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Diaper Need: A Change for Better Health

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Sallie Porter at Rutgers School of Nursing
Sallie Porter
Lorraine Steefel
Lorraine Steefel
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Although diapers are essential for child health, nearly one in three American families cannot afford them (National Diaper Bank Network, 2013). A gap referred to as diaper need, the difference between the numbers of diapers infants require to stay clean and comfortable less the amount of diapers a family can afford without cutting back on other basic essentials, can have severe consequences for infants parents, and society. Within the context of the need for and economics of diapers, these severe consequences alert pediatric nurses to the impact they can have to bridge the diaper gap, thereby helping to alleviate diaper-related conditions and providing holistic, family-centered care.
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PEDIATRIC NURSING/May-June 2015/Vol. 41/No. 3 141
D
iaper dermatitis is the most
common skin disorder diag-
nosed during infancy (Bor -
kowski, 2004; Scheinfeld,
2005). At least half of all infants
exhibit diaper dermatitis at least once
during their diapering years (Shin,
2005). Diaper-related conditions ac -
count for approximately one million
pediatric outpatient visits each year
for children four years of age and
under (Ward, Fleischer, Feldman, &
Krowchuk, 2000). Diaper-related diag-
noses include diaper dermatitis, Can -
didiasis of unspecified location, bal-
anitis, intertrigo, and vulvovaginitis.
Diaper dermatitis necessitates quick
treatment because it can progress to
skin breakdown with secondary infec-
tions, such as Candida albicans or
Staphylococcus aureus, and may re quire
hospitalization (Nield & Kamat,
2007).
Although frequent diaper change
is a primary means to prevention and
treatment of diaper dermatitis (Adalat,
Wall, & Goodyear, 2007; Borkowski,
2004; Heimall, Story, Stellar, & Davis,
2006; Nield & Kamat, 2007; Visscher,
2009), parents of the 5.7 million chil-
dren under three years of age who live
in poverty in the United States may
struggle to provide diapers for their
children (Addy & Wright, 2012). Eco -
nomic constraints may force parents
to make choices between the pur-
chase of sufficient diapers and the
purchase of other necessities, such as
food and clothing (Raver, Letourneau,
Scott, & D’Agostino, 2010). Purchas -
ing diapers with Supplemental Nu -
trition Assistance Program (SNAP)
funds (previously known as Food
This expected wet diaper guide-
line extrapolates to 2,555 diapers
needed per year (7 diapers/365 days)
with a total annual cost of approxi-
mately $945.00 for disposable dia-
pers, using an averaged per-unit cost
as found on an Internet-based retail
diaper distributor (www.diapers.com).
Based on the average 6.3 diapers used
per day for American infants, diaper
manufacturers estimate the cost high-
er at $1,500 annually (Browne, 2011;
Karp, 2011; Neff, 2011). The cost of
diapers may be even higher for fami-
lies with low incomes. Because of eco-
nomic constraints, these families
often cannot buy in bulk; lack trans-
portation to supermarkets, discount
stores, and warehouses with the low-
est diaper prices; have limited or no
Internet access for purchasing; and
must rely on local convenience stores
to purchase diapers. Cloth diapers are
seen by some as cost-saving because
they may be reused; however, low-
income families may not have ade-
quate resources required for the pur-
chase of sufficient amounts and facil-
ities for daily laundering. Further,
many child care centers require in -
fants to wear disposable diapers.
Diapers are considered a basic
necessity by almost all mothers (Raver
et al., 2010). With 48% of infants and
toddlers under three years of age in
the United States living in low-
income families, diapers may be a dif-
ficult-to-afford basic necessity (Addy
& Wright, 2010). Families need ap -
proximately twice as much income as
the federal poverty line’s estimate of
Stamps) or through the use of Special
Supplemental Nutrition Program for
Women, Infants and Children (WIC)
vouchers is not permitted. A gap,
referred to as diaper need, is created
when the amount of diapers needed
to keep infants comfortable and dry is
more than the ability to afford them
without resorting to cut backs on
other basic essentials.
The potentially severe complica-
tions of diaper need to infants, par-
ents, and society should motivate
pediatric nurses to work to lessen the
diaper gap and its consequences.
Pediatric nurses may address the eco-
nomic, causative factors with strate-
gies that tackle diaper need, thereby
helping to alleviate diaper-related
conditions and providing holistic
family-centered care. This article dis-
cusses the need for and economics of
diapers and the impact pediatric nurs-
es can make regarding diaper need on
both the patient-family and within
the pediatric system of care.
Diaper Economics
Diapers are expensive necessities
that help parents both maintain and
monitor their infant’s health. New -
borns should be changed frequently,
as often as every hour; older infants,
every three to four hours (Shin, 2005).
Pediatric nurses advise parents to look
for six-to-eight wet diapers per day to
determine that their infant is suffi-
ciently hydrated and taking in ade-
quate volumes of breast milk and/or
formula.
Although diapers are essential for child health, nearly one in three American fam-
ilies cannot afford them (National Diaper Bank Network, 2013). A gap referred to
as diaper need, the difference between the numbers of diapers infants require to
stay clean and comfortable less the amount of diapers a family can afford without
cutting back on other basic essentials, can have severe consequences for
infants, parents, and society. Within the context of the need for and economics
of diapers, these severe consequences alert pediatric nurses to the impact they
can have to bridge the diaper gap, thereby helping to alleviate diaper-related
conditions and providing holistic, family-centered care.
