Sunday, April 28, 2013

Do Cloth Diapers Really Delay Walking?

I'd like to comment on a recent study from the Journal of Developmental Science entitled "Go Naked: Diapers affect Infant Walking". The article is meant to highlight diapers as a possible source of variation in studies on infant mobility.  Walking was analyzed while children were walking naked, while wearing a disposable diaper, or while wearing a cloth diaper. While it is not stated outright, the article potentially suggests that cloth diapered children may have delayed walking skills compared to disposable diapered peers. This possibility has created quite the controversy among cloth diapering parents.


Today I'll share my opinions on the results of these studies.  I noted several aspects of study design that could have altered the results using cloth diapers:


1. Almost all participants are new to cloth diapers

90% of 13-month-olds and 93.3% of 19-month-olds in this study normally wore disposable diapers.  This indicates that most infants hadn't had previous experience wearing cloth diapers.  The investigators argue that the novelty of wearing cloth diapers wasn't a factor in their results.  They noted that most infants in the study hadn't had experience walking naked, yet walking naked was easiest for participants.  However, I think this assumption is overstated.  It's not as if children have never been naked, yet wearing a cloth diaper is an entirely new experience.  An exclusively disposable diapered child would likely react differently when placed into a foreign type of diaper.

2. Type of cloth diapers selected is not representative


The specific type of cloth diaper used in this study was not specified; however, it was noted that cloth diapers were folded, indicating that they were either prefold or flat style diapers.  I found it surprising that for a study published in 2012, a more modern style of diaper was not selected.  In the 2012 Cloth Diaper Pulse Survey from Diapers Shops, only 16% of cloth diapering parents reported that traditional flat or prefold diapers were their preferred choice of cloth diaper.  Over 50% of parents reported preferring "pocket" style diapers: a modern and trim-fitting variety of cloth diaper that does not involve folding.  The traditional variety of cloth diaper used in this study does not accurately reflect the type of cloth diaper commonly used by today's cloth diapering parent.  Images in the article comparing walking while wearing the different varieties of diapers show a child wearing an extremely bulky cloth diaper that is not commonly used by the cloth diapering community.

Modern "Pocket" diaper is trim-fitting and less bulky than traditional cloth diapers

3. Cloth Diapers were folded for "night time" use

This study noted that cloth diapers were folded for "night time use" when they were put on the babies.  Cloth diapering parents who commonly use traditional cloth diapers, know there are a variety of ways to fold diapers.  Each particular fold has benefits and drawbacks, and a night time fold would not be selected for daytime use.  Folds like "bikini twist" create very little bulk between the legs and are a preferred choice for during the day.  Night time folds would be selected for absorbancy instead of comfort while walking.  Therefore, the study used a diaper fold that would be used during a time when the child was not ambulating.

4. Small sample size

Small numbers of participants seems to plague many human studies, and I couldn't do a review without at least mentioning that this is a small study.  With only 30 participants per age group and data being removed due to non-cooperative babies, we have to use extreme care when talking about the results.  A larger study with more children, more ethnic diversity, and more cloth diapered babies may have had a different outcome.


5. Babies are only tested in dry diapers

This study only looked at the effects of walking in dry diapers.  A wet disposable diaper can quickly become bulky and heavy.  Since many parents leave children in disposable diapers for more than two hours, children would commonly be ambulating in an expanded diaper.

Statements that potentially cause confusion:


"Possibly, infants who learn to walk while naked—without the additional challenge posed by a diaper—might show more rapid gains in posture and coordination, facilitating earlier onset ages and faster improvements. This would be consistent with reported historical changes in infant walking: Infants today walk sooner and better than those of previous generations, when all infants wore cloth diapers (Shirley, 1931)."


This statement gives the reader the impression that the cultural shift to disposable diapers has, in some way, facilitated earlier walking in infants.  However, there are far too many factors to make a correlation between walking and diapering.  As one example; infants today are generally born larger than they were in the 1930s, and larger babies may walk earlier than smaller babies.

