Diaper dermatitis: a survey of risk factors in Thai children aged under 24 months.

BACKGROUND: To identify the prevalence and risk factors associated with diaper dermatitis in Thai children aged 1-24 months. METHODS: This was a cross-sectional study of 1153 participants using structural questionnaires, which was conducted at Khon Kaen University Faculty of Medicine Pediatric department in Thailand. Univariate and multivariate logistic regression analyses were used to test the association between diaper dermatitis and its possible risk factors. RESULTS: The prevalence of diaper dermatitis among the study population was 36.1%, a rate which significantly decreased with age. The highest prevalence was found in subjects who were one to six months old. Risk factors that had a statistically significant association with diaper dermatitis in both univariate and multivariate analysis were i) diaper changing fewer than three times/night, ii) previous episodes of diaper rash, iii) using cloth diapers, and iv) topical application of baby talcum powder to the diaper area. CONCLUSIONS: Frequent diaper changings during the daytime do not compensate for fewer changings during the night. Moreover, the use of baby talcum powder on the diaper area significantly increased the risk of diaper dermatitis among the study population. These findings should be applied in future preventive strategies for diaper dermatitis in this age group.

Neonatal skin care: Developments in care to maintain neonatal barrier function and prevention of diaper dermatitis.

BACKGROUND: Understanding the importance of the barrier function of the skin of preterm and term neonates is crucial in effective neonatal skin and diaper care. This literature search aimed to review the development of different practices in neonatal care to maintain skin barrier function, in turn preventing diaper dermatitis. METHODS: We performed two quantitative literature searches of English language studies: an initial literature search of studies published in the last 5 years was conducted using Cinahl, Medline, Embase, British Nursing Index, and DelphiS, followed by a second search of publications from 1990 to 2017 using the National Institute of Clinical Excellence Health Databases Advanced Search using key words, synonyms, and Boolean phrasing. Titles and abstracts were reviewed for relevance. RESULTS: One hundred ten studies were analyzed for the purpose of this review; however, data are of variable quality. Guidance can be drawn from the existing literature relating to best practice options for diaper area cleansing methods, diaper type selection, and use of barrier creams. More research is required into the benefit or otherwise of diaper-free time. CONCLUSIONS: Super-absorbent diapers reduce moisture at skin level and reduce diaper dermatitis. Barrier creams carry benefit both in prevention and cure but do not provide a substitute for frequent diaper changes. The literature does not demonstrate superiority of one cleansing method over another, but neither the use of wipes nor water increases diaper dermatitis prevalence. Further studies are required to explore the potential benefit of diaper-free time, taking due consideration of the practicalities, particularly for vulnerable neonates within the Intensive Care setting.

The impact of diaper design on mitigating known causes of diaper dermatitis.

BACKGROUND: Diapers play a critical role in infant health. In addition to providing sanitary methods of disposing of urine and feces, they can also directly impact skin health. Prolonged exposure to wetness and fecal matter has been shown to be a key driver of diaper dermatitis. This study sought to evaluate how diaper construction can affect absorption of stool. METHODS: Methods included laboratory testing of stool absorbency as well as an at-home diaper evaluation study, which examined a diaper's ability to keep fecal matter from the skin. Breastfed infant stool was given special consideration, as its properties make it difficult to contain. RESULTS: Laboratory results demonstrated that a meshlike aperture diaper was better able to absorb fecal matter. The at-home diaper evaluation study confirmed that a meshlike aperture diaper design resulted in fewer instances of stool being present on skin during diaper changes. CONCLUSION: Diapers with a meshlike aperture topsheet may represent a better way to mitigate known causes of diaper dermatitis through their superior ability to absorb fecal matter.

Prevention and treatment of diaper dermatitis.

Diaper dermatitis (DD) is one of the most common skin conditions that infants suffer from and their caregivers manage in the first months post-birth. As such, questions of effective prevention and treatment of the condition often arise. Nonmedical skincare practices that support healthy skin barrier function can prevent DD manifestation or alleviate the condition in many cases. The usage of barrier emollients and improved diaper technology contributes to keeping moisture and irritants away from an infant's delicate skin. This paper addresses facts behind commonly asked questions from caregivers regarding DD and discusses effective measures to prevent and treat the condition.

