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.

Disposable diaper overuse is associated with primary enuresis in children.

This research investigated the association between prolonged disposable diaper (DD) wearing in infancy and primary enuresis (PNE). As a case-control study, we collected data from 376 children with enuresis and 379 healthy children who were sex- and age-matched at three tertiary care institutions in mainland China from August 2017 to July 2018. The results of adjusted logistic regression showed the odds ratios (95% confidence intervals) for PNE across the categories of age of daytime DD use cessation were as follows: ≥ 25 months: 1.00, 18-24 months: 0.25 (0.17-0.37), and ≤ 17 months: 0.11 (0.06-0.20), independent of age, mother education, residence, toilet training approach, breastfeeding duration, UTI, constipation, anaphylactic disease and family history. After a similar multivariable adjustment, increased age of daytime DD use (per-month) had a positive correlation with PNE, OR = 1.17, 95% CI 1.13-1.20 and non-linear relationship was detected, whose point was 21 months (the effect sizes and the 95%CI on the left and right sides of inflection point were 1.04 (0.99-1.10), P = 0.131 and 1.25 (1.18-1.31), P < 0.001). Subgroup analysis found that the effect of duration of disposable diaper exposure for each additional month, those children had accepted assisted infant toilet training/elimination communication (AITT/EC) practice had a lower risk of PNE (OR = 1.08, 95% CI 1.04-1.12), compared with those without AITT/EC practice (OR = 1.20, 95% CI 1.14-1.27), P for interaction < 0.001. In conclusion, the children diagnosed with primary enuresis after age 5 stopped using disposable diapers at daytime later than the control group. Association between duration of DD exposure and the risk of childhood enuresis is modified by AITT/EC practice. Timely cessation use of disposable diaper and practice AITT/EC may shorten the time to nocturnal continence, and the prospective cohort studies are needed to verify the discoveries.

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.

Dermatitis irritativa del pañal: revisión bibliográfica / Irritative diaper dermatitis: literature review

Objetivo: El objetivo de esta revisión es describir la clínica y el diagnóstico diferencial, la prevención y la educación sanitaria en la dermatitis irritativa del pañal (DIP). Método: Se realizó una revisión de las guías de práctica clínica de las diferentes sociedades científicas y grupos de trabajo relevantes, así como una búsqueda en bases de datos bibliográficas. Resultado: Los resultados de la revisión se estructuraron en las siguientes secciones: clínica y diagnóstico, prevención, productos protectores y efecto barrera, y educación sanitaria (papel de la matrona). Conclusión: El abordaje de la DIP debe ir orientado hacia la prevención y el tratamiento sintomático de las lesiones establecidas. La mejor estrategia es actuar sobre la prevención, con un buen asesoramiento a los padres sobre el cuidado de la piel del área del pañal, incidiendo principalmente en la higiene de ésta, la aplicación regular de productos protectores de la piel en cada cambio de pañal y el correcto uso del pañal

Objective: The objective of this review is to describe the clinical and differential diagnosis, prevention and health education in irritative diaper dermatitis. Method: A review of the clinical practice guidelines of the different scientific societies and relevant working groups and search in bibliographic databases were carried out. Result: The results of the review were structured in the following sections: clinical and diagnostic, prevention, protective products and barrier effect, and health education: role of the midwife. Conclusion: The approach should be oriented towards the prevention and symptomatic treatment of established lesions. The best strategy is to act on prevention, with good advice to parents on the skin care of the diaper area, focusing mainly on the hygiene of this, the regular application of skin protection products at each diaper change and the correct use of the diaper

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.

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.

Granuloma Glutaeale Infantum: A Re-emerging Complication of Diaper Dermatitis.

Granuloma gluteale infantum is a rare nodular complication of irritant diaper dermatitis. The association of this condition with the widespread use of nondisposable cloth diapers has been increasingly recognized. We present the case of an 18-month-old girl with granuloma gluteale infantum. Our aims are to emphasize the importance of clinical recognition of this re-emerging complication of diaper dermatitis and to point out the potential role of topical calcineurin inhibitors as a treatment option.

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.

Construcción de un instrumento de valoración del riesgo y gravedad de las lesiones del área del pañal en lactantes RDIC-lac / Construction of an instrument of risk assessment and injury severity for the diaper area in infants: RDIC-lac