 

Conclusions


I found the results of the naked walking vs. walking with a diaper story to be very interesting in this study.  The authors are clearly experts in infant mobility and wanted to ask the question: "Do children walk differently in diapers vs without diapers?"  I feel that the cloth diaper vs. disposable diaper story was not complete and may have given parents an incorrect perception that cloth diapers limit development of walking skills.  Parents are extremely sensitive to comparisons between children, and misinterpreting the results of this study may make some parents decline to give cloth diapering a try.  I was disappointed that cloth diapers were represented as old fashioned and bulky: stereotypes that do not accurately reflect attributes of modern cloth diapers. I think it is important to keep in mind that Proctor and Gamble (makers of Pampers) did contribute funding to this work. 
 
With the multitude of factors affecting infant walking, plus the new variety of cloth diapers available, cloth diapering parents can rest assured that their choice of diaper is not detrimental to their children.  However, I would suggest that parents do give their children opportunities to have diaper-free time based on the findings of this study.  We know that diaper-free time is not only great for preventing rashes and encouraging potty training, but it helps children move their bodies without restriction.


The opinions expressed in this review are my own.  As with all scientific review, my intent is to provide positive criticism and further our understanding of the research. I feel qualified to review the scientific content of this article based on my PhD in biomedical research, and my current work studying movement disorders.  I am also a parent who has exclusively cloth diapered two children. 

10 comments:

  1. You really hit the ball out of the park on this one, Nissa! This is extremely well-researched and I like how you critically examine the methods used in the study, as well as the conclusions that were made. And I'm still not even convinced that walking sooner is necessarily a better thing, and something parents should worry about. In the grand scheme of things, does it really matter whether a toddler starts walking at 12 months instead of 14 months? - Anne

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    1. Absolutely! I remember we felt a similar way about our daughter and learning to crawl. We had been trying to sell our house and couldn't have baby gates up. She was a late crawler and finally took off like mad at 10 months just as we were moving out. It was such a relief that she wasn't able to get into things and potentially get hurt while we were in the middle of packing.

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  2. My daughter started crawling at 7 months and walking at 9.5 months. Cloth diapers definitely do not have to delay mobility!

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  3. My son is 14 months, just started taking his first steps this week! He didn't pull to standing until 13 months. He is a bit behind in gross motor skills, but I would not contribute this delay to cloth diapers!

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  4. Out of my three children, the one who wore disposables learned to walk the latest. I really think you make some great, thought-provoking points here. Great article!

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  5. Awesome post!

    Both of my boys walked earlier than some of their friends in their play group that wore disposables. It is also sad that P&G had funded the study, because I think that it was also them that funded a study about the effects of cloth on the environment and even went as far as to say that disposables were biodegrade-able (would share the youtube video of their commercials, but has long since been removed).

    It is so important to look at "research" from all different angles, and you did a fabulous job!

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    1. P&G are certainly getting a run for their money with some many people switching to cloth. It's just so smart! I really feel for my friends using disposables because they are calculating the cost for every diaper they use on the children. It's just not sustainable on so many levels.

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  6. ashton walked started to walk around 13 months with cd, adry started walking at 8 months i dont believe cd have anything to do with that.. honestly it all depends on baby.

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  7. Thanks again for your analyzing, Nissa! As you know, my daughter S is 21 months old and exclusively cloth diapered (except during my little experiment and during her PT therapy hour) and still not walking. I think that I am one of the many parents out there who felt like their choices could impact the mobility of their child, and I felt terrible. I now feel more confident after experimenting and reading your review. Thanks again!,
    Audrey

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    1. I'm so glad this was helpful for you. I'm sure there are many other parents who were questioning their decision to cloth diaper after reading this potentially misleading data. Hopefully your little one will take off walking soon! There are so many factors as to when a child takes those first steps. Our daughter also took her time walking. For us, a big help was transitioning to a daycare room where most of her peers were walking: after that she finally got the confidence to start pulling herself up and trying for those first steps.

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