Sallie Porter, DNP, PhD, APN, is an
Assistant Professor, the University of
Medicine and Dentistry of New Jersey, School
of Nursing, Newark, NJ.
Lorraine Steefel, DNP, RN, is an Adjunct
Assistant Professor, the University of
Medicine and Dentistry of New Jersey, School
of Nursing, Newark, NJ.
Diaper Need: A Change for Better Health
Sallie Porter and Lorraine Steefel
142 PEDIATRIC NURSING/May-June 2015/Vol. 41/No. 3
what it takes to make ends meet just
to provide basic needs, such as hous-
ing and food (Addy & Wright, 2010).
Diaper need may be of significant
concern to many families with infants
and young children, with 27.5% of
pregnant and parenting women re -
porting diaper need in a recent study
(Smith, Kruse, Weir, & Goldblum, 2013).
Consequences of Diaper
Need
As shown in Table 1, diaper need
creates economic and health issues.
Norovirus, rotavirus, and other infec-
tious agents can contaminate feces.
Leaking and soiled diapers can lead to
the spread of illness within the family
Diaper Need: A Change for Better Health
economic resources (Raver et al.,
2010).
Because diaper changes are a rou-
tine part of infant caregiving, the in -
ability to meet an infant or toddler’s
need for sufficient diaper changes
may negatively affect maternal feel-
ings, such as a mother’s feelings of
being a good parent (Raver et al.,
2010). Mothers are distressed by dia-
per dermatitis (Heimall et al., 2006).
Mothers with infants who exhibit fre-
quent or severe diaper dermatitis may
have feelings of embarrassment, guilt,
and frustration. If diaper dermatitis is
severe and prolonged, allegations of
child abuse and neglect may occur
(Kazaks & Lane, 2000; Scheinfeld,
2005). Stress and concern related to
diaper need might have a negative
impact on parent-infant interaction.
This is especially important because
women with mental health issues
report a higher diaper need than
women without mental health con-
cerns, creating potentially greater risk
for negative social and emotional
effects (Smith et al., 2013). In order to
reduce diaper costs, mothers may
attempt developmentally inappropri-
ate toilet training.
Implications for Pediatric
Nurses
Approximately one-quarter (21%
to 27.5%) of parenting women report
diaper need in which they lack ade-
quate diapers to keep their child suffi-
ciently diapered for hygiene and com-
fort (Raver et al., 2010; Smith et al.,
2013). This, as well as the high fre-
quency of diaper dermatitis in very
young children, and the fact almost
half of infants and toddlers in the
United States live in low-income fam-
ilies, make it likely that pediatric nurs-
es will care for a child and family
experiencing diaper need (Addy &
Wright, 2012; Shin, 2005).
Diaper dermatitis is most often
managed in primary care settings
(Nield & Kamat, 2007) where routine
diaper dermatitis management advice
includes more frequent diaper chang-
ing and potential use of medications,
as well as parental support and educa-
tion (Gupta & Skinner, 2004). Pedia -
tric nurses need to consider diaper
need as a contributing factor or
underlying cause of diaper dermatitis
and include ways to ease the factors
causing diaper need as part of the
management plan.
and community (e.g., child care, com-
munity pools). Frequent hand-to-
mouth behavior by infants can exacer-
bate the spread of germs from soiled
diapers. Less frequent disposable dia-
per changes increase the risk of urinary
tract infection (Sugimura et al., 2009).
Without sufficient diapers, par-
ents may elect to keep children
home from child care, early child-
hood education, early Head Start,
early intervention, and therapy
appointments, thus limiting early
development/early education oppor-
tunities that are especially important
for low-income children (Palley,
2012). Diaper need may also cause
parents to stay at home and miss
work or school, further diminishing
Table 1.
Potential Consequences of Diaper Need
Factors Potential Consequences
Physical Discomfort or pain
Increased diaper-area breakdown
Urinary tract infection
Communicable disease
Poor hygiene
Oral-fecal contamination
Skin infections
Behavioral/
developmental
Irritability
Crying
Fussiness
Children kept home from child care and early childhood
development programs
Negative impact on peer relationships during toddler years
Reduced opportunities for enrichment
Parental attempts at developmentally inappropriate toilet training
Economic Purchase less clothing, food, or other necessities or baby care items
Borrow money or diapers
Utility bills or rent not paid
Medication prescriptions not filled
Parents miss work or school to tend to ill child
Payment of child care bills delayed
Social/
emotional
Maternal guilt
Maternal frustration
Maternal embarrassment
Negative impact on mother’s feelings of parenting
Cause parents to stay home and miss appointments
Allegations of child abuse and neglect
Family dynamics disrupted
Negative impact on parent-infant interaction
PEDIATRIC NURSING/May-June 2015/Vol. 41/No. 3 143
A first step toward addressing dia-
per need is taken with the recognition
of diaper need and the underlying
social factors that impact child and
family health. These factors may
include poverty, inadequate housing,
and low health literacy. To identify
individual families who are experi-
encing diaper need, the pediatric
nurse should complete a comprehen-
sive family social history at the child’s
first health encounter in a particular
pediatric setting. The family social
history should include assessment of
difficult economic circumstances
(e.g., job loss, food insecurity, health
insurance changes, homelessness)
and of new and chronic family stres-
sors. The family social history should
be updated at each subsequent child/
family health encounter. Pediatric
nurses should be aware of those fami-
lies who may be at special risk for dia-
per need, including parents with
more than one child in diapers,
mothers with mental health con-
cerns, and infants with conditions
that increase stooling (e.g., diarrheal
illness, neonatal abstinence syn-
drome, and short gut syndrome)
(Smith et al., 2013; Sublett, 2013).
