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Deciding on nappies- cloth versus disposable

They say that if you keep an item of clothing in your cupboard for long enough, it is bound to come back into fashion. Recently I noticed a number of babies coming into my practice with their bottoms clad in colourful cloth nappies. They are certainly a far cry from the bulky, terry nappies of years gone by but it would seem that cloth nappies are definitely coming back into fashion. The question is which one is best?

From my research it would appear that a case can be made for both. One would need to consider which makes the most sense to you in terms of your lifestyle, environmental concerns, cost constraints and time. The medical fraternity hasn’t had too much to say about this quandary but I did come across some interesting medical data that is worth adding to the debate.

What is the effect on the environment?

When chatting to the parents in my practice it would appear that this is the number one motivating factor for reverting to cloth nappies. However, cloth nappies do also have an impact on the environment. Let’s take a look

  • LandfillsStudies show that disposable nappies take around five hundred years to disintegrate in our landfills. Looking at it that way it means that if a baby had worn a disposable nappy on board Jan Van Riebeeck’s ship, which arrived in the Cape in 1652 it would still be needing a further 131 years to decompose. Yikes!

-Cloth nappies do not pose the same landfill issue if they are repurposed, passed on or placed in the compost as long as the plastic clips have been removed.

  • MethaneIf a baby in disposable nappies is responsible for 680kg’s of methane gas in the first two and a half years of life then out little treasures are producing as much greenhouse gas as a cow produces in 6 years. To think that cows have been getting the bad wrap for global warming all this time! The methane gas comes from stool being left in the nappy when it is thrown away and ends up in landfills.

On the flipside, a UK Environmental study found that 560kg’s of methane is produced by a baby in cloth nappies in the first two and a half years.

  • Natural ResourcesDisposable nappies make use of materials that are often sourced from unsustainably logged forests. While a lot has been done to reduce the use of these materials the new gel used in these nappies has impacted their biodegradability. A recent study conducted by the CSIR has cited the very real possibility of using chicken feathers as an alternative to the absorbent gel. Chicken feathers have the features necessary to meet the requirements of comfort, ability to absorb moisture, prevent leakage and are durable.

-Cotton nappies, as their name suggests rely on a crop which requires a lot of pesticides, fertilizers and water to get a yield. These nappies do need to be washed at 60⁰C to kill off any harmful bugs. In many cases parents resort to tumble drying nappies. The washing process is then contributing to larger carbon emissions. Obviously washing involves water, electricity and detergents. These factors also place a burden on natural resources.

What about the cost?

A baby generally uses six to eight nappies a day. This will probably amount to about 10 000 nappies before your baby is potty trained. At current prices it is estimated that disposable nappies will probably cost you around R30 000 versus R15 000 for the cloth nappies in a 30 month period. Obviously if you are able to pass the cloth nappies on to your next child they become even more economical.

Cloth nappies will however require a much bigger outlay initially because you will probably start with around 24 nappies. This is so that you don’t have to wash every day.

Time is also a cost factor for many parents. Making time for washing cloth nappies during a busy work day may seem daunting.

I have heard that disposable nappies contain chemicals. Should I be concerned?

Disposable nappies do contain a number of chemicals. In the controversy around cloth versus disposable nappies it has been strongly suggested that disposable nappies are responsible for exposing babies to chemicals which may cause harm. These chemicals include perfumes, dyes, adhesive chemicals, dioxin and so on.

Those in the disposable nappy industry have however, done extensive research into the products and assure users that they are safe. One such study categorically states “The majority of the diaper materials are polymers that are safe and do not have inherent toxicity issues. Trace amounts of non-polymeric materials, such as colorants, are assessed based on their skin contact potential. New materials or design features are introduced in marketed products only if they have been shown to be safe under the conditions of recommended or foreseeable use.”

The major concern with these chemicals is that they may cause skin rashes or be absorbed by the baby’s skin and thereby cause harm.

What does the medical fraternity recommend?

In 1949 the Journal of Paediatrics published an article in which medical conditions arising from nappies were considered. At this time cloth nappies were definitely the order of the day. The conditions included intertrigo (infection in the creases of the groin), diaper rash, ammoniacal dermatitis and urinary tract infections. Out of this study came the recommendation for nappies that met 11 criteria. These included comfort, convenience, cost and good absorptive ability. Industry sprang into action to meet these requirements and the disposable nappy was born.

Current studies have considered the medical impact of both cloth and disposable nappies. These include:

  • Diaper Dermatitis/Nappy rashA baby’s skin is susceptible to irritation especially in the nappy area because it is exposed to urine, poop and friction. These factors trigger inflammation of the skin resulting in a raised, red, painful rash that causes the skin to flake off. Research has shown that disposable nappies are so effective at keeping the baby’s skin out of contact with the urine and poop that this condition has decreased by 50% since the 1980’s. The new 3 layered reusable nappies have responded to parent’s desire for more natural products and these do offer better protection against diaper dermatitis than the other cloth nappies. Understand that most children will experience diaper dermatitis at some stage of their lives but seems to be more common in the age group 9 to 12 months.
  • Diaper Dye DermatitisSome disposable nappies have fun blue, pink and green dyes added to them. Unfortunately, these same dyes may cause an allergy to some babies and result in a rash. It is important to remove the allergen from contact with your baby’s skin by either choosing a dye-free disposable or a cloth nappy.
  • EnuresisThis is a condition in which children over the age of 5 years still wet their beds at night. These children are neurologically normal but there is a delay in brain-bladder function. This condition has many causes but a recent study has linked prolonged disposable nappy use as another possible cause. Disposable nappies are so effective at keeping the child comfortable that the warning from the brain that a full bladder means discomfort has been affected. Enuresis does have a social and psychological effect on children.
  • Delayed toilet training- In the 1950’s it was usual for children to potty train between the ages of 18 months to 2 years. Nowadays the age is closer to 3 or 3.5 years. Toilet training is linked to a child’s ability to communicate and their readiness to toilet train. If a child is not uncomfortable the likelihood of wanting the nappy off is lessened. While there are guidelines on toilet training, researchers do warn that delaying potty training for too long can result in a dysfunctional bladder. Be it really effective disposable nappies or the new reusable nappies, parents need to be aware of the need for children to develop the neurological pathway necessary for bladder control. This is achieved during toilet training at an appropriate age.
  • DrowningsIn days when nappy buckets were common in households many children drowned when they fell head first into the buckets. Toddlers are naturally inquisitive and water always holds an attraction. Due to a toddlers center of gravity and under developed co-ordination, it makes it difficult for them to get out of the bucket once they are in face down. The majority of drownings were children who had learnt to pull themselves up to standing or first walking. If you are using cloth nappies which require soaking before washing, a very secure lid is required. The bucket should ideally be stored up and away from any toddlers reach.


Disposable nappies do definitely contribute to the problem of waste management. In South Africa 1.1 million tons are thrown away each year and those that are not discarded properly are posing a risk to our river systems. Pick-it-up announced last year that Johannesburg’s landfills were reaching capacity.  In South Africa 80% of children currently wear disposable nappies meaning that the environmental issue should become a driving factor for reducing the use of disposable nappies. On the other hand convenience, time and other environmental factors still make disposable nappies attractive. If your child does have recurrent, difficult to treat nappy rash then finding an alternative nappy is important. In all probability a combination of day time cloth nappies and disposable nappies, which are less likely to leak at night, may prove to be the most popular choice for parents.

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