540374
research-article2014
CPJXXX10.1177/0009922814540374Clinical PediatricsSteele
Editorial
Diaper Care for Happier and Healthier Babies
Clinical Pediatrics 2014, Vol. 53(9S) 7S–8S © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922814540374 cpj.sagepub.com
Russell W. Steele, MD1 When our first child (who is now a pediatrician) was born in 1967, my wife and I began our journey through not only the many incredible joys but also the challenges in caring for children. One of the very first new experiences was the dreaded diaper management. We had been given adequate cloth diapers in a baby shower and also the “rubber pants” that were necessary to control socially unacceptable spillage. We knew that with my wife’s modest salary as a teacher we could not afford a diaper service, so we selected an apartment right next to the building’s laundry room so that my wife could more easily wash diapers every day or every other day. Meanwhile the odiferous diaper pail was kept as far from visitors as possible. We then moved to the East Coast for my internship and discovered an incredible new product that was being test marketed there—Pampers. We had never heard of them in New Orleans. We quickly discarded our cloth diapers and became modern parents. We also invested in flushable diaper liners that greatly reduced the major unpleasant part of the discarded disposable diapers. Unfortunately, after going West for my pediatric residency we discovered that the product was not available, so we had to return to cloth diapers, although we were still unable to afford a diaper service. In the past, irritant diaper dermatitis represented 10% to 20% percent of all rashes for which parents sought medical attention,1-3 while today that number is greatly reduced. There is now evidence that highly absorbable disposable diapers not only reduce the incidence of irritant dermatitis1-4 but also a range of other skin infections in the diaper region, such as those caused by Staphylococcus, group A beta-hemolytic streptococcus (GABHS),5 Candida,6 Jacquet’s erosive dermatitis,7 and herpes progenitalis.8 Although controlled clinical trials comparing infections in cloth versus disposable diapers in children are not available, the temporally associated reduction in these many types of diaper rashes is compelling. There is also abundant indirect evidence. Disruption of the skin barrier from any cause increases colonization and subsequent infection with potentially pathogenic skin flora, particularly Staphylococcus aureus and GABHS, and irritant dermatitis is usually seen prior to these secondary infections. It is well documented that if irritant dermatitis persists for more than 3 days, Candida infection increases.6
Furthermore, the ulcers in the perineal region of Jacquet’s erosive diaper dermatitis are associated with persistent urine on the skin, infrequent diaper changing, and diarrhea, all of which are better controlled with absorbent disposable diapers. The major concern of parents is the discomfort that diaper rashes produce, interrupting sleep and compromising normal play activity. The best advice to those parents who do choose cloth diapers is to change diapers frequently and as soon as possible after urination or defecation, a challenge guided primarily by the “sniff test.” The increased pH of urine and stool, irritant chemicals, friction of the diaper material, and overhydration of the skin all contribute to inflammation of the baby’s highly sensitive skin. First-line therapy for mild to moderate irritant diaper dermatitis is a topical barrier that reduces skin contact with urine and feces. The best way to manage refractory dermatitis is to leave the baby undiapered as much as possible, but particularly during naps and nighttime sleeping. Obviously this approach can become quite messy. The articles in this monograph offer the reader detailed information on the benefits and safety of highly absorbent disposable diapers that now make children happier and their skin healthier. The detailed information about their design and construction to reduce friction and keep urine and the fluid portion of stool away from the baby’s skin allows pediatricians and other primary care physicians to better advise parents in this routine aspect of child care. You will find that new products are better fitting and less bulky for comfort and more environmentally friendly, the latter an important issue for us as well as for future generations. For both the child and parents, extended dryness and reduced leakage increase our quality of life. These advances all assure a reduction in the incidence and severity of diaper dermatitis. The major advance in construction of newer diapers is absorbency, which accounts for the reduction in 1
Ochsner Hospital for Children, New Orleans, LA, USA