After assessing child and family
needs, pediatric nurses may access
The Community Services Locator of
the MCH Library of Georgetown
University (http://www.mchlibrary.
info/KnowledgePaths/kp_communi
ty.html) and share relevant informa-
tion with parents in a non-stigmatiz-
ing way about national, state, and
their practice setting, pediatric nurses
may also establish a micro diaper
bank at their place of practice where
parents may obtain or donate diapers.
Pediatric nurses may initiate a diaper
drive with a local business, profes-
sional as sociation, or pediatric confer-
ence. They may reach out to their
local diaper bank to offer pediatric
health ex pertise to further the diaper
bank’s efforts.
Pediatric nurses should gather
stories about families experiencing
diaper need, document the frequency
of diaper need in their own practice
setting, and inform policy makers
(personal communication, Joanne
Goldblum, July 7, 2012). They should
also share the concept of diaper need
with other health care professionals
in staff meetings, grand rounds, child
health listservs, and professional asso-
ciations to raise awareness of diaper
need and advocate for child health
and well-being. Raising general com-
munity awareness about diaper need
may be an important role for pedi-
atric nurses and may be accomplished
through civic group speaking engage-
ments and letters to the editor.
Pediatric nurses may also encourage
the development of a mobile app to
assist families in locating local diaper
need resources.
References
Adalat, S., Wall, D., & Goodyear, H. (2007).
Diaper dermatitis-frequency and con-
tributory factors in hospital attending
children. Pediatric Dermatology, 24(5),
local resources available to assist with
concrete needs, such as the provision
of food, housing, utilities, or child
care. From resource listings available
at the National Diaper Bank Network
(http://www.diaperbanknetwork.org),
pediatric nurses can connect families
to a local diaper bank as a resource
that assists families to obtain diapers
(see Table 2). The pediatric nurse may
also find it helpful to keep an onsite
listing of local organizations and
groups that assist families.
Some families may need assis-
tance with transportation or navigat-
ing bureaucratic barriers to obtain
needed services. When providing in -
formation, pediatric nurses must con-
sider parents’ literacy level and their
culture and language, and provide
support and explanations where
needed. Reinforcement of verbal in -
formation via brochures, bulletin
boards, and websites may be helpful.
Additional support and explanations
may be necessary for parents who are
adolescents, have a disability, or are
illiterate.
Diaper need has advocacy impli-
cations for pediatric nurses. As child
advocates, pediatric nurses may advo-
cate for the elimination of health dis-
parities and inequities by supporting
polices that address social determi-
nants of health. The conditions and
systems in which people live and
work that are shaped by the distribu-
tion of money, power, and resources
(Centers for Disease Control and
Prevention, 2013). In concert with
Table 2.
United States Diaper Need Resources
Resource Website
Austin Diaper Bank Austin, TX www.austindiapers.org
Baby2Baby, Los Angeles, CA http://baby2baby.org
DC Diaper Bank, Washington, DC http://www.dcdiaperbank.org
Detroit Area Diaper Bank, Metro Detroit and Southwest MI http://www.detroitareadiaperbank.org
The Diaper Bank, North Haven, CT www.thediaperbank.org
Diaper Bank of South Arizona, Southern Arizona http://www.diaperbank.org
Help A Mother Out, California, Nationwide http://www.helpamotherout.org
Infant Crisis Services, Oklahoma City, OK http://www.infantcrisis.org
LA Diaper Drive, Los Angeles, CA http://www.diaperdrive.org
National Diaper Bank Network, Nationwide http://www.diaperbanknetwork.org
Nestlings Diaper Bank, Holland, MI http://www.nestlings.org
Project Undercover, Cranston, RI www.projectundercover.net
TriCities Diaper Min, Bristol, VA http://tridiaperbank.blogspot.com
West Side Baby, Seattle, WA http://www.westsidebaby.org
144 PEDIATRIC NURSING/May-June 2015/Vol. 41/No. 3
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... Although a requirement for the health and hygiene of infants and toddlers, millions of families in the United States with low incomes have unmet needs for diapers. 1 Diaper need forces families to make decisions about whether to spend money on diapers or on another basic needs, to have a supply of diapers adequate for changes at healthy intervals. [1][2][3][4][5][6] An issue of public health concern, the experience of diaper need negatively impacts physical health for children (e.g., susceptibility to skin and urinary tract infections as well as poor sleep) and mental health for parents and caregivers. [1][2][3][4][5][6][7][8][9][10] In an effort to save money on diapers, parents and caregivers may attempt to toilet train early, before children show signs of developmental readiness. ...
... [1][2][3][4][5][6] An issue of public health concern, the experience of diaper need negatively impacts physical health for children (e.g., susceptibility to skin and urinary tract infections as well as poor sleep) and mental health for parents and caregivers. [1][2][3][4][5][6][7][8][9][10] In an effort to save money on diapers, parents and caregivers may attempt to toilet train early, before children show signs of developmental readiness. 3,5 Although state and federal policy programs address some needs for food, housing, and health care, no such program exists to help families meet the basic need of diapers. ...
... [1][2][3][4][5][6][7][8][9][10] In an effort to save money on diapers, parents and caregivers may attempt to toilet train early, before children show signs of developmental readiness. 3,5 Although state and federal policy programs address some needs for food, housing, and health care, no such program exists to help families meet the basic need of diapers. Families experiencing diaper need have reported coexisting forms of material hardship, including food insecurity and challenges meeting needs for: housing, transportation, other hygiene products, education, utilities, and medical bills. ...
