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The diapers worn by today's infants have technologic advances their cloth-clad grandparents could never have imagined. Rash-preventing additives, absorbent polymer gels, imprinted colorful cartoon characters, antileak elasticized borders, and reclosable hook and loop closures distinguish disposable diapers from their cloth predecessors and make the diapering chore more palatable. Advocates of reusable cloth diapers now have breathable diaper covers to replace plastic pants, and all-in-one garments and commercial laundering with home delivery can also save time.
With all of these choices, anxious parents may challenge the pediatrician with questions on which diapering system is best for their infant's health and for the health of the environment.
DIAPER WARS: DISPOSABLE VERSUS REUSABLE
A 1997 New York Times headline proclaimed, "In the Diaper Wars, Cloth has Just About Folded."1 The article described the closing of the last commercial diaper laundering service located in New York City, and noted that 80% of infants in the United States wear disposable diapers.
Disposable Diapers
Disposable diapers are all-in-one garments that can be adjusted to fit snugly around the waist and upper thighs to contain urine and feces. Each diaper is composed of three layers. The layer closest to the skin is a nonwoven paper topsheet that allows sweat, water, and liquid stool to pass through and then acts as a moisture barrier. It may be impregnated with petrolatum, antibacterials, and /or aloe vera to enhance skin barrier function, combat friction, and treat mild diaper rash.
Liquid then passes through to the second layer, the absorbent lining. Disposable diapers that use polyacrylase gel as the absorbent (along with cellulose fluff) have been repeatedly shown to reduce the incidence of generic (ie, classic chafing or irritant contact) diaper rash compared with cloth diapers.2 In its unhydrated state, this gel is a nontoxic powder that absorbs 80 times its weight in water. It draws fluid below the nonwoven skin-touching surface of the disposable diaper, making a moist, clear, tapioca bead-like gel. The skin surface remains dry, a valuable attribute if the diaper is not changed immediately. Decreased exposure to urine and fecal enzymes and lessened friction from wet diaper or wet skin surface contact mean less generic diaper rash.
The third layer is an impermeable plastic or nonwoven vapor-permeable cloth. The latter keeps the...