Corresponding Author: Russell W. Steele, Ochsner Hospital for Children, 1315 Jefferson Highway, New Orleans, LA 70121, USA. Email: [email protected]
8S skin pathology and this is reviewed in detail. The next issue after efficacy is safety and this has been studied extensively. Components of these diapers include primarily polymers, which are used in many of our own clothes and color pigments used to decorate and provide guidance for product use. There was no evidence of skin irritation or sensitization with these pigments. I must admit that I never thought that color pigment on the skin might be an issue. The topic of diaper care is very appropriate for our journal, Clinical Pediatrics, which is dedicated to common outpatient issues relevant to the practicing pediatrician, family practice physician, their nurses, nurse practitioners, and everyone who ministers to children. Moreover, the publications in this monograph should be shared with parents who appreciate information that offers them details and the basis for recommendations on approaches to the care of their neonates and infants as they make decisions to improve the quality of their young children’s lives. No issue is too trivial for the concerned and dedicated parent, and diaper care is not only an important aspect of child care but when planned
Clinical Pediatrics 53(9S) appropriately, can provide improved comfort for the young child and assure a happier and skin care healthier early life. References 1. Levy M. Diaper rash syndrome or dermatitis. Cutis. 2001;67:37. 2. Ward DB, Fleischer AB Jr, Feldman SR, Krowchuk DP. Characterization of diaper dermatitis in the United States. Arch Pediatr Adolesc Med. 2000;154:943-946. 3. Singalavanija S, Frieden IJ. Diaper dermatitis. Pediatr Rev. 1995;16:142-147. 4. Baer EL, Davies MW, Easterbrook KJ. Disposable nappies for preventing napkin dermatitis in infants. Cochrane Database Syst Rev. 2006;(3):CD004262. 5. Brilliant LC. Perianal streptococcal dermatitis. Am Fam Physician. 2000;61:391-393. 6. Wolf R, Wolf D, Tüzün B, Tüzün Y. Diaper dermatitis. Clin Dermatol. 2000;18:657-660. 7. Kazaks EL, Lane AT. Diaper dermatitis. Pediatr Clin North Am. 2000;47:909-919. 8. Pandhi D, Kumar S, Reddy BS. Sexually transmitted diseases in children. J Dermatol. 2003;30:314-320.
Copyright of Clinical Pediatrics is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
research-article2014
CPJXXX10.1177/0009922814540374Clinical PediatricsSteele
Editorial
Diaper Care for Happier and Healthier Babies
Clinical Pediatrics 2014, Vol. 53(9S) 7S–8S © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922814540374 cpj.sagepub.com
Russell W. Steele, MD1 When our first child (who is now a pediatrician) was born in 1967, my wife and I began our journey through not only the many incredible joys but also the challenges in caring for children. One of the very first new experiences was the dreaded diaper management. We had been given adequate cloth diapers in a baby shower and also the “rubber pants” that were necessary to control socially unacceptable spillage. We knew that with my wife’s modest salary as a teacher we could not afford a diaper service, so we selected an apartment right next to the building’s laundry room so that my wife could more easily wash diapers every day or every other day. Meanwhile the odiferous diaper pail was kept as far from visitors as possible. We then moved to the East Coast for my internship and discovered an incredible new product that was being test marketed there—Pampers. We had never heard of them in New Orleans. We quickly discarded our cloth diapers and became modern parents. We also invested in flushable diaper liners that greatly reduced the major unpleasant part of the discarded disposable diapers. Unfortunately, after going West for my pediatric residency we discovered that the product was not available, so we had to return to cloth diapers, although we were still unable to afford a diaper service. In the past, irritant diaper dermatitis represented 10% to 20% percent of all rashes for which parents sought medical attention,1-3 while today that number is greatly reduced. There is now evidence that highly absorbable disposable diapers not only reduce the incidence of irritant dermatitis1-4 but also a range of other skin infections in the diaper region, such as those caused by Staphylococcus, group A beta-hemolytic streptococcus (GABHS),5 Candida,6 Jacquet’s erosive dermatitis,7 and herpes progenitalis.8 Although controlled clinical trials comparing infections in cloth versus disposable diapers in children are not available, the temporally associated reduction in these many types of diaper rashes is compelling. There is also abundant indirect evidence. Disruption of the skin barrier from any cause increases colonization and subsequent infection with potentially pathogenic skin flora, particularly Staphylococcus aureus and GABHS, and irritant dermatitis is usually seen prior to these secondary infections. It is well documented that if irritant dermatitis persists for more than 3 days, Candida infection increases.6