Priority Areas for Child Diaper Access: Low-Income Neighborhoods with Limited Retail Access to the Basic Need of Diapers
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Full-text available
  • Sep 2022
Introduction: Although a requirement for the health and hygiene of young children, millions of US families with low-incomes have unmet needs for diapers. The present study explored retail options in Durham County, NC for purchasing diapers in low-income neighborhoods in effort to increase our understanding of the overall context of diaper need. Methods: During June 2018, we visited 63 retailers selling 2460 child diaper products in 29 census tracts with a median household income ≤200% of the federal poverty guideline. Corner stores were the only retailers to sell products without original packaging, including one corner store selling loose diapers for $1.49 each. Next, we calculated bus routes to determine accessibility of the retailer with the lowest prices and greatest selection. One-way bus travel from all other census tracts to a big-box store required taking two buses combined with an average of 11 min walking for an average travel time of 43 min. We deemed census tracts as “priority areas for diaper access” when they were characterized as: (1) low income and (2) low access with no retailer selling all of the 10 most common child diaper sizes. Results: Nearly half (n=13) of the census tracts in our sample met our criteria for priority areas. We compared neighborhood characteristics of priority areas with all other county census tracts. Families living in priority areas were statistically significantly more likely to: identify as Black or African American, face challenges affording housing costs, have homes or automobiles in need of repair, experience neighborhood violence, and have less educational attainment.
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... Diaper need is defined as an inability to obtain supplies required to keep an infant dry, clean, and healthy without decreasing spending on food or other essential goods (Massengale et al., 2020;Porter & Steefel, 2015). Delayed diaper changing or reusing soiled diapers are common mitigation strategies (Feeding America, 2013;Massengale et al., 2017). ...
... Delayed diaper changing or reusing soiled diapers are common mitigation strategies (Feeding America, 2013;Massengale et al., 2017). Prolonged exposure to feces and urine erodes skin integrity, leading to dermatitis and increased risk of urinary tract infections (Blume-Peytavi et al., 2016;Porter & Steefel, 2015). Diaper need is associated with increased pediatric medical visits for dermatitis and urinary tract infections (Sobowale et al., 2021). ...
... Mothers experiencing diaper need have significantly higher depressive symptoms than their peers (Austin & Smith, 2017). Furthermore, as childcare attendance can be contingent on the provision of diapers, an inadequate supply prohibits parents from attending school or working to earn wages to purchase more diapers (Massengale et al., 2017;Porter & Steefel, 2015). The two primary federal programs for underresourced families with young children, the Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children, do not allow for diapers as a covered benefit. ...
Diaper Need as a Measure of Material Hardship During COVID-19
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  • Dec 2021
Background: Diaper need is a lack of reliable access to a sufficient quantity of diaper supplies. It is an essential pediatric social determinant of health measure that is useful for exploring the effects of the COVID-19 pandemic on families of young children. Objective: This study aimed to identify the predictors of diaper need and the associations between diaper need and psychosocial outcomes among underresourced families with neurodiverse children. Methods: This cross-sectional study included 129 caregivers of children aged 0-36 months who completed an online survey in early 2021, during the height of the COVID-19 pandemic. Participants completed a diaper need assessment, the Hunger Vital Signs Food Insecurity Screener, the Perceived Stress Scale, and the Infant Behavioral Questionnaire subscale. Relationships were explored using independent-samples t-tests, chi-square tests, and multiple regression analyses. Results: Seventy-six percent of caregivers reported some diaper need, and 87.6% reported food insecurity. Greater than one third (39.5%) reported high diaper need. Common mitigation strategies included using a towel or other cloth like a diaper, not using a diaper, and keeping the child in the same diaper for longer than usual. In multivariate modeling, food insecurity, household size, and parent age were significantly associated with high diaper need. Families experiencing food insecurity were 4.24 times more likely to experience high diaper need than food-secure families. High diaper need compared to low or no diaper need was associated with increased parent perceived stress. Discussion: We found high levels of diaper need and food insecurity for families during the COVID-19 pandemic. The association of high diaper need and stress indicates an inadequate supply of diapers adversely affects parent stress. Nurses may consider including diaper need in social determinants of health screening and prioritize connecting families to appropriate resources.
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... Diaper need is generally driven by the high cost of diapers for caregivers. Drawing on the approximate cost of diapers and estimates from diaper manufacturers, Porter and Steefel (2015) estimate that a family will spend between $945 and $1,500 diapering a single child for a year. Diapers can be disproportionately expensive for low-income families who are unable to afford the upfront cost of purchasing diapers in bulk, exacerbating long-term economic expenses (Boesch, 2018). ...
... Diaper need can also prevent a child from attending daycare because many facilities require caregivers to provide diapers (Smith et al., 2013). This can have economic consequences for parents who are forced to stay home with children, unable to attend work or school (Porter & Steefel, 2015. Researchers have also identified a correlation between diaper need and higher rates of maternal depression, as mothers experience guilt when they are unable to meet the needs of their child (Smith et al., 2013). ...
