As a father and pediatrician, I’ve changed many diapers — enough to teach me that diapers are a daily reminder that as humans we deplete resources as we consume, and we make messes with our waste.

Those landfill diapers that are so easily tossed into the trash are clearly a major ecological issue. But what about the energy, water, and often chlorine involved in laundering cloth diapers? Comparing the environmental impact of different types of diapers has been the subject of a number of studies-with differing results often linked to the vested interests of those behind the study.

The largest and most objective study to date was carried out by the Environment Agency, the public body responsible for protecting the environment in England and Wales. The panel compared disposable diapers to home-laundered cloth diapers and commercially laundered cotton diapers in terms of global warming, ozone depletion, smog formation, depletion of nonrenewable resources, water pollution, acidification, human toxicity, and land pollution. The study did not include what I call hybrid diapers-the reusable diapers equipped with flushable, biodegradable liners.

This study found that overall environmental impact is about the same for all three options they did consider; the biggest impact is on global warming, resource depletion, and acidification. For disposable diapers, the most significant impact comes during manufacture; for home-laundered diapers, the primary impact comes from the electricity used in washing and drying; for commercially laundered diapers, the biggest impact comes from use of fuels and electricity.

Thus, according to the Environment Agency, if you choose cloth diapers, the first focus should be on reducing the energy used during washing and drying and reducing fuels and emissions during transportation (see Chapter Seven for more information about laundry). If you choose disposable diapers, focus first on greener manufacturing, such as used by the Eco-Diapers mentioned previously.

Although the Environment Agency report is more thorough than other analyses to date, it is still quite incomplete. For instance, it looked only at the major brands used-not the greener alternatives. It didn’t look at making choices back at the very beginning of the manufacturing process: at the oil rigs where the plastic liners of landfill diapers begin, at the forests where the wood pulp starts as trees, and in the cotton fields long before cotton is a cloth. There is a big difference between cotton grown drenched in toxic chemicals and cotton organically grown, between sustainable forestry and irresponsible logging, between dioxin-producing chlorine gas in pulp mills and bleach-free diapers.

Whatever we choose for diapers, we have an unavoidable impact on the environment. But whatever we choose, we can make those diapers a little greener.

Dr. Greene’s Answer:

Orange smudges are usually urate crystals. They are normal, soft, like tiny cubes of Jell-O — sometimes smushed, and sometimes confused with drops of blood in the diaper.

These are more common when kids are a bit dehydrated, but they can show up in healthy babies at anytime.

It just comes from having lots of urate in the urine. Sometimes orange food or some medications (such as rifampin or phenazopyridine (Pyridium)) can also be the culprit for orange smudges in the diaper.

As long as your child is in diapers, every single bowel movement will be right there for you to see at changing time. The first bowel movements are the thick, sticky, tarry meconium stools formed while the baby is still inside you. During the first week, though, these give way, starting a parade of stool changes that last throughout the diaper years.

The foods your child eats make a big difference in the consistency and the timing of the stools. For some babies, the adjustments happen without thought. For some babies, though, stool management becomes an important skill for their parents to learn!

In boys, the scrotal sac is marvelously designed to maintain the testicles within a narrow temperature range, just below normal body temperature. When it is cold out, the sac constricts and draws the testicles close to the body for warmth; when hot, the sac is loose to keep them cooler.

When an undescended testicle is left untreated (especially beyond a year), its higher temperature causes an increasing risk down the road of infertility and testicular cancer.

Here’s the news — disposable, plastic-lined diapers keep testicles hotter than core body temperature (and as much as 1.8 degrees F higher than testicles in cloth diapers)! The October 2000 issue of Archives of Disease in Childhood speculates that perhaps the significant rise in male infertility over the last 25 years is due to the widespread use of diapers that keep kids too warm. This has certainly not been proven, but time will tell. For now, the reasoning makes a lot of sense to me.

In our online community, someone inquired about a baby who had eaten some of the gel out of her diaper. I was pleased to answer this query, but I want to be sure that every parent and grandparent and sitter knows about Poison Control Centers. This free 24-hour service is the first place to call whenever a child has ingested something suspicious.

Thankfully, diaper gel is a nontoxic water-absorbing substance that passes through kids without doing harm. There is a theoretical risk that it could swell inside as it absorbed water, causing intestinal blockage, but I have never heard of this happening.

While safe, I wouldn’t recommend diaper gel as a culinary treat!

Dr. Greene’s Answer:

Diapers were a wonderful invention, controlling infants’ waste products in a relatively convenient, clean, and healthy way. Still, ever since children began to wear diapers, diaper rash has been the most common skin disorder of infancy.

A surprising number of different entities fall under the label of diaper rash:

• Friction rash. This is the most common form of diaper rash, and affects almost all babies at some time. It is most common on areas where friction is most pronounced, such as the inner thighs, or under the elastic of diapers that are too tight. It comes and goes quickly, and responds well to frequent diaper changes, looser diapers, airing out, and protective barriers.
• Irritant rash. This is most conspicuous on the exposed areas, such as the round part of the buttocks. It tends to spare skin folds and creases. It’s generally the result of contact with stool enzymes or irritants such as harsh soaps, baby wipes, detergents, or topical medicines.
• Allergic rash. This may occur in combination with an irritant rash or by itself. It is also more common on exposed areas. The skin looks like poison oak.
• Intertrigo. Moist heat causes this common type of diaper rash that occurs deep in the skin folds. The involved skin looks thin, as if it has lost several layers.
• Seborrhea rash. A salmon-colored, greasy rash with yellowish scales characterizes this diaper rash that is also worse in the skin folds.
• Psoriasis. This stubborn rash doesn’t necessarily look distinctive. Other signs of psoriasis usually accompany the diaper rash, though, such as pitting of the nails or dark red areas with sharp borders and fine silvery scales on the trunk, face, or scalp.
• A number of rare diseases such as congenital syphilis, histiocytosis X, zinc deficiency, Wiscott-Aldrich syndrome, acrodermatitis enteropathica, or Jacquet’s dermatitis all cause characteristic diaper rashes. These are extremely uncommon, but should be considered in prolonged, severe rashes that are unresponsive to the appropriate therapy.

 
Skin wetness is the common denominator underlying the various causes of diaper rash. Even skin lesions of systemic illnesses tend to concentrate in areas where the skin is already damaged (the Koebner phenomenon). Urinary wetness increases skin friction, raises the skin pH, makes the skin less cohesive, and makes it more permeable. These effects combine to intensify the action of stool enzymes or other irritants that then inflame the skin. In all the above diaper rashes, the outermost layer of skin — stratum corneum — has been damaged. With this protective layer breached, it is easy for microorganisms such as yeast or bacteria to invade the inflamed skin. This makes the rash worse and less responsive to usual treatments.

Yeast is by far the most common type of organism found in a diaper rash. The organism is quite prevalent and thrives in warm, moist skin. Yeast involvement should be suspected in any diaper rash that has not improved dramatically with 72 hours of appropriate therapy. Current or recent antibiotic use makes a yeast infection even more likely, since this reduces the amount of the skin’s ‘good’ bacteria that fight infection. Classically a yeast rash is beefy red with sharp raised borders and white scales. Small satellite lesions surround the main rash. Even without the classic pattern, however, yeast is often present.

Your daughter may well have a yeast rash. Try adding a cream such as 2% miconazole to your usual diaper rash regimen. Continue air drying and applying a protective layer such as a diaper cream over the miconazole. Washing with warm water may also be helpful. If the rash has not improved within 72 hours of this treatment, it is probably still a yeast infection, but contact your doctor for additional help.