Diapers are a part of everyday life with a baby. Cloth and disposable each offer advantages and disadvantages. For optimal motor development, there are some 
important considerations that tend to affect cloth-wearers more, but can also affect disposable-wearers. Note, this article address typical development. For babies experiencing hip dysplasia, please consult your doctor(s).
The Effects of Big Diapers
When you’re shopping for cloth or disposable options, take into account the size of the diaper when worn. Some diapers can be big, spreading Baby’s legs wide and limiting movement in the lower spine.
For healthy movement development, Baby needs to be able to:
Being able to curl into a ball shape (“flexion”) is very important for development of movement, muscle tone, coordination, and nervous system regulation
- Curl into a C-shape, called “flexion” (important for milestone development, digestion, and the nervous system’s ability to balance stimulation with recuperation)
- Bring each leg into alignment with her hip joints and spine in belly crawling so that the push of her foot will travel well through her body to carry her forward
- Bring her knees under her hip joints in hands-and-knees crawling, and into optimal alignment for kneeling and walking.
The relationship of the legs, hip joints, pelvis, and spine supports a healthy back for life. Diaper-induced wideness can skew alignment, cause compensations, and lead to W-sitting (See “W-Sitting Revisited” by pediatric physical therapists).
DIY
Don’t listen to me—listen to your body! For fun, get down on the floor and experiment so you know for yourself.
- Crawl on your hands and knees comfortably. Notice where your knees land and how much distance is between them.
- Then spread your knees wider, as if you were wearing a diaper that didn’t allow your knees to come close together, and crawl like so.
- Experiment with the placement of your knees and feel the difference it makes in your lower back, side muscles, jaw, mindstate, and other parts of yourself.
Watch Your Baby Crawl
The next time you see your baby crawl, notice where her knees land. Optimally, the knees will come through under the hip joints. Diapers can make a baby’s knees spread wider than the hip joints while crawling, which can have an unhappy affect on the lower back, whether it shows up now or in 40 years. Wide knees are also less stable in movement because they don’t allow force to travel efficiently in the most direct route through the bones and joints. Wide diapers and widespread knees can also encourage W-sitting. Even if your baby is not yet crawling, spend some time watching how your baby’s legs relate to each other.
What to Look For in Diapers
This doesn’t mean ditch diapers altogether! It’s about making informed choices.
- Lie your baby (6 mo or older) on her back. Without a diaper on, gently bend her knees and bring them toward each other. (Do not do this with a newborn or if there’s concern about hip dysplasia) How close together do her knees move easily? Then put a diaper on and do the same thing to compare. Does the diaper allow movement of the knees toward each other? How much of a difference is it? The intention here is not to force the knees together, but to gently feel your baby’s natural range of motion without a diaper, and then to find out if the diaper restricts access to her natural movement.
- Younger than 6 months: with very gentle, non-forcing touch, you may be able to get a sense of your baby’s natural range of movement. Please don’t force the knees together, for hip safety.
- Look for companies that offer a variety of sizes and stick to the smallest possible size needed.
- No matter which diapers you choose, give your baby diaper-free time, wearing only swimming/training pants if desired.
Knees-Together Time
Kneeling (kneel-sitting back on the heels and kneel-standing on the knees) offers many wonderful benefits! Kneeling comes in once babies begin to crawl on hands and knees, sit back from crawling, and pull to standing. For optimal movement development, babies need access to knees-together time in these positions. Kneeling–with the forelegs under the body (not W-sitting)–re-engages midline, provides an efficient transition into and out of hands-and-knees crawling, and supports coordination of the legs and torso. It even helps establish healthy support in the lower back. If you notice Baby’s legs spreading wide while crawling or W-sitting, respectfully and gently scoot her knees in toward each other underneath her so that she can kneel-sit. Kneel-sitting generally provides healthier alignment, as well as more options and freedom of movement than W-sitting.
Kneel-sitting is a fantastic, fantastic, fantastic thing for babies to do!
From kneel-sitting, Baby can move in any direction . . . including up to kneel-standing and eventually into walking.
But before disposables all babies were in cloth, and they ended up just fine didn’t they?
I can’t speak to what cloth diapers were like in history; but I can speak for the babies whom this issue affects. “Fine” is relative. Again, this is about looking at the size and effects of any diaper, but especially cloth because it has more potential to be bulky. Many physical challenges in adulthood stem from a variety of issues in infancy. In the case of big diapers, the diapers direct the movement, rather than the baby’s natural reflexes—and this can create compensation patterns. These compensations can easily go unnoticed in a “healthy,” active child, but they linger in the body and can become problematic later in life (including back, hip, and knee challenges).