The Carework of Cloth Diapering: Opportunities and Challenges for Mitigating Diaper Need
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  • Apr 2023
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... 12 Diaper need is an adverse childhood experience linked to racialized poverty and worse mental and physical health for both children and parents. [16][17][18][19][20] Mothers of color report racialized diaper-related stigma, stress, and surveillance, suggesting that diaper need contributes to racial disparities in maternal and infant health. 21,22 Previous research reveals that parents cope with diaper need by using "diaper stretching" strategies associated with diaper dermatitis. ...
Racial Disparities in Incidence of Diaper Dermatitis and Implications for Diaper Inequities
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Full-text available
  • Sep 2024
Objectives: To examine if the likelihood of infants and toddlers requiring medical care for diaper dermatitis, a condition linked to infrequent diaper changes and possible diaper need, is different across racial/ethnic groups. Materials/Methods: This is a population-based retrospective study. We collected data via public records requests from the California Department of Health Care Access and Information to determine the number of patients aged 0 to 3 years diagnosed with diaper dermatitis from 2010 to 2021 in emergency departments (EDs) and hospitals. We used two sample t-tests to compare the incidences of ED visits and in-patient hospitalization during the 11-year time period to identify differences across racial/ethnic groups. Results: From 2010 to 2021, there were 184,097 total diagnoses of diaper dermatitis, 53,678 of which received in-patient treatment. The annual mean was 15,341 and ranged between 9,407 and 17,425. The prevalence (per 1,000 children aged 0–5 of the respective race) was highest for the Black population averaging 9.56 (range: 5.79 to 11.37). The prevalence was 5.93 (3.75 to 7) for the White population, 2.49 (1.78 to 3.14) for Asian/Pacific Islanders, and 6.67 (4.25 to 7.52) for the Hispanic population. We find that Black children were disproportionately diagnosed with diaper dermatitis in California hospitals and EDs (p < 0.001). Conclusions: Racial disparities in medical conditions that can result from lack of sufficient diapers point to diaper need as a social determinant of health deserving of greater public attention and policy redress.
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... [9][10][11][12][13] Nappy rash may seem a trivial condition but severe nappy rash may be an indication of child neglect/abuse and has the potential to progress to serious complications which require hospitalisation for example, vulvovaginitis and candidiasis. 9,14,15 Several key factors have been identified in the aetiology and pathophysiology of IAD (Figure 1), which are studied in this paper. 16 Currently, there is no internationally accepted method used to diagnose and categorise the severity of IAD. ...
The multi‐factorial modes of action of urease in the pathogenesis of incontinence associated dermatitis
Article
Full-text available
  • Mar 2024
Background Incontinence Associated Dermatitis (IAD) is a type of skin inflammation caused by chronic exposure to urine and/or faeces. Current treatment strategies involve creating a barrier between the skin and urine/faeces rather than targeting specific irritants. Urease expressing pathogens catalyse the conversion of urea, present in urine, into ammonia. The accumulation of ammonia causes an elevation in skin pH which is believed to activate faecal enzymes which damage skin, and opportunistic pathogens, which lead to secondary infections. Objectives To develop a better, multi‐factorial model of IAD pathogenesis, including the effect of urease‐expressing bacteria on skin, mechanism of damage of urease and urease‐triggered activity of faecal enzymes and secondary pathogens. To study the effect of urease inhibition on preventing IAD skin damage. Methods Five separate studies were made using ex vivo porcine skin and in vivo human skin models. Measurements of the change in skin barrier function were made using skin impedance, trans‐epidermal water loss (TEWL), stratum corneum moisture and pH. Skin was exposed to artificial urine, inoculated with various microbes, enzymes and chemicals to examine the influence of: 1) urease‐positive Proteus mirabilis 2) ammonia, 3) combination of P. mirabilis and a faecal enzyme, trypsin, 4) combination of P. mirabilis and opportunistic pathogens, Candida albicans and Staphylococcus aureus, 5) inhibition of urease using acetohydroxamic acid (AHA) on barrier function. Results The urease‐mediated production of ammonia had two principal effects: it elevated skin pH and caused inflammation, leading to significant breakdown in skin (stratum corneum) barrier function. Urease was found to further increase the activity of faecal enzymes and opportunistic pathogens, due to elevated skin pH. The urease inhibitor, AHA, was shown to have significantly reduced damage to skin barrier function, measured as its electrical resistance. Conclusions Targeted therapeutic strategies should be developed to prevent the manifestation of IAD, rather than creating a generic barrier between skin and urine/faeces. Urease has been identified as a crucial component in the manifestation of IAD, due to its role in the production of ammonia. Urease inhibition provides a promising therapeutic target to halt the progression of IAD.
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... Children in diapers require 8-12 diapers per day, costing *$70-80 per month. 1 A family experiences ''diaper need'' when they are unable to afford enough diapers without compromising on other basic needs, such as food, housing, utilities, and medical care. 2 Diaper need is associated with multiple adverse health outcomes, including increased pediatric care visits for diaper dermatitis and urinary tract infections and maternal depressive symptoms. 3,4 Two nationally representative studies of parents of young children suggest that about one in three experience diaper need. ...
