have misled the American consumer to believe that as long as a baby is dry, that they are clean. The
urine in a wet diaper breaks down into ammonia and is a breeding ground for harmful bacteria regardless of how dry it feels.
Whatever kind of diaper you use, cotton or disposable, babies should be changed often… about every two hours! Bacteria begin to form as soon as a child wets or soils,
and leaving a diaper on a baby for prolonged periods can not only produce irritation and rash but may compromise the skin to the point of serious infection. The chemical dryness of singleuse has
produced a great lowering of standards in baby care because parents are led to believe that as long as the diaper feels dry, it's all right to leave on. It isn't. Dry does not
mean clean, and the urine absorbed by the chemicals used in singleuse diapers stays right next to a baby's skin. (As do feces, which are a tremendous breeding ground for noxious bacteria.)
Chemicals are not a substitute for the attention babies need, and "set-and-forget" diapering is not healthy.
Another area of concern are the toxic chemicals present in most singleuse diapers. Nearly all singleuse diapers use sodium polyacrylate to absorb moisture. Sodium
polyacrylate is the same sort of substance that was used in Rely tampons in the mid1980s.4 Many consumers notice clear beads of gel on their baby's genitals after a diaper change. This material is sodium polyacrylate.
An additional serious concern is the risk that dioxin, a byproduct of the paperbleaching process, may exist in singleuse diapers. Dioxin in various forms has been shown
to cause cancer, birth defects, liver damage, and skin diseases.5
Disposable diapers linked to asthma6
Harsh perfumes and chemical emissions have long been known to induce asthma-like symptoms in children and adults. Now, researchers have found that disposable diapers might be
a trigger for asthma.
A study published in the October, 1999 issue of the Archives of Environmental Health found that laboratory mice exposed to various brands of disposable diapers suffered
increased eye, nose, and throat irritation, including bronchoconstriction similar to that of an asthma attack. Six leading cotton and disposable diaper brands were tested; cloth diapers were not
found to cause respiratory problems among the lab mice.7
Dr. Rosalind C. Anderson, lead author of the report, "Acute Respiratory Effects of Diaper Emissions," explains that the diapers were tested right out of the
package, and one at a time. Even in a mid-sized room, the emissions from one diaper were high enough to produce asthma-like symptoms. Solvents and other substances are typically added to
products during the manufacturing process in order to affect malleability and other properties, Dr. Anderson explains. "Even if you don't want these chemicals in the final product,
it's hard to take them out. We are finding chemical off-gasses in all sorts of baby products besides diapers, including baby mattresses and mattress covers," she says.
What chemicals were released from the diapers? Tolune, xylene, ethylbenzene, styrene, and isopropylbenzene, among others. Dr. Anderson says these, like certain
scents, are bronchial irritants. "It's similar to when asthmatics smell perfume and all of a sudden their chests get tight." Although mice are much smaller than humans, they
were chosen for the study because their physiology and biochemistry are similar to that of humans. Of the brands tested, three diaper brands were found not to affect the breathing of the lab
mice: American Fiber and Finishing Co., Gladrags organic cotton diapers, and Tender Care disposable diapers.
Further study is needed to determine what level of diaper chemical emission triggers infant respiratory distress. In the meantime, Dr. Anderson advises asthmatic
mothers to avoid exposure to these chemicals, and to be mindful of the fact that their children may be sensitive to these and other asthma antagonists such as dust mites, roaches, and smoking.
Asthma rates are on a sharp incline in the US and worldwide, particularly among poor and inner-city children.
Read the entire article
Increased scrotal temperature in single-use diaper may lead to male infertility8
The increased use of single-use diapers may explain the increase in male infertility over the past 25 years, suggests a study in the Archives of Disease in Childhood.
The research shows that singleuse diapers lined with plastic significantly increase the temperature of the scrotum when compared to the scrotal temperature of boys using cloth diapers.
Temperature is critical to normal testicular development and sperm health.
