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Cloth Diapered Children and Day Care Providers
Is Cloth a Hygienic within a Day Care Setting?
By: Heather L. Sanders
At some point or another a good
portion of parents are faced with the issue of finding and placing their
infant or toddler in a day care setting. According to Frank E. Young,
M.D., PhD, Commissioner of Food and Drugs for the U.S. Food and Drug
Administration, “Day-care centers have become a way of life in
America. More than half of all mothers of children too young to care for
themselves hold jobs outside the home. For them – indeed for millions of
American families – day-care centers provide a service that is a necessity.
If both parents work, a solo parent caring for a child must work, or other
family support systems are inadequate, child day care answers a critical
need.” (1) As if the issue of choosing a Day Care facility is not
problematic enough, there is the added dilemma that some facilities do
not/will not accept cloth diapers.
To be fair, there are many reasons
parents decide to cloth diaper their children – health being one of those
possible reasons … and that same reasoning, yet from a different
viewpoint, is what shapes the somewhat misdirected/misinformed policies of
some Day Care facilities to refuse cloth diapers at their place of
business.
On
the brim of the ongoing debate regarding whether cloth or disposables are
better overall for children, there is the less discussed concern regarding
whether the use of either system is healthiest for all concerned (the
children attending the day care and its workers). Based on the same
precautions and respecting the same concerns of advocates for disposable
diaper usage in day care systems, some of today’s modern cloth diapering
systems can easily be incorporated right alongside disposable diapers
without deviating from a routine or compromising the health of any
involved.
Today’s Diapering Systems.
Just as all things of necessity seem to evolve to meet the growing
demand for ease and convenience in our fast-paced world, so have
cloth diapers. So, to better understand the efficacy of
blending both disposable and cloth diapers under the same system
in a day care facility, it need be recognized that cloth diapers
are no longer defined by simple flat fold cotton squares and
plastic pull-on pants. Modern cloth diapering encompasses a
variety of designs – some of which closely resemble the fit and
convenience of a disposable diaper, yet in a reusable form.
- Fitted Diapers
are designed in fit/style to secure with tabs like a disposable, yet
require a waterproof diaper cover.
- Wrap-Style Covers
secure a regular flat fold or prefolded diaper to baby with wrap around
tab closures – again, much like a disposable.
- All-In-One Diapers
are most comparable to the disposable diapers. They are
comprised of a multiple-layered cotton inner lining attached to an outer
waterproof covering. All-In-One diapers, like disposables, have tabs
that wrap around baby to secure the diaper. The difference being that
All-In-Ones secure with Velcro/aplix or snap closures instead of diaper
tape.
Personal Preference Aside.
Setting aside
personal preference and preconceived notions, the basic root of the
concerns that shape day care policies, county compliance, state licensing
requirements, national organization recommendations and the local
municipalities, seems to have little to do with the actual type of diaper
being used. It is the desire to minimize illnesses within the day care
system – especially enteric (small intestine) infections – that prompts
the policies being enforced.
So what do we know of enteric
infections as it relates to diapers? According
to the FDA, enteric infections are usually attributed to food poisoning.
However, in the day care system they are more commonly linked to fecal
contamination. “In these cases, infections are transmitted directly
from the feces to the mouth usually by way of the hands … or other
objects which go into the mouth.”(3) According to Young, “The cause
of these infections is usually some well-known pathogen such as the
hepatitis A virus, rotavirus, Giardia, E.coli, Cryptosporidium, Shigella,
or Campytobacter.” (1)
Disposable and cloth both meet the
national standard. Both disposable diapers and
two of today’s cloth diapers (primarily the All-In-Ones, but also the
Wrap-Style Covers that hold in a flatfold or prefolded diaper) meet the
physical requirements of the nationally recognized standards by being
“able to contain urine and stool and minimize fecal contamination of the
children, caregivers, environmental surfaces, and objects in the child
care setting.,” (5) With both types of diapers meeting the same
requirements, it would stand to reason that the possibility for fecal
contamination would not lie within the choice of diapering system, but
rather, the person responsible for changing the diaper. The logical area
of concern in a day care setting, regardless of diaper type, should be
less concentrated on the disposable –v– cloth issue and more concentrated
on the actual diapering procedure as carried out by an informed and
properly trained day care worker.
Regardless of the
choice in diapering systems, the same preventive
measures should be taken to minimize risks of infection from fecal
contamination both during, and directly after, diaper changes.