Diaper Use Increases the Risk of Buttock and Perineal Abscesses.

OBJECTIVES: Over the last decade, there has been a notable increase in the incidence of abscesses. Children in the diaper-wearing age group are disproportionately affected, and most of these abscesses occur in the buttock and perineal region. Using case-control methodology, we sought to determine if diaper use itself is an independent risk factor for abscess formation. METHODS: Cases were patients, at least 2 years of age but less than 4 years, who presented to the emergency department with a complaint of a buttock or perineal abscess. Age-matched controls presented to the emergency department for unrelated reasons. Caregivers of subjects responded to a survey regarding diaper use (toilet trained, for sleep only, or all day), type and brand of diaper, and diaper hygiene-related factors. RESULTS: We enrolled 465 patients (93 cases, 372 controls). Fully toilet trained children were less likely to have buttock and perineal abscess than their sleep-only and all-day diaper-wearing peers. Limiting diaper use to naptime and overnights (sleep only) did not confer protection against abscesses. Diaper hygiene-related factors did not affect the risk of abscess formation. Female sex was also identified as a strong risk factor for buttock and perineal abscess formation. CONCLUSIONS: Diaper use is a potentially modifiable risk factor for buttock and perineal abscess formation in young children.

Safety evaluation for ingredients used in baby care products: Consideration of diaper rash.

Diaper rash can adversely impact the barrier properties of skin, with potential implications for increased absorption of chemicals through the skin, and this should be accounted for in any exposure assessment used in the safety evaluation of consumer products used in the diaper ("nappy") area. In the absence of a quantitative evaluation of the potential impact of diaper rash, a default assumption of 100% dermal penetration is often made for substances applied in the diaper area. We consider here the extent, duration and severity of diaper rash and make a recommendation for conservative assumptions to incorporate into exposure assessments. Using a time-weighted average, the potential impact of diaper rash is illustrated for substances that have varying degrees of absorption through healthy skin. Results confirm that for assessments that already assume dermal absorption of 50% or higher, there is no impact on the overall exposure assessment. For substances that have a very low degree of dermal penetration (1%) through healthy skin, the impact of rash is expected to be less-than four-fold. This can be refined with additional data as there are many examples of poorly absorbed compounds for which dermal penetration is still low even for compromised skin.

Bullous diaper dermatitis with cloth diaper use.

Irritant diaper dermatitis occurs at a higher frequency with cloth diaper use than disposable diapers. We present four cases of vesiculobullous, erosive diaper dermatitis occurring in older infants and toddlers with cloth diaper use that resolved completely after transitioning to disposable diapers. This is the first report of vesicles and bullae as a type of irritant diaper dermatitis.

Reflex Seizures Triggered by Diaper Change in Dravet Syndrome.

Dravet syndrome (DS) is a severe epilepsy syndrome characterized by early onset of multiple types of seizures. We report the first case of reflex seizures triggered by diaper change in a girl at 9 months old and 2 years old with a mutation in the SCN1A gene causing DS. Reflex seizures have been reported in patients with DS provoked by increased body temperature or visual stimulation. The case we report widens the spectrum of triggers causing reflex seizures in children with DS. Cortical hyperexcitability resulting from the genetic defect explains the tendency to experience such reflex seizures.

Exposure Factor considerations for safety evaluation of modern disposable diapers.

Modern disposable diapers are complex products and ubiquitous globally. A robust safety assessment for disposable diapers include two important exposure parameters, i) frequency of diaper use & ii) constituent transfer from diaper to skin from direct and indirect skin contact materials. This article uses published information and original studies to quantify the exposure parameters for diapers. Using growth tables for the first three years of diapered life, an average body weight of 10-11 kg can be calculated, with a 10th percentile for females (8.5-8.8 kg). Data from surveys and diary studies were conducted to determine the frequency of use of diapers. The overall mean in the US is 4.7 diapers per day with a 75th, 90th, and 95th percentile of 5.0, 6.0, and 7.0 respectively. Using diaper topsheet-lotion transfer as a model, direct transfer to skin from the topsheet was 3.0-4.3% of the starting amount of lotion. Indirect transfer of diaper core materials as a measure of re-wetting of the skin via urine resurfacing back to the topsheet under pressure was estimated at a range of 0.32-0.66% averaging 0.46%. As described, a thorough data-based understanding of exposure is critical for a robust exposure based safety assessment of disposable diapers.

