Diaper-free infants: growing up without diapers?

Associate Professor Milivoj Jovančević, MD, PhD, paediatrician

In recent years, the notion that children should be allowed to grow up diaper-free has been gaining attention in developed countries. Consequently, an increasing number of parents are practising this idea in some way. In Croatia, this is still something of a novelty. What exactly is the “diaper-free movement”?

A large number of culturally and economically diverse communities do not use diapers. The mother is more or less constantly in contact with the infant and can easily recognise the signals which communicate the need to urinate or defecate. The parent responds to these signals by placing the child in an appropriate position, usually by placing the infant on the underarms in a sitting position and holding him/her above an area for urine and stool elimination. In less developed countries where people typically relieve themselves in nature, these areas are found in the natural environment (e.g. the meadow or drain at the roadside). In developed countries, these include the toilet or the sink. Unlike their diapered counterparts, diaper-free infants quickly establish control of their bladder and bowel movements. Diaper use is often considered to be the main cause of the later establishment of control, and diapers are sometimes used until the age of 3.

Expert opinion on the appropriateness and possible benefits or drawbacks of this movement varies considerably, indicating that there is no commonly held opinion, partly because there is no systematic research into all aspects of this complex story.

From the point of view of early emotional development, the parents’ ability to identify infant signals and show readiness to respond to them in an appropriate way is undoubtedly beneficial. This shows infants that their mother understands them and will satisfy all their needs. This process is of great importance for early emotional development and for the formation of the secure type of attachment, which provides the basis for mental and physical health in adulthood. However, the modern way of life has brought changes that may interfere with this process. Delivery age has increased (in Croatia, the average age for giving birth for the first time is 26) and the traditional way of life in which several generations lived under one roof and provided mutual support has disappeared. The age difference between generations has increased, and young people typically live apart from their parents and other family members. Left to their own devices and faced with challenging life and work demands, mothers often do not have enough confidence, security or time to be in harmonious, constant contact with their children. In cases like this, the inability to identify infant signals (especially during the first months) can be an additional source of frustration. I believe this is the reason why many mothers get rid of diapers at a later stage in the child’s life, after a harmonious mother–infant relationship has been established and infant signals appear more obvious and understandable. Some children are “difficult” – psychologists say they should come with instruction manuals since everything the parents do is met with protests and dissatisfaction. In cases like this, successful cooperation in establishing control over urination and defecation is highly unlikely. In conclusion, when it comes to parental and infant emotional health, it is important to respect both the parents’ and infants’ individuality and remove diapers at a moment when everyone involved seems ready to adapt.

Cultural differences related to relieving oneself (manner, place, waste disposal) vary considerably in different parts of the world and need to be respected.

From a biological point of view, remaining traces of faeces and urine on the skin and genitals bring nothing but trouble. The situation is significantly better for infants (regardless of diapers) since the majority of households in developed Western cultures have running water and high hygiene standards. In underdeveloped countries, where these are (for the most part) lacking, communicable diseases of the digestive tract and urinary tract inflammations are the main problem.

Physiologically speaking, defecation should be performed in a bent or squatting position which makes it easier to effectively empty the bowels. The fact that infants who learn to empty their bowels in this manner have fewer problems with infant cramps also supports this notion. Bear in mind that diapers were probably not used for thousands of years, so it is to be expected that (from an evolutional standpoint) humans are better adapted to growing up without diapers. The absence of diapers is therefore not likely to cause health or neurodevelopment difficulties.

From an ecological point of view, disposable diapers present a global biological waste (potentially contagious) and nylon disposal problem. On the other hand, cloth diapers also affect the environment, given the production and disposal of detergents and carbon dioxide released in the production of electric energy used for washing.

Finally, the economic benefits (for parents) of going diaper-free seem unquestionable, but the drop in diaper production has (significantly lower) indirect negative effects.

In conclusion, we can recommend this method if both the parents and child accept it, and feel free and comfortable with it.