Diaper Need During the COVID-19 Pandemic Associated with Poverty, Food Insecurity, and Chronic Illness: An Analysis of a Representative State Sample of Caretakers with Young Children
Article
Full-text available
  • Mar 2022
Objectives: Diaper need is an important form of material hardship for families with young children. This study quantified diaper need during the COVID-19 pandemic and examined factors associated with diaper need. Methods: Using a representative statewide sample of adults in Massachusetts, diaper need was assessed during the COVID-19 pandemic among respondents with at least one child 0–4 years of age in diapers (n=353). Bivariate tests examined associations between diaper need and individual and household factors. Multivariable regression was used to examine associations between diaper need and demographic factors, job loss, and mental health during the pandemic. Results: More than one in three respondents reported diaper need (36.0%). Demographic factors associated with diaper need were age <25 years, Latino ethnicity, having less than a high school degree, unemployment before the pandemic, household income <50,000,householdfoodinsecurity,orhavingahouseholdmemberwithachronicdisease.Diaperneedwashigheramongrespondentswhoutilizedanutritionassistanceprogramorafoodpantryduringthepandemic.Inmultivariableanalysesconsideringjoblossandmentalhealthduringthepandemic,diaperneedwasassociatedwithhouseholdincome<50,000, household food insecurity, or having a household member with a chronic disease. Diaper need was higher among respondents who utilized a nutrition assistance program or a food pantry during the pandemic. In multivariable analyses considering job loss and mental health during the pandemic, diaper need was associated with household income <50,000 (odds ratio [OR] 3.61; confidence interval [95% CI] 1.40–9.26) and a chronic disease diagnosis within the household (OR 4.26; 95% CI 1.77–10.29). Conclusions: This study indicates a level of diaper need similar to what was documented before the COVID-19 pandemic despite federal stimulus payments and increased distributions by local diaper banks. The findings identify groups at increased risk and suggest opportunities to reach those at risk through food assistance programs.
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... 3,4 Diaper need is the gap between the number of diapers required for infants to stay clean and the number of diapers a family can afford without cutting back on other basic needs. 5 Diapering an infant is a primary parental activity, but for low-income families, diapering imposes a significant financial burden. The U.S. Bureau of Labor Statistics reported the poorest 20% of families spent almost 14% of their 2014 household income on diapers. ...
Diaper Need is Associated with Pediatric Care Utilization: An Analysis of a Nationally Representative Sample of Parents of Young Children
Article
  • Oct 2020
Objective To examine the possible association between diaper need, difficulty affording an adequate amount of diapers, and pediatric care visits for urinary tract infections (UTIs) and diaper dermatitis (DD). Study design This cross-sectional analysis using nationally representative survey data collected July-August 2017 using a web-based panel, examined 981 parents of children between 0-3 years old in the United States (response rate, 94%). Survey weighting for differential probabilities of selection and nonresponse was used to estimate the prevalence of diaper need and to perform multivariable logistic regression of the association between parent reported diaper need and visits to the pediatrician for diaper rash or urinary tract infections within the past 12-months. Results An estimated 36% of parents endorsed diaper need. Both diaper need (adjusted odds ratio [aOR] 2.37; 95% CI 1.69–3.31) and visiting organizations to receive diapers (aOR 2.14; 95% CI 1.43–3.21) were associated with DD visits. Similar associations were found for diaper need (aOR 2.63; 95% CI 1.54–4.49) and visiting organizations to receive diapers (aOR 4.50; 95% CI 2.63–7.70) for UTI visits. Conclusions Diaper need is common and associated with increased pediatric care visits. These findings suggest pediatric provider and policy interventions decreasing diaper need could improve child health and reduce associated health care utilization.
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Prevalence of diaper need and diaper dermatitis and associated risk factors among children aged 1–24 months in a referral hospital in Ghana: A cross-sectional study
Article
Full-text available
  • May 2023
Objectives This research aimed to determine the prevalence of diaper need and diaper dermatitis (DD) and associated risk factors in children aged 1–24 months. Methods Data were collected through face-to-face exit interviews with 456 mothers at a Child Welfare Clinic. A chi-square, correlation, and multivariate logistic regression analyses at a significance level of p < 0.05 were conducted. Results The prevalence of diaper need was found to be 53.5%, with lower odds observed in households with monthly incomes greater than 167andinchildrenonbreastmilkonly.Diaperneedwashigherinparentswithnoformaleducationanduseofdisposablediapers.TheprevalenceofDDwas27.4167 and in children on breastmilk only. Diaper need was higher in parents with no formal education and use of disposable diapers. The prevalence of DD was 27.4%, with lower odds observed in households with monthly incomes greater than 167 and in children less than 6 months old and on breastmilk only. There was a moderately positive correlation between diaper need and DD. Conclusion The researchers recommend affordable alternative diapering methods and educating parents on the importance of frequent diaper changes to improve the prevalence of diaper need and DD. Overall, this study highlights the significant prevalence of diaper need and DD among children and identifies the important associated risk factors.
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Detecting and monitoring incontinence associated dermatitis: Does impedance spectroscopy have a part to play?
Article
  • Mar 2023
  • P I MECH ENG H
In this review, current understanding of the prevention and treatment of Incontinence Associated Dermatitis (IAD) is discussed. The need for preventative measures which target specific faecal/urinary irritants is highlighted, including the role of urease inhibitors. There is no existing internationally and clinically accepted method to diagnose and categorise the severity of IAD. Diagnosis currently relies on visual inspection; non-invasive techniques to assess skin barrier function could remove subjectiveness, particularly in darker skin tones. Impedance spectroscopy is a non-invasive technique which can be used to monitor skin barrier function, supporting visual assessments. Six studies (2003-2021) which used impedance to assess dermatitis were reviewed; inflamed skin was distinguishable from healthy skin in each case. This suggests that impedance spectroscopy could be useful in diagnosis early-stage IAD, potentially enabling earlier intervention. Finally, the authors present their initial findings on the role of urease in skin breakdown in an in vivo IAD model, using impedance spectroscopy.
