For babies, infants, and toddlers with a tendency towards eczema or sensitive skin, one of the most important things to consider in helping their skin is choosing the right diapers as a part of their skincare routine. Read more...
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What are diapers made of?
Diapers are composed of multiple layers. The top layer that touches the baby’s skin is meant to wick away moisture to the second layer. This layer is absorbent. It is usually composed of Super Absorbent Polymers (SAP). The last layer is waterproof to hold in the moisture and prevent it from leaking out onto clothing. Dyes may be added to the lining as a wetness indicator. There may also be fragrances and lotions that can play a role in a skincare routine.
Video: Techei
What is the top sheet made of?
The top sheet is the portion of the diaper in direct contact with the baby's skin. This does not vary much between diapers.
Brand | Top Sheet | Lotions |
Pampers | ||
Huggies | ||
Luvs | Polyester (Acquisition layer) | |
Honest Diapers | | |
Seventh Generation | | |
Coterie |
From the chart above (with hyperlinks to brand websites) you can see there is not much variation in the materials chosen for the top layer. This layer is intended to be soft and wicking to pull moisture away from the skin into the next layer, the absorbent layer. The differences between brands and variations within brands may be found more so in any dyes, fragrances, or lotions embedded in this layer.
What is in the absorbent layer?
The absorbent layer is home to the workhorse of the diaper, the super absorbent polymers (SAPs).
Brand | Super absorbent polymers |
Pampers | |
Huggies | |
Luvs | |
Honest Diapers | |
Seventh Generation | |
Coterie |
From a look at the varying products used by different brands, there is not a significant difference in the SAPs chosen. The main point of differentiation here is likely in sourcing and volume used for absorbency. The goal of this layer is to rapidly absorb moisture and wick it away from the skin to avoid skin irritation and breakdown. There are likely variations in the ability of each brand's SAPs to do so.
What is in the outer layer?
The role of the outer layer is to protect clothing and skin from the moisture trapped in the absorbent layer.
Brand | Outer Layer |
Pampers | |
Huggies | |
Luvs | |
Honest Diapers | |
Seventh Generation | |
Coterie |
Again, not much difference between brands when it comes to the materials chosen for the outer layer.
Video: Techei
So what other differences may diapers have between brands?
The main differences that diaper brands and variations within a brand may have are:
Presence of fragrances
Presence of dyes
Presence of lotions
Although brands may advertise that they are free of other compounds, the reality is that most brands do not use these anyway or have a use for them for the construction of the diaper.
Does it really matter which brand I choose for diapers?
Although adult diapers meet the criteria of a medical device placing it under greater scrutiny and regulations, infant diapers do not. This means that they do not need to disclose ingredients (although most brands appear to) and do not need to undergo an FDA approval process.
I look at this question through a few lenses. Most infants and toddlers do not necessarily have routine issues with most brands chosen. My medical view will be skewed by the patients I see since naturally I only see those impacted by challenges and not those that do well. Many diaper-related rashes may be managed with barrier creams to reduce friction and moisture building up between the diaper and the skin however not all will respond.
For those that face challenges finding the right product, given that most of the variability between products lies in the presence or absence of fragrances, dyes, and/or lotions, this is likely the best place to start. If you are still faced with challenges talk to your Pediatrician and Dermatologist about options or possible patch testing to better define the source of the reaction.
Beyond the diaper area, do you recommend changing diapers for any other reason?
Early on in my career, I worked with a Pediatric Dermatologist that told me she found that the body surface area of infants is so small with the diaper consuming much of it that she felt strongly that the presence of dyes in diapers would serve as a source of sensitization for kids with a tendency towards eczema or atopic dermatitis. Because it is not a true allergy and because the dyes chosen in diapers are not disperse dyes (that we test for on allergy testing), it was difficult to confirm this connection other than by practical experience. For kids with challenges with eczema and atopic dermatitis - even outside the diaper area and maybe not even impacting the diaper area - having them change to all-white diapers without dyes, without cartoon characters was one of her recommendations to reduce the chances of eczema flares. I have to say that in my hands in 20 years of practice, this recommendation has held true. It's a small change to make and it makes a world of difference as a part of my overall management strategy for recurrent eczema in this age group.
What about cloth diapers, are they better?
Cloth diapers can be challenging to gauge as there is a lot of variability amongst brands, styles, and even DIY options. Disposable diapers on the other hand are a bit more standardized and are composed of multiple layers. The top layer that touches the baby’s skin is meant to wick away moisture to the second layer. This layer is absorbent. It is usually composed of Super Absorbent Polymers (SAP). The last layer is waterproof to hold in the moisture and prevent it from leaking out onto clothing. Dyes may be added to the lining as a wetness indicator. There may also be fragrances and lotions that can play a role in a skincare routine.
Cloth diapers on the other hand can be made of various materials. Traditionally cotton may have been used and over the years a waterproof covering was added. Now, brands are using a variety of materials including polyester, and cotton, and I have also come across bamboo.
The key to finding the right material is to understand the pros and cons of each and the risks to infant skin.
To reduce the potential irritation to infant skin there needs to be two major factors to consider concerning the point of contact with skin: absorbency and friction.
In disposable diapers, just about every brand I have reviewed uses polypropylene as the top sheet. This is designed to wick away moisture quickly from the skin to reduce a build-up of moisture that can trigger diaper rashes. It is also smooth textured contributing to less friction overall that can inflame skin. Cloth diapers may have polyester, cotton, or even bamboo in this area. Polyester is a synthetic and tends to be hydrophobic and initially repels water before absorbing and wicking it away. The studies my labs have performed on polyester show a slight delay in absorption. This factor has contributed to some frustrations consumers have had with this material increasingly used in men's wear, athletic clothing, and loungewear. The benefit to polyester though is that once it pulls moisture in, it can pull through and dry quicker as it releases it to the air. This is great for sports use so that the fabric is less damp. However, with cloth diapers that may have an outer waterproof covering, this moisture may not be released into the air quickly. Because polyester is hydrophobic, it holds onto oils and residues more so than cotton. These are not always released in routine laundering and may require the use of fabric rinses to lift residues more effectively.
Cotton is soft textured and hydrophilic, drawing in moisture and absorbing it. It also holds onto the moisture. It does not tend to like to hold onto oils and residues and releases these easily in the laundering process. For infant skin, it may feel better but to those changing the diaper, it may feel more damp because of how well it holds onto moisture. Bamboo will have similar properties.
Cloth diapers as a rule tend to need to be changed sooner than disposable diapers. Users will often feel like cotton needs to be changed sooner than polyester because of this damp feeling but this does not necessarily mean they are better for infant skin, just better for the caregiver.
Bear in mind, that the studies available on textiles and skin are usually more focused on sweating, infection control, and functional properties such as flame retardancy, sun protection, etc. There are very few medical articles on cloth diapers. The unique exposures for the diaper region, microbial exposure, and the need for effective cleaning that could impact risks of bacterial overgrowth, odor control, and irritation to the skin need to be considered. For this reason, proper laundering practices also matter. Using the right detergent, dosing detergent correctly, not overloading the laundry machine, use of fabric rinses to alter the pH in the rinse cycle to lift residues, and avoiding irritating ingredients that could be left behind from the wash is important.
My preference based on the knowledge available for cloth diapers given the fact that they need to be laundered and reused is to choose cotton. Polyester components of disposable diapers are not unreasonable as there can be some benefits but polyester requires added care in the laundering process to clear out residues that bacteria attach to and contribute to infection risk and odors.
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