The researchers monitored the scrotal temperature of 48 healthy boys, including five premature babies, from birth up to the age of 55 months, using a tiny, noninvasive
thermal probe. The study ranged over two 24-hour periods. During one of the periods the boys wore reusable cotton diapers; during the other, they wore plastic-lined singleuse
diapers. Temperature was measured during waking and sleeping hours; and rectal temperature was also measured for comparison.
The study shows that scrotal temperature, which closely reflects testicular temperature, is increased in boys wearing singleuse plastic-lined diapers. The mean
difference in scrotal temperature between the two ranged between .6°C and 1.1°C (1.1°F and 2.0°F). The authors of the study conclude that the insulation properties of the single-use diapers
impaired normal testicular cooling mechanisms and in 13 of the boys studied, the cooling mechanism failed altogether.
In adults, it has been shown that exposure to high temperatures can reduce sperm count in adult males. The subsequent risk of adult infertility in boys whose testicles
fail to descend at the normal age is thought to be attributable to increased testicular temperature. The authors of the study conclude that a prolonged increase in scrotal temperature in early
childhood may therefore have an important role in subsequent testicular health and function, with implications for male fertility.
Manufacturing and Disposal
An estimated 18 billion single-use diapers are thrown in landfills each year, taking as many as 500 years to decompose, and commonly contain raw, untreated sewage.
Disposable diapers make up the third largest source of solid waste in landfills, after newspapers and food and beverage containers.9 It takes upwards of 82,000 tons of plastic and
1.3 million tons of wood pulp, or a quarter-million trees, to manufacture the disposable diapers that cover the bottoms of 90 percent of the babies born in the US.10
The negative impact of single-use diapers on the environment goes far beyond the disposal problem. A study prepared by The Landbank Consultancy for The Women's
Environmental Network shows that singleuse diapers use 3.5 times as much energy, 8 times as much nonregenerable raw materials, and 90 times as much renewable material as cloth diapers.11
In a world with an expanding population and increasingly limited available resources, the need for conservation in daytoday activities becomes much more evident.
A report written by Carl Lehrburger, Jocelyn Mullen, and C.V. Jones concluded in part "Single-use diapers are shown to generate significantly more solid waste, to
consume greater quantities of energy and raw materials, and to generate more potentially toxic pollutants on a per-diaper-change basis."12 The report continues "Considering the overall environmental burdens, and most notably the higher volumes of solid waste produced and energy and raw materials consumed by singleuse diapers, reusable diapers are determined to be superior from an environmental perspective."12
Lehrburger concludes in another report "The conclusions of this study are that in light of dwindling landfill capacity, growing waste disposal costs and potential public
health concerns, the use of reusable cotton diapers should be encouraged over singleuse diapers, and the elimination of singleuse diapers going to landfills is a desirable and reasonable public
Single-use diapers are, as their name implies, used once, then discarded. They are almost always sent to landfills or incinerators, never reused and almost never
recycled. In contrast, the average cloth diaper is used between 100 and 150 times as a diaper, and then retired. Retired cloth diapers are in high demand and have a second lifecycle as
rags for detailing shops, window washing services, janitorial services, piano retailers, and assorted other businesses where soft, lint-free rags are needed.
Whether using cloth or single-use diapers, a baby should be immediately changed after it wets or soils a diaper. Based on this fact, the average infant should be
changed approximately 70-80 times per week. Below is a comparison of the costs of singleuse and a cloth diaper service:
Figure 1: Comparison of Weekly Cost
* Average number of diapers per week for newborns
Cloth Diaper Service
30 diapers per week
40 diapers per week
50 diapers per week
60 diapers per week
70 diapers per week*
80 diapers per week
90 diapers per week
100 diapers per week
Some may argue that single-use diapers don't need to be changed as often as cloth, which justifies
their higher cost per diaper. We strongly disagree. Leaving a baby in a soiled diaper, whether it is
cloth or singleuse, is an open invitation for diaper rash and other problems. A baby's diaper is not meant to be used as a septic tank.