Investigation of the amount of transdermal exposure of newborn babies to phthalates in paper diapers and certification of the safety of paper diapers.

A risk assessment study of seven phthalates in paper diapers for newborn babies produced in Japan was performed. The diapers were purchased and the contents of the seven phthalates were determined and estimated amounts of exposure were calculated based on the eluted rate into artificial medium of urine or sweat, average weight of infants, and frequency of use. Di-2-ethylhexyl phthalate and di-n-butyl phthalate were detected in the topsheets and determined to be 0.6 µg/g and 0.2 µg/g, respectively. The daily estimated exposure volume was calculated to be in the range of 1.86 × 10(-10)-2.98 × 10(-6) mg/kg/day as follows: content of seven phthalates in the topsheet (0.1-1 µg/g) × eluted rate of phthalates into artificial sweat (0.0006-2.4%) × weight of the topsheet of a diaper (1.5 g) × the number of diapers used per day (12 sheets) × skin absorption rate (0.005-0.1)/average body weight (2.9 kg). For hazard assessment, we used 0.2-300 mg/kg/day for the seven phthalates based on the data available at international agencies. The margin of exposure to the seven phthalates was 6.71 × 10(4)-1.99 × 10(11), indicating that the risk of exposure to phthalates from the diapers produced in Japan was negligible.

Diaper Need: A Change for Better Health.

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.

Is there a relationship between hygiene practices and skin and soft tissue infections in diapered children?

OBJECTIVES: The perineal and gluteal regions are the most frequent areas of skin and soft tissue infection (SSTI) in diapered children. No studies have investigated the relationship between perineal and general hygiene practices and SSTIs in this population. This study was conducted to evaluate this relationship. METHODS: A cross-sectional observational study was conducted in an urban pediatric emergency department. Subjects were recruited into 3 study groups as follows: gluteal/perineal SSTIs (SSTI), diaper dermatitis (DD), or healthy normal skin (NS). Survey responses were analyzed for significance followed by a clinically oriented staged regression to model predictors of SSTI compared with the NS and DD groups. RESULTS: There were 100 subjects in the SSTI, 206 in the NS, and 151 in the DD groups. Race was the only demographic characteristic that differed between the groups. After adjustment for race, no day care attendance, history of SSTI, household contact with SSTI history, and higher propensity for diaper rash were associated with SSTI compared with NS. Regression results comparing SSTI to DD revealed no day care attendance, history of SSTI, household contact with SSTI history, less sensitive skin, and less diaper cream use to be predictors of SSTI. CONCLUSIONS: Perineal and general hygiene practices were not significantly different between children with SSTI compared with children with NS or DD. Based on the results of this study, further prospective studies should evaluate diaper hygiene practices that prevent DD and subsequent SSTIs, the preventative role of day care attendance, and effective interventions that minimize the risk of recurrent SSTIs.

Go naked: diapers affect infant walking.

In light of cross-cultural and experimental research highlighting effects of childrearing practices on infant motor skill, we asked whether wearing diapers, a seemingly innocuous childrearing practice, affects infant walking. Diapers introduce bulk between the legs, potentially exacerbating infants' poor balance and wide stance. We show that walking is adversely affected by old-fashioned cloth diapers, and that even modern disposable diapers - habitually worn by most infants in the sample - incur a cost relative to walking naked. Infants displayed less mature gait patterns and more missteps and falls while wearing diapers. Thus, infants' own diapers constitute an ongoing biomechanical perturbation while learning to walk. Furthermore, shifts in diapering practices may have contributed to historical and cross-cultural differences in infant walking.

