The diaper question: Cloth vs. disposable

By Catherine E. Toth
Advertiser Staff Writer

Sharon Tamashiro says she prefers the convenience of using disposable diapers for her 3-month-old son, Shawn. Deborah Booker • The Honolulu Advertiser

Convenience and cost are her reasons: "Nowadays, I don't have time," said the 38-year-old mother of two from Nu'uanu. "Everybody is so busy."

But about 15 miles away in 'Aina Haina, Susan Donlon has chosen the other option, finding cloth diapers a more natural fit for her baby and her eco-conscious lifestyle.

"I just think it's better for the baby," said the 44-year-old mother of three. "It's more natural and it saves the environment."

But most parents today don't even think about cloth diapers — disposables are just too convenient. The numbers tell the story: Americans spend more than $3 billion on disposable diapers each year. Nine out of 10 diaper changes in the United States are made with a disposable product, reported Kimberly-Clark Corp., the manufacturer of Huggies brand diapers.

Advocates of cloth diapers, however, are quick to point out cost isn't an excuse any more and that cloth isn't the hassle that most people think.

"We're battling to get parents back into cloth," said Lori Moniz, president of Dolphin Diaper Service, the only cloth diaper service in Hawai'i, which provides diaper delivery and pick-up once a week. "We're battling people who think it's convenient and cheaper to use disposables." Moniz, who said she used disposable diapers with her first two children, has been an advocate of cloth diapers since discovering the benefits seven moths ago, when her youngest son was born.

"I had to fight (the urge to use disposables) myself in the beginning," said the 30-year-old Kailua resident, whose company has more than 60 clients. "But once I started using cloth, I realized it's not as hard as I thought."

Environmental impact

The choice is a personal one.

"A lot of ... (the decision-making) has to do with philosophy," said Dr. Jeremy Lam, pediatrician at Kapi'iolani Medical Center for Women and Children. "Parents who are very ecological-minded and recycle would be more apt to not cause more waste, and use cloth."

According to statistics provided by Dolphin Diaper Service, a disposable diaper takes up to 500 years to biodegrade; a cotton diaper biodegrades in less than six months. An article on Ecobaby.com reported that about 5 million tons of untreated body excrement, which may carry more than 100 intestinal viruses, makes its way into landfills via disposable diapers. Some of these viruses may leach into the water table. And each year an estimated 1 billion trees are used to make disposable diapers.

But cloth diapers aren't exempt from environmental snares.

"When you look at the environmental impact, it's equal," said Dr. Lisa Shigemura, pediatrician at Straub's Kane'ohe Family Health Center. "When you look at everything, it's such a personal preference."

The Vegetarian Times agrees, reporting that neither cloth diapers nor disposables are particularly "green," analogous to the paper-versus-plastic argument with regard to supermarket sacks.

Disposable diapers are made from wood pulp and from plastic derived from petroleum. Sewn into most disposables is a salt-based chemical that increases absorbency.

Cotton, though a renewable resource, is one of the most water-and-chemical-intensive crops grown, using an estimated 25 percent of the world's insecticides and 10 percent of the world's herbicides. Cloth, as with disposables, is processed in bleach, itself an environmental concern. And laundering cloth diapers uses water and energy, and releases detergents, bleaches and disinfectants into municipal wastewater treatment systems and the environment.

Despite evidence that cloth and disposable diapers can be environmentally detrimental, some parents still believe that cloth diapers are a greener choice.

"It just feels like the right decision," said Connie Conover, a certified nurse-midwife and expectant mother, who received a gift certificate for diaper services from friends. "It just seems like such a better way to go."

Pins are history

Cost was a factor for Tamashiro when she decided to use disposables, who said she spends about $30 a month on diapers.

Moniz said the cost of cloth diapers is $68 a month for 280 diapers, 24 cents a diaper, dropped off and picked up weekly. Today's cloth diapers are equipped with Velcro instead of pins, making them easier to use for parents and safer for babies.

Though Moniz said she has seen her business grow of late, the pediatricians interviewed reported no increase in parents using cloth diapers.

When she's asked, pediatrician Shigemura tells parents to use whatever they find comfortable: "Either one is fine. Most of my patients use disposables."

Most pediatricians, like Shigemura, don't advocate one over the other, although in some cases cloth may be recommended for babies who have allergies or skin sensitivities. But experts say there's no hard evidence that disposable diapers are solely responsible for diaper rash.

"That may be true for some babies with very sensitive skin," Shigemura said. "Disposable diapers may cause irritation."

But Shigemura, as well as others, said that more important than which diaper type is chosen is that parents understand the need for the baby to be changed regularly. "That's more important than (whether the baby's wearing) cloth or disposables," Shigemura said.

Pediatrician Lam said that though there are more cases of diaper dermatitis with babies using disposable diapers, that may be because there are more disposable-wearing infants. "You can get diaper dermatitis from using cloth diapers," Lam said. "Everything from fungus to bacteria to chemicals to allergies can cause that."

The American Academy of Pediatrics has stated that research suggests diaper rash is less common with the use of disposable diapers. But regardless of which type of diapers is used, diaper rash occurs less often and is less severe when diapers are changed often.

The consensus from experts is that parents need to make an individual decision about diaper type based on their child-rearing philosophy.

"My opinion is basically to look at the options," said Sandy Polson, a registered nurse and certified Lamaze childbirth educator at Kaiser Permanente's Honolulu Clinic, who used both cloth and disposables with her two daughters. "I think most people just think disposables and don't look at the options. Certainly, I realize it's hard to wash cloth diapers when you're busy yourself, but I would hope that people have an open mind."

Diaper rash problems

Some parents opt for cloth diapers to lower the risk of diaper rash. But experts say diaper rash is not restricted to infants wearing disposables, and failure to change diapers often enough is more often the key factor in this problem.

According to the American Academy of Pediatrics, diaper rash can be caused by too much moisture in the diaper area, chaffing or rubbing, prolonged contact of the skin with urine or feces, yeast or bacterial infection or an allergic reaction to diaper material.

More than half of babies between 4 months and 15 months of age develop diaper rash at least once in a two-month period.

To treat diaper rash, the AAP offers these tips:

• Change wet or soiled diapers often.
• Use clear water to cleanse the diaper area with each diaper change.
• Use a squirt bottle to apply water to avoid rubbing the skin too hard.
• Pat the area dry. Don't rub. Allow the area to air-dry completely.
• After the baby is dry, apply a thick layer of protective ointment or cream that contains zinc oxide or petrolatum to form a protective coating on the skin.
• Check with your pediatrician if the rash is accompanied by blisters or pus-filled sores, does not go away within 48 to 72 hours or spreads or gets worse.

Catherine E. Toth can be reached at ctoth@honoluluadvertiser.com.