Furthermore, the ulcers in the perineal region of Jacquet’s erosive diaper dermatitis are associated with persistent urine on the skin, infrequent diaper changing, and diarrhea, all of which are better controlled with absorbent disposable diapers. The major concern of parents is the discomfort that diaper rashes produce, interrupting sleep and compromising normal play activity. The best advice to those parents who do choose cloth diapers is to change diapers frequently and as soon as possible after urination or defecation, a challenge guided primarily by the “sniff test.” The increased pH of urine and stool, irritant chemicals, friction of the diaper material, and overhydration of the skin all contribute to inflammation of the baby’s highly sensitive skin. First-line therapy for mild to moderate irritant diaper dermatitis is a topical barrier that reduces skin contact with urine and feces. The best way to manage refractory dermatitis is to leave the baby undiapered as much as possible, but particularly during naps and nighttime sleeping. Obviously this approach can become quite messy. The articles in this monograph offer the reader detailed information on the benefits and safety of highly absorbent disposable diapers that now make children happier and their skin healthier. The detailed information about their design and construction to reduce friction and keep urine and the fluid portion of stool away from the baby’s skin allows pediatricians and other primary care physicians to better advise parents in this routine aspect of child care. You will find that new products are better fitting and less bulky for comfort and more environmentally friendly, the latter an important issue for us as well as for future generations. For both the child and parents, extended dryness and reduced leakage increase our quality of life. These advances all assure a reduction in the incidence and severity of diaper dermatitis. The major advance in construction of newer diapers is absorbency, which accounts for the reduction in 1
Ochsner Hospital for Children, New Orleans, LA, USA
Corresponding Author: Russell W. Steele, Ochsner Hospital for Children, 1315 Jefferson Highway, New Orleans, LA 70121, USA. Email: [email protected]
8S skin pathology and this is reviewed in detail. The next issue after efficacy is safety and this has been studied extensively. Components of these diapers include primarily polymers, which are used in many of our own clothes and color pigments used to decorate and provide guidance for product use. There was no evidence of skin irritation or sensitization with these pigments. I must admit that I never thought that color pigment on the skin might be an issue. The topic of diaper care is very appropriate for our journal, Clinical Pediatrics, which is dedicated to common outpatient issues relevant to the practicing pediatrician, family practice physician, their nurses, nurse practitioners, and everyone who ministers to children. Moreover, the publications in this monograph should be shared with parents who appreciate information that offers them details and the basis for recommendations on approaches to the care of their neonates and infants as they make decisions to improve the quality of their young children’s lives. No issue is too trivial for the concerned and dedicated parent, and diaper care is not only an important aspect of child care but when planned
Clinical Pediatrics 53(9S) appropriately, can provide improved comfort for the young child and assure a happier and skin care healthier early life. References 1. Levy M. Diaper rash syndrome or dermatitis. Cutis. 2001;67:37. 2. Ward DB, Fleischer AB Jr, Feldman SR, Krowchuk DP. Characterization of diaper dermatitis in the United States. Arch Pediatr Adolesc Med. 2000;154:943-946. 3. Singalavanija S, Frieden IJ. Diaper dermatitis. Pediatr Rev. 1995;16:142-147. 4. Baer EL, Davies MW, Easterbrook KJ. Disposable nappies for preventing napkin dermatitis in infants. Cochrane Database Syst Rev. 2006;(3):CD004262. 5. Brilliant LC. Perianal streptococcal dermatitis. Am Fam Physician. 2000;61:391-393. 6. Wolf R, Wolf D, Tüzün B, Tüzün Y. Diaper dermatitis. Clin Dermatol. 2000;18:657-660. 7. Kazaks EL, Lane AT. Diaper dermatitis. Pediatr Clin North Am. 2000;47:909-919. 8. Pandhi D, Kumar S, Reddy BS. Sexually transmitted diseases in children. J Dermatol. 2003;30:314-320.
Copyright of Clinical Pediatrics is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