“Changing diapers in a sanitary way may be one of the most important
things day care staff can do to prevent the spread of infectious organisms
present in fecal material.” (4) Hygienic diaper changing procedures
have been published by a plethora of organizations: The Food and Drug
Administration (FDA), U.S. Center for Disease Control (CDC), each State’s
Department of Health Services, the American Public Health Association (APHA),
the American Academy of Pediatrics (AAP) to name a few, not to mention
countless local governing agencies and child care organizations. It would
be nice to assume that most day care workers are educated by their
employers and versed in minimizing the spread of infections at the diaper
changing area before tending to any child in a day care
environment. Do not take for granted that this is the case. In fact, as
an educated ‘consumer,’ a question you would want to pose in interviewing
any day care center prior to placement of your child is not whether or not
they accept cloth diapers, but instead, “What type of initial and on-going
education or direction is given your day care workers regarding minimizing
the spreading of infections?” The American Public Health Association
found this worth further attention. In one of the APHA’s Public Policy
Statements they supported, “… research on the health, safety, and
handling of various types of diapers (home-laundered, cloth diaper
services, and disposable diapers) in day care settings in order to guide
the development of standards for these settings.” (2)
To date there is biased
research like The Personal Absorbent Products Council (PAPC) which
reported that disposable diapers offer superior health benefits and that
there is “… clear evidence that disposable diapers are
significantly more effective than double cloth diapers and plastic
overpants in reducing the risk of spread of gastrointestinal illnesses.”
(9) Even by reading this it can be recognized that the PAPC does not take
into account the newer styles of All-In-One Cloth Diapers that mimic style
and function of the disposable diaper, but with the added benefit of being
reusable. Why would they? Cloth is not their market.
The minimal requirements for reducing the spread of illness should be the
same whether a day care worker is changing a disposable diaper or a
cloth diaper of comparable style. First and foremost being good hand
hygiene. In October 2002, the Center for Disease Control’s Healthcare
Infection Control Practices Advisory Committee (HICPAC), in collaboration
with the Society for Healthcare Epidemiology of America (SHEA), the
Association of Professionals in Infection Control and Epidemiology (APIC)
and the Infectious Disease Society of America (IDSA) released updated hand
hygiene guidelines for health care settings emphasizing that “Clean hands
are the single most important factor in preventing the spread of dangerous
germs” and that hand hygiene prevents infections and saves lives. (6)
Day care workers are as active in caring for children as the health care
professionals in this study are in caring for their patients. Both deal
with the possibilities of spreading dangerous germs, which could lead to
infection, if good hand hygiene is not adhered to with uncompromised
consistency.
The disposal of diaper ‘waste’ in day
care settings. Actual contact with fecal matter
remains the longest standing argument in favor of the sole usage of disposable
diapers in day care settings. Fecal contamination “can be a prime source of
disease in centers that care for children under 3 – those still in diapers and
still being toilet trained.” (1) The truth is that whether cloth or
disposables are being used, according to The American Public Health Association
(APHA), the fecal matter should be handled the same with either diapering
system. The APHA’s Public
Policy Statement #8910, Health and
Environmental Hazards of Disposable Diapers states:
Acknowledging that the World Health
Organization advocates adequate disposal of human excreta, and knowing that more
than 100 different enteric viruses, including polio and hepatitis are known to
be excreted in human feces and that these viruses can live for months after the
stool has passed from the body; and realizing that the product labels
instructing consumers to empty the feces into the toilet before disposing of the
diaper are not commonly followed by consumers; and knowing that human excreta
entering the waste stream via disposable diapers pose potential health risks to
sanitation workers and threaten to contaminate groundwater if landfills are not
properly constructed; therefore
1. Supports
public education to educate consumers about diapering choices and their
potential environmental consequences so that they can make an informed choice; 2. Supports consumer education so that if disposable diapers are used, the
users dispose of them in a prudent manner so as to minimize the risk of disease
transmission . . . (2)
Day Care Facilities that allow for/accept
cloth diapers are often given state or local requirements and recommendations
regarding the disposal of feces, for example, “Soiled cloth diapers shall be
emptied of feces in the toilet and placed in a securely covered container which
is not accessible to children. The container shall be emptied and sanitized
daily.”(7) Yet, it is surprising that in spite of the APHA’s public stance
on proper disposal of fecal matter, their recommendation is only recognized in
day care facilities as related to cloth. There are no directives with what is
required of the feces when changing a child in a disposable diaper. It is
simply understood that the feces will remain in the disposable diaper to
be tossed in with the trash headed for a landfill. The concern should not be
over the problem of discovering how to best handle fecal matter concerning
changing cloth diapers, but rather, why we are not ‘handling’ fecal matter with
regards to disposable diapers.
Disillusionment of Diaper Changes.
The supposition is that disposable diapers require
less handling or possible fecal contamination than do cloth diapers – therefore,
possibly reducing the contamination of other items in the nearby environment.
The rationale that is contaminating our landfills and disallowing some day care
facilities to accept cloth diapers says that – “Containing and minimizing
the handling of soiled diapers so they do not contaminate other surfaces is
essential to prevent the spread of infectious disease. Putting stool into a
toilet in the child care facility increases the likelihood that other surfaces
will be contaminated during the disposal. There is no reason to use the toilet
for stool if disposable diapers are being used.” (8) Yet, if attention is
being paid to the recommendations of the APHA and the World Health Organization
(WHO) and sanitary diaper changing measures are being followed, the
diaper changing system of an All-In-One Cloth Diaper (or similar style) should
not differ from a disposable diapering system. All feces should be deposited in
the toilet for the safe management of waste.
Hygienic diaper changes.