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A Quality Improvement Approach to Perineal Skin Care: Using Standardized Guidelines and Novel Diaper Wipes to Reduce Diaper Dermatitis in NICU Infants
Article
  • Sep 2020
Background: Diaper dermatitis (DD) causes discomfort and emotional distress and creates possible sources of infection among newborn intensive care unit infants. Diaper dermatitis remains prevalent despite studies documenting an understanding of prevention and treatment modalities. Standardizing perineal skin care guidelines could reduce DD. Purpose: Implement perineal skin care guidelines, while introducing novel diaper wipes, to decrease the incidence of DD by 20% within a 1-year period. Methods: Our unit reviewed evidence-based literature to develop a standardized perineal care guideline for prevention and treatment, encompassing the use of novel, preservative-free diaper wipes with grapefruit seed extract. The outcome measures were the incidence and duration of DD. Process compliances were monitored. The balancing measure was the rate of fungal skin infection while using preservative-free wipes. Findings: Between July 2017 and March 2019, 1070 infants were admitted for 1 or more days, with 11% of those being born at less than 30 weeks of gestational age. After guideline implementation in January 2018, the incidence of DD decreased by 16.7%. The incidence of severe cases dropped by 34.9%, with 3.5 days per 100 patient-days shortened duration. Process compliance was achieved. Neonates tolerated the novel wipes without increased fungal skin infection. Implications for practice: The Perineal Skin Care Guidelines could reduce the rate and duration of DD. Newborn intensive care unit infants tolerated the novel diaper wipes. Implications for research: Additional research on wipes containing other types of extracts or ingredients.
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Diaper Need and Its Impact on Child Health
Article
Full-text available
  • Jul 2013
  • Pediatrics
Background: This is the first peer-reviewed study to quantify diaper need, propose a method to measure diaper need, and explore psychosocial variables associated with diaper need in a large sample of urban, low-income families. Methods: Data were derived from a cross-sectional study in 877 pregnant and parenting women. Mothers completed surveys on topics related to mental health, basic needs, and health care use. Logistic regression was used to estimate the relationship between diaper need and psychosocial correlates. Results: Almost 30% of mothers reported diaper need. Hispanic women were significantly more likely to report diaper need than African American women (odds ratio [OR]: 1.96; 95% confidence interval [CI]: 1.51-3.33), and women ≥ 45 years of age were significantly more likely than women between the ages of 20 and 44 years to report diaper need (OR: 2.53; 95% CI: 1.21-5.28). Women who reported mental health need were significantly more likely than women who did not report mental health need to report diaper need (OR: 1.89; 95% CI: 1.16-3.09). Conclusions: Although a majority of studies have examined family socioeconomic status as income and educational and employment status, emerging research suggests that indicators of material hardship are increasingly important to child health. This study supports this premise with the suggestion that an adequate supply of diapers may prove a tangible way of reducing parenting stress, a critical factor influencing child health and development. There is potential for pediatric providers to inquire about diaper need and refer families to a local diaper distribution service as 1 method to reduce parenting stress.
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Expected struggles: U.S. child care policy
Article
  • Apr 2012
  • CHILD YOUTH SERV REV
Many industrialized countries have publically supported child care policies in place. However, the United States is an outlier in this policy realm. The child care policies that exist in the U.S. are very limited and they are framed as poverty based programs. This article is based on interviews with 19 child care policy experts including policy advocates, researchers, and funders. In addition, secondary data is examined to explain how advocates for a seemingly out of favor issue seek to position themselves both individually and collectively to get this issue placed on the national agenda. The findings suggest that the child care advocates have developed multiple frames to address child care policy. Some advocacy groups and their spokespeople have framed child care as a poverty issue, others have framed it as a women's rights issue and, more recently, some policy advocates have framed child care as an educational issue. Sometimes, there is overlap and the same group may frame child care issues differently depending upon the legislative issue at hand. In part, these frames reflect existing policies as a result of what Pierson (1993) refers to as policy feedback. Nonetheless, this lack of cohesion in framing has led to the continued development of policies that have created multiple interest groups, all seeking resources for similar goals that are not always aligned.
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Recent advances in diaper dermatitis: Etiology and treatment
Article
  • Feb 2009
Diaper dermatitis is a highly prevalent condition that causes discomfort and stress for patients and frustration for healthcare staff. Diaper technology has evolved to substantially lessen the severity of diaper dermatitis, but additional improvements are needed. Premature infants and incontinent adults are particularly at risk for developing diaper dermatitis and its potential consequences. Contributing factors include overhydration, irritants, friction, increased skin pH, diet, gestational age, antibiotic use, diarrhea and medical condition. Treatments aim to reduce hydration, provide a semipermeable 'layer' to facilitate skin barrier repair, shield the skin from irritants, deactivate specific fecal components and maintain skin surface contact. The published research on the effects of diaper dermatitis treatments is especially sparse. Controlled clinical trials are needed to provide definitive evidence for selection of effective treatments. This article discusses the incidence and etiology of diaper dermatitis in infants and adults. It provides the scientific basis for repair of diaper skin barrier damage and describes recent developments that will be available in the future.