Many parents who use single-use diapers think nothing of spending $15 or $20 on diapers when they
shop for groceries, which quickly gets hidden in the total grocery bill. When this hidden cost is revealed,
and the cost of additional diapering because of delayed potty training, it becomes immediately apparent that cloth diapering is far less costly than the total cost of singleuse diapers.
Figure 1: Comparison of Total Cost
Cloth Diaper Service
24 Months (104 weeks)
36 Months (156 weeks)
48 Months (208 weeks)
The chart above assumes an average of 70 diapers per week throughout the diapering period, with
stable pricing for both single-use diapers and cloth diaper service ($39.90 per week for single-use
diapers, $17.50 per week for cloth diaper service as shown in the previous chart). Clearly, when
compared diaper for diaper, cloth has an indisputable economic advantage over singleuse diapers.
When you consider the fact that most babies diapered using cloth diapers are toilet trained up to a year earlier, the economic advantage of cloth is even more dramatic.
Convenience and Practicality
Things have changed since 1955
The large multinational manufacturers of disposable diapers have been successful at convincing
uninformed consumers about how easy using single-use diapers is. However, they neglect to mention
how cloth diapering has progressed since the folding and pinning of the 1950s. Modern cloth diapering
now gives you the option of using diaper wraps which secure the diaper in place with Velcro fasteners, and make pinning and extensive folding unnecessary.
As mentioned earlier, the average babies wearing cloth diapers are toilet trained at 24-30 months,
while the average age for babies wearing single-use diapers is 3642 months. This not only has
obvious economic implications, but it is highly significant for your baby's development. Toilet training is
an important step on the way to increased competence, confidence, and sense of self. Having an estimated one year less of diapering is a real convenience that the single-use diaper manufacturers
TO SUM IT ALL UP
There is a noticeable increased awareness and interest in cloth diapering as a viable alternative to the
shortsighted and wasteful practice of using single-use diapers. This article and its references
demonstrate that cloth diapering holds clear and significant health and developmental, environmental,
and economic advantages over singleuse diapering. Additionally, the convenience of modern cloth
diapering rivals the convenience of singleuse diapers, particularly when a diaper laundering service is used.
For further information, contact the National Association of Diaper Services on the Internet at www.diapernet.com.
Copyright © 1998-2002 National Association of Diaper Services
All Rights Reserved.
1. The New York Times, January 12, 1999
2. The Wall Street Journal, May 4, 1993
3. Journal of Pediatrics, 1959, Vol 54 pp. 793-800 "Relationship of Peri-Anal Dermititis to Fecel pH" by
Drs. Tamio, Steiner, Benjamin Clinical Pediatrics, May 1991, Vol 30 Department of Internal Medicine &
Pediatrics, Loyola University Medical Ctr. Newborn Chemical Exposure from over-the-counter Skin-Care Products by Drs. Cetta, Lambert, & Ross
4. Judy Braiman-Lipson, Empire State Consumer Association, Rochester, NY.
5. EPA, Integrated Risk Assessment for Dioxins and Furans from Chlorine Bleaching in Pulp and Paper Mills.
6. Reprinted by permission of Mothering, Issue 98, www.mothering.com
7. Anderson, Rosalind, and Julius Anderson. "Acute Respiratory Effects of Diaper Emissions," Archives of Environmental Health, 54, October 1999.
8. Partsch, Aukamp, and Sippell. "Scrotal temperature is increased in disposable plastic lined nappies."
Division of Pediatric Endocrinology, Department of Pediatrics, Christian-Albrechts-University of Kiel. May 2000.
9. EPA, "Positive Steps towards Waste Reduction," June 1989
10. Rhode Island Solid Waste Management Corporation.
11. The Landbank Consultancy Limited, "A Review of Proctor & Gamble's Environmental Balances for
Disposable and Re-usable Nappies" July 1991
12. Leherburger/Mullen/Jones, "Diapers: Environmental Impacts and Lifecycle Analysis," January 1991
13. Carl Leherburger, "Diapers in the Waste Stream: A Review of Waste Management and Public Policy Issues"
14. Kmart.com, April 3, 2004, Huggies® Ultratrim, size M, 14-pack, $7.98 plus tax