Because proper hygiene seems to be the determining factor in the
spread of infection through fecal contamination, diaper changing areas in day
care facilities should be washed and disinfected after every diaper change –
disposable or cloth. The diaper changing area should be located in close
proximity with a faucet for the ease of immediate hand-washing – and to decrease
the ‘spreading’ of germs en route to the hand-washing area. Day care facilities
often use disposable pads between the infant’s bare bottom and the diaper
changing surface – with wax paper being the most effective as it does not have
absorbent properties – and dispose of these pads after each diaper change.
Surfaces used for diapering should be used for the sole purpose of diapering for
that very same reason … again, decreasing the possibility of contaminating
surfaces used for other duties. Finally, if there are fecal contents in
either cloth or disposable, it should be emptied into the toilet. After
emptying any fecal contents that will fall out of the diaper, dunking is
unnecessary, and the diapers can be disposed of accordingly: cloth diaper can be
placed in a waterproof bag that is taken home daily with the child for
laundering and disposable diapers can be discarded in a plastic lined garbage
can.
The BANANAS Child Care Information &
Referral service states that “Regardless of the type of diapers used, the
steps to reducing the spread of illness are the same” (3) and suggest the
following steps in their handout for ‘Promoting Health and Hygiene in a Child
Care Setting’:
- Proper hand-washing by adults and
children (this if the children are toilet training).
- Surface sanitizing
- Proper diaper disposal
- Minimizing the handling of diaper wastes
with latex gloves being made available for ‘messy’ diaper changes – or in the
case where visible blood is present in feces or urine.
- Having the children wear clothes over
diapers.
A Healthy Conclusion.
The health of children and day care providers is not tied-up in the types of
diapers allowed if proper hygiene is consistently monitored and followed. Just
as a disposable diaper improperly handled could result in fecal contamination
and disease, so might a cloth diaper. Both systems paired under the same health
and hygiene guidelines can be equally as infectious if handled poorly or equally
as safe when handled knowledgeably. Cloth diapering parents should continue to
present their diapering systems to prospective day care providers with the
expectation that acceptance is not an issue. Day care facilities and
communities, on the other hand, should educate themselves regarding today’s
choices for cloth diapering towards a developed awareness that cloth diapering
can be as convenient and hygienic as its paper alternative for diapering babies.
For more ideas on how you can make an impact
within your community refer to the City Council’s report in Sunnyvale.
Subject: Encouraging Use of Cloth Diapers to Reduce Solid Waste Management
Expenses – RTC #99-246. This origin of this study was prompted following
one woman’s question, “What can the City do to encourage the use of cloth
diapers as an alternative to using and throwing away disposable diapers.”
(10)
Sources:
(1) Young, Frank E., M.d., Ph.D, Commissioner of Food and Drugs, U.S. Food
and Drug Administration, June 2002, In Day-Care Centers, Cleanliness Is a
Must.
(2) American Public Health Association (APHA) Public Policy Statement 8910:
Health and Environmental Hazards of Disposable Diapers.
(3) BANANAS Northern Alameda County's Child Care Information and Referral
Service. BANANAS Handout: Promoting Health & Hygiene in a Child Care
Setting, www.bananasinc.org
(4) Alaska Dept. of Environmental Conservation Food Safety and Sanitation.
Diapering Guidelines for Day Care Providers.
(5) National Resource Center for Health and Safety in Child Care, Caring
for Our Children: National Health and Safety Performance Standards, 2nd
Edition, 2002. STANDARD 3.012-Type of Diapers.
(6) Department of Health and Human Services, Hand Hygiene in Healthcare
Settings, CDC releases new hand-hygiene guidelines. October 25, 2002.
(7) Child Care Standards, 65C-22, Florida Administrative Code, March
18, 1999, www.orchd.state.fl.us
(8) National Resource Center for Health and Safety in Child Care, Caring
for Our Children: National Health and Safety Performance Standards, 2nd
Edition, 2002. STANDARD 3.018-Handling Cloth Diapers.
(9) The Benefits and Safety of Disposable Diapers. PAPC,
Personal Absorbent Products Council.
(10) SUBJECT: Encouraging Use of Cloth Diapers to Reduce Solid Waste
Management Expenses-RTC #99-246, June 8, 1999, City of Sunnyvale, CA
www.ci.sunnyvale.ca.us/199906/rtcs/99-246.asp
Content Copyright © Heather L Sanders.
May not be reprinted without permission.
About the author ::
Heather Sanders lives in Huntsville, TX with her husband and 3 kids. Heather has started and sold two successful online cloth diapering businesses, including The Diaper Hyena. In addition to those two businesses, she has written exclusively for Diaper Pin in the Cut of Cloth section. Shortly thereafter, she wrote a few articles for Natural Family Online and in 2004, served as one of the Moderators for the Cloth Diapering Forums at Mothering.com. Later, she worked as the Assistant Administrator for the entire forum and served on the Expert Panel at Mothering.com for Cloth Diapering.
Heather was one of the founders of Real Diaper Association, owns and manages Clothdiapersale.com and blogs personally at www.ohmystinkinheck.com.
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