Objetivo. Diseño de una escala para valorar el deterioro de la integridad cutánea en el área del pañal del lactante y la gravedad de la lesión para la prevención y manejo de la dermatitis irritativa de pañal. Metodología. Estudio en 3 etapas: 1) revisión exhaustiva y lectura crítica de literatura para el diseño preliminar del instrumento; 2) evaluación crítica de propuesta inicial por grupo de expertos (enfermería y medicina pediátrica) con cuestionarios de opinión y guía de preguntas ad hoc; 3) análisis de contenido mediante tabulación de datos para la modificación y diseño final del instrumento. Ámbito. Gerencia de Atención Primaria de Tenerife. Resultados. En la 1.ª fase se diseña una propuesta de instrumento: dos grupos de factores de riesgo (10 moduladores del riesgo y 9 de alto riesgo) y escala de gravedad con 5 aspectos a valorar de 4-5 ítems cada uno (profundidad, localización, extensión, tipo de lesión, signos de infección). En la 2.ª fase participan 19 profesionales. Se realiza una tabulación de los datos agrupados en factores a añadir u omitir. La 3.ª fase finaliza con una versión del instrumento modificada: 10 factores moduladores, 5 de alto riesgo y 4 ítems para cada aspecto a valorar en escala de gravedad. Discusión-Conclusiones. La escasa bibliografía encontrada y la ausencia de herramientas similares justificaron el diseño. La siguiente fase será la validación del instrumento RDIC-lac. Relevancia clínica. Susceptibilidad de prevenir lesiones cutáneas en el área del pañal en la edad pediátrica (AU)

Objective. To design an instrument to measure impairment of skin integrity in the diaper area of infants and severity of injury for the prevention and management of irritative diaper dermatitis. Methodology. Design in 3 phases: 1) comprehensive review and critical appraisal of literature to design the preliminary content of the instrument; 2) critical evaluation of initial proposal by an expert group (nursing and pediatric medicine) with opinion survey and ad hoc questions; 3) content analysis using data tabulation for the modification and final design of the instrument. Setting. Primary Care Management of Tenerife Results. In the 1st phase a proposed instrument is designed: two groups of risk factors (10 modulators risk and 9 high risk); and a severity scale with 5 aspects to assess including 4-5 items each (depth, location, extension, type of injury, signs of infection). The 2nd phase involved 19 professionals. A Tabulation of the data grouped into add or omit factors was used. The 3rd phase ends with a modified version of the instrument: 10 modulating factors, 5 of hig risk and 4 items for each aspect to assess severity. Discussion-Conclusions. The scarce bibliography found and the absence of similar tools explain the design. The next phase will be the validation of RDIC-lac instrument. Clinical relevance. Susceptibility to prevent skin lesions in the diaper area in the pediatric age (AU)

Patch Test Series for Allergic Perineal Dermatitis in the Diapered Infant.

BACKGROUND: Allergic perineal dermatitis (PD) due to diaper wipes, topical medicaments, or diapers has been reported. Although patch testing is the criterion standard for detection of allergic contact dermatitis in children, this is limited by body surface area, decreased tolerance of the patch testing procedure, and increased false-positive rates due to irritant reactions. Therefore, a targeted patch testing series is necessary to better screen diapered infants for possible allergic PD. OBJECTIVE: We propose 2 patch test series (PD series 1 and 2) to screen infants with possible allergic PD. METHODS: Allergens are chosen using existing sensitization data of common allergens in children, published case reports, and the collective experience of American Contact Dermatitis Society members through an electronic survey. RESULTS: PD series 1 includes 23 potential allergens found in wet wipes and topical diaper preparations. PD series 2 contains 10 potential allergens most commonly found in diapers. CONCLUSIONS: We believe that these judiciously chosen patch test series will increase the yield of detecting the causes of allergic PD while not exposing children to an unnecessarily large screening patch test panel.

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.

Introduction: "The Napkin Area and its Dermatoses" symposium proceedings, World Congress of Pediatric Dermatology, September 2013.

Dr Antonio Torrelo, President of the 12(th) World Congress of Pediatric Dermatology, introduces the supplement as providing an opportunity for readers to access the lectures and related presentations delivered at the World Congress of Pediatric Dermatology held September 25-27, 2013, in Madrid.

Potential Allergens in Disposable Diaper Wipes, Topical Diaper Preparations, and Disposable Diapers: Under-recognized Etiology of Pediatric Perineal Dermatitis.

BACKGROUND: Allergic contact dermatitis in young children may be an under-recognized cause of perineal dermatitis. The diapered infant skin is uniquely susceptible to allergic contact dermatitis because of more permeable neonatal skin, a moist environment, frequent contact with irritants and resultant skin barrier breakdown, and exposure to topical products such as diaper wipes, diaper preparations, and disposable diapers. To our knowledge, potential allergens in these products have not been thoroughly catalogued or studied. OBJECTIVE: We explore and review potential allergenic ingredients in diaper wipes, topical diaper preparations, and disposable diapers. METHOD: We analyzed 63 diaper wipes, 41 topical diaper preparations, and the 3 top selling diaper brands available from two of the largest retailers in the United States. Each potential allergen is discussed, and epidemiologic studies of rates of sensitization to potential allergens in children are also reported. CONCLUSIONS: Botanical extracts, including members of the Compositae family, were the most commonly represented potential allergen in both diaper wipes and topical preparations. Other potential allergens identified with high frequency include α-tocopherol, fragrances, propylene glycol, parabens, iodopropynyl butylcarbamate, and lanolin. Frequent culprits such as formaldehyde releasers and methylchloroisothiazolinone/methylisothiazolinone were not prevalent in our analyzed products.