Allergic contact dermatitis to Pampers Drymax.

We present four cases of children less than 2 years of age, seen in four different practices, with a similar, unique, and specific presentation of diaper dermatitis, all while using Pampers Baby Dry with Drymax technology. To date, no reported cases exist of allergic contact dermatitis to Pampers Dryweave in medical literature.

Petechiae/purpura in well-appearing infants.

BACKGROUND: Well infants with petechiae and/or purpura can present to emergency departments, and their management can be difficult. Many will have extensive investigations and treatment that may not be necessary. METHODS: This was a retrospective and descriptive audit investigating well infants (<8 months of age) presenting with petechiae or purpura in the absence of fever to a pediatric emergency department over a 9½-year period. All presenting problems of petechiae or purpura were reviewed. Patients were excluded if they appeared unwell, were febrile or have a history of fever, or had eccyhmoses on presentation. RESULTS: Thirty-six babies were identified. The average age was 3.8 months (range, 1-7 months). The majority of the infants had localized purpura/petechiae to the lower limbs (92%) with two thirds of these patients having bilateral signs. None had generalized signs. Most infants had a full blood count (94%), coagulation profile (59%) and C-reactive protein (59%), and blood cultures (59%), with all being normal (except for mild elevation in platelets). Nine patients were admitted for observation, with only 1 patient having progression of signs. This patient had a diagnosis of acute hemorrhagic edema of infancy. The rest of the patients were thought to have either a mechanical reason for their petechiae/purpura (tourniquet phenomena) or a formal diagnosis was not specified. CONCLUSIONS: Well infants with localized purpura and/or petechiae with an absence of fever are more likely to have a benign etiology. Further study is required to determine if a full blood count and coagulation profile is necessary, or a period of observation (4 hours) is all that is required. If there is no progression of signs, it is likely that they can be safely discharged. The likely cause may be due to a tourniquet phenomenon (eg, diaper).

Frequency and severity of diaper dermatitis with use of traditional Chinese cloth diapers: observations in 3- to 9-month-old children.

Chinese cloth diapers differ from disposable diapers in several respects that are central to our understanding of the etiology of diaper dermatitis (DD), yet there are no published reports on the dermatological correlates of this manner of infant care, which is prevalent among the world's second-largest pediatric population. The objective was to determine the prevalence and severity of DD in exclusive users of Chinese cloth diapers. This observational study was conducted during a single home visit to 694 Chinese children who were exclusive users of cloth diapers in five inland cities of China. During each home visit, study nurses documented the presence and severity of DD using a visual dermatological scale and conducted transepidermal water loss (TEWL) and pH measurements. Diaper dermatitis was rare in the buttocks and genital area of the children (<20%) but was common in the perianal and intertriginous regions (50-70%). TEWL and pH were mildly higher in babies with DD than in those without DD in the genital and buttocks area. Diaper dermatitis is common in children who use traditional Chinese cloth diapers, especially in the perianal and intertriginous regions.

Effect of wearing diapers on toddler's gait.

Gait maturation in infants develops gradually through several phases. However, external factors such as childrearing practices, especially the wearing of diapers, may affect an infant's motor development. This study investigated the influence of different bulk stresses on the gait of toddlers wearing a disposable diaper. Twenty-six healthy toddlers (age: 19.2 ± 0.9 months) participated in this study. We measured the joint kinematics (pelvis angle and hip-joint angle) and spatiotemporal parameters (step length and step width) of the toddlers' gait under four dress conditions (wearing Type A_WET, Type A_DRY, and Type B_WET diapers and naked). Type B_WET had a higher bulk stress than Type A_WET, and Type A_DRY had lower stress than Type A _ WET. Our results indicate that the walk of toddlers when wearing a diaper differs from that when naked. This difference is due to the effect of the bulk of the diaper on the lower limb. A high bulk stress has a greater influence than that of a low bulk stress on joint dynamics and step width. Therefore, our findings suggest that wearing diapers with high bulk stress may inhibit the natural gait patterns of toddlers.