Cloth diapers: Are they the answer to less diaper rash?

Cloth diapers are considered less likely to cause diaper rash, but that's not always the case.

Although cloth diapers may leave the impression that they can cause less irritation to the skin, caregivers sometimes forget how these diapers are laundered.

Surface irritation is the leading cause of all types of diaper rash, said Bernard A. Cohen, MD, professor of dermatology and pediatrics at Johns Hopkins School of Medicine and director of the Johns Hopkins University Pediatric Dermatology and Cutaneous Laser Center as well as section editor of Dermcase in Contemporary Pediatrics, and this can happen with cloth diapers just as easily as with disposable diapers.

According to 2017 case study, irritant diaper dermatitis can actually occur more often with cloth diapers than with disposable diapers—and with increased severity. The case study details 4 cases of vesiculobullous erosive diaper dermatitis in older infants and toddlers that developed when cloth diapers were in use but resolved completely after a switch to disposable diapers.1

Advocates of cloth diapers argue that they can be more comfortable, reduce diaper rash incidence, and are more environmentally friendly, but the American Academy of Pediatrics (AAP) refutes many of these claims.

Cloth diapers are not as absorbent as disposable options and are usually used with protective covers that aren’t very breathable, according to the AAP. In terms of the environment, AAP points out that it takes a lot of energy to produce cotton diapers—plus the water to clean them.2

Cleaning is another concern when it comes to cloth, as some users may overlook what type of detergent they are using and how they are laundering diapers.

Cleansers can be highly irritating to the skin, noted Cohen, and many people overlook their laundry detergents. This is usually more of a concern when children start wearing cloth underwear during toilet training, but cloth diapers can expose the delicate diaper area to detergents much earlier than in children who wear disposable diapers.

Cohen suggested using detergents that are free of fragrance or irritants—or even just using vinegar. Other resources also suggest avoiding fabric softeners or dryer sheets, checking with cloth diaper manufacturers on best practices for cleaning, and using an extra rinse cycle after washing to remove any detergent residue.3

References

1. Harfmann K, Chen A, Witman P. Bullous diaper dermatitis with cloth diaper use. Pediatr Dermatol. 2017;34(6):e309-e312. doi:10.1111/pde.13263

2. Jana L, Shu J. Diapers: Cloth or Disposable? Updated May 17, 2021. Accessed October 5, 2021. https://www.healthychildren.org/English/ages-stages/baby/diapers-clothing/Pages/Diapers-Disposable-or-Cloth.aspx

3. Tellado M. Diaper Rash. Updated September 1, 2019. Accessed October 5, 2021. https://kidshealth.org/en/parents/diaper-rash.html