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Neonatal Abstinence Syndrome: Therapeutic Interventions
Article
  • Nov 2012
Neonatal Abstinence Syndrome (NAS) occurs in infants exposed to opiates or illicit drugs during pregnancy. It can be severe and cause long hospital stays after birth and with symptoms up to 6 months after birth. Pharmacologic interventions are commonly used as treatment for NAS; however, their safety and efficacy are not fully recognized. Pharmacologic treatments for NAS include medications such as methadone, buprenorphine, morphine, and phenobarbital. Nonpharmacologic interventions and complementary therapies have been documented in neonates. However, there are gaps in literature regarding these therapies in neonatal withdrawal. This article provides an overview of the possible risks, benefits, and outcomes of pharmacologic and complementary therapies in the neonatal population and illustrates the gaps in their use for neonatal withdrawal.
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Diaper Dermatitis‐Frequency and Contributory Factors in Hospital Attending Children
Article
  • Oct 2007
  • PEDIATR DERMATOL
  The incidence and prevalence of diaper dermatitis varies widely between published studies. It is a condition which causes considerable parental anxiety. To better understand the frequency of diaper dermatitis, treatment practices, and the current importance of previously identified etiologic factors, a questionnaire survey of parents who had children wearing diapers (n = 532) attending a large United Kingdom district general hospital was undertaken. At the time of survey, only 16% of the study population had diaper dermatitis. Forty-eight percent of the study population had never had an episode of diaper dermatitis. In a multivariate analysis, current diaper dermatitis was independently associated with four factors: presence of oral thrush, number of previous episodes, frequency of diaper changes, and diarrhea. Recurrent episodes of diaper dermatitis were associated with increasing age, lack of barrier cream use, current diaper rash, and frequency of diaper changes. In the majority of children with diaper dermatitis at the time of survey, treatment had been instituted in the community. Diaper dermatitis usually presents and is treated successfully outside the hospital setting and is not a common clinical problem in secondary care.
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Beginning at the Bottom: Evidence-Based Care of Diaper Dermatitis
Article
  • Nov 2011
Diaper dermatitis (DD), an acute inflammatory reaction of skin in the perineal area, is an extremely common pediatric condition. Nurses' practice of preventing and treating DD is inconsistent and often not evidence-based. In addition, a 2008 Skin Injury Prevalence Study at our hospital revealed that 24% of inpatients had DD. The authors developed a project to determine a consistent and evidence-based approach to DD prevention and treatment including the availability of products. A complete literature review was conducted in addition to benchmarking with other pediatric hospitals, consultation with topic experts, and evaluation of current nursing practice prior to revising the existing perineal skin care nursing standard. The evidence supports frequent diaper changes, use of super absorbent diapers, and protection of perineal skin with a product containing petrolatum and/or zinc oxide. As supported by the literature, we revised the standard to include improvements in practice as well as product updates for prevention and treatment. Hospital-wide implementation of the revised standard included training "Skin Care Champions" to educate staff and support practice improvements. Ongoing education and monitoring by the Skin Care Champions is necessary to further improve the prevention and treatment of DD for our patients.
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Association Between the Frequency of Disposable Diaper Changing and Urinary Tract Infection in Infants
Article
  • Jan 2009
Often diapers are not changed after infants pass urine. To define the association between the frequency of changing diapers and urinary tract infection (UTI) in infants. Urine samples were tested in 131 infants (aged from 2 months to 2.5 years) who had a temperature > or =38 degrees C. The authors investigated the number of times diapers were changed daily. A total of 128 infants, excluding 3 cases, were divided into 2 groups: group A, without UTI (n = 96); group B, with UTI (n = 32). The number of times diapers were changed was compared between the groups. In group A and group B, the number of times diapers were changed daily were 7.5 +/- 1.4 and 4.7 +/- 1.4, respectively. The number of times diapers were changed was significantly lower (P < .0001) in group B than in group A. Among infants wearing disposable diapers, there is an increased risk of UTI as the frequency of changing diapers decreases.
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Characterization of Diaper Dermatitis in the United States
Article
  • Oct 2000
  • Arch Pediatr Adolesc Med
Diaper dermatitis is the most common dermatologic disorder of infancy. This study evaluates the frequency of outpatient visits resulting in this diagnosis, specialties of physicians providing services, demographics of patients, and leading agents used in treatment. Records of 272,841 encounters from the National Ambulatory Medical Care Survey (1990-1997) were examined for visits in which diaper dermatitis was diagnosed in children. The likelihood of diagnosis in the general pediatric population was calculated and the leading treatment agents were ranked. There were approximately 8.2 million visits in which diaper dermatitis was diagnosed. For the pediatric population in the at-risk age range, there was a 1 in 4 likelihood of being diagnosed with the skin disorder. Pediatricians provided 75% of services for the treatment of diaper dermatitis; the demographics of patients were similar to those of comparably aged individuals in the general population. Nystatin was the leading treatment agent prescribed (27% of visits), followed by clotrimazole (16%), a combination product of nystatin and triamcinolone (16%), hydrocortisone (8%), and a combination product of clotrimazole and betamethasone dipropionate (6%). Visits for diaper dermatitis are frequent, and pediatricians are the physicians most often called on to provide treatment. No portion of the pediatric population is disproportionately diagnosed. The frequent use of potent corticosteroids contained in combination agents is a potential target for improving the management of diaper dermatitis.
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Diaper dermatitis that does not quit
Article
  • Mar 2005
Diaper dermatitis is one of the most common skin disorders in infants. The humid, moist environment under the diaper makes the skin more susceptible to injury from exposure to irritants particularly related to urine and feces. A gentle cleansing routine, frequent diaper changes, and a thick barrier cream help control this condition. Irritant diaper dermatitis should be distinguished from other skin conditions that may develop in this sensitive area.
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