Think Functionally and Shop with Awareness
Some babies may not be affected by their diapers. For some babies, this is a question of optimal development vs he’ll-be-okay development. For others still, it can turn a “normal” situation into an unnecessary difficulty that can affect not only movement, but also learning and self confidence.
Whether there are concerns or none, whether cloth or disposable, every baby benefits from diaper-free time! Optimal joint development… Freedom of movement… Having the most potential available within ourselves to rely on in everyday life… Why not make the effort to build the best foundation possible in the first year?
Eliza Parker is a certified Infant Developmental Movement Educator®, Aware Parenting Instructor, Body-Mind Centering® Practitioner, and is trained as a Feldenkrais® Practitioner.
© Eliza Parker 2014, All Rights Reserved
Hi Eliza! I just found your blog and love it! This post is very informative and valuable to me. I did the test that you recommend and even though my cloth diapers are very thin I wasn’t able to bring my baby’s knees close. I use cloth diapers only as a backup because I practice Elimination Communication. But , since my little guy is my third child he’s def more in the diapers than what I would like. I want to avoid the chemicals on the disposables, but I must admit that after doing the test it was obvious that they impact his movement less. However, every time that he wears a disposable diaper, even the organic ones like Seventh Generation, he develops a rash on his leg. Any suggestions? Have you found any cloth diapers that seem to be more ergonomic from a free movement perspective? Thanks aa lot!
Hello! Thanks; so glad you found it! I’m not up on the leanest cloth diapers, but some of my cloth families supplement with diaper-free time, either with underwear (like Tiny Undies) or swim pants, or nothing but on a waterproof mat. Have you tried other brands too, like 365 and Honest? Let me know what solutions you come up with!
I saw in earlier comments that you mentioned a possible future post about Elimination Communication. I am 30 weeks pregnant with my first baby (a girl) and have read Diaper Free by Ingrid Bauer. I would be interested in reading what you have to say if you have done any research on the developmental implications of ElimComm.
When I stumbled across this blog from a link you had posted on the Chatham Chatlist, and read post after post, I was so glad that I had found it. The research and experience you have to offer makes so much logical sense and ties into everything my husband is learning at the Body Therapy Institute for body awareness.
Thank you for writing!
Hi, so glad you found my blog! I have not looked further into Elimination Communication, but I usually hear that people like it. My two thoughts are:
– I know of one baby who then wouldn’t go in a diaper (at least poop, don’t know about pee); be aware if this becomes stressful for the baby especially when you’re out and about (but again, I’ve only seen this once so far)
– Try to avoid prop-sitting (on toilet/sink) for long periods of time before the baby can get into sitting by himself (I recommend not prop-sitting babies until they find their own way into it, but short periods of time for functional purposes are okay)
🙂
I’ve known about your work through the AwP groups dating back probably to around late 2014 (baby #1). I’ve done as much to not position my babies or lead the movements for them and I receive comments on their balance and coordination all the time! They’re 4.5 & 2.5 now. So thank you Eliza for this blog! Now I’m on baby #3 and, sadly (to me) last baby for our family. So I wanted to finally try Elimination communication (we did cloth previously with lots of diaper free time). I’ve been wondering all along what your take would be “what would Eliza say?”. I was worried about holding her in sitting. She seems to have had a lot of releasing to do (a la AwP) these last couple days where I have begun to do the legs-hold over a tiny “potty”. Her expression is one of total confusion and mind-blown when I first held her upright! So it’s a catch 22- non-ergonomic diapers or aided sitting? Which is worse? Thanks to being #3 her emotional releasing seems to be pretty productive and she’s sleeping and nursing better than I even knew was possible! I wonder about me leading her to upright and her brain then learning that it wants that and driving her toward working more on that than she naturally would have come to on her own… I guess we’ll see when we get to that bridge! I’m wondering if doing the legs-hold cradled back against my body sort of evens out those concerns. I can’t really explain well what I mean by that – I don’t know what terms you’d use Eliza.
My baby used to wear cloth diabers when he was about 5 months old till maybe he is 9 months old. Now he is 17 months old and his knees are wide apart, his legs are bent and does not look like other children’s legs which look straight and perfectly normal. What can I do to fix his legs. Please HELP.
Hello, your child’s situation may not be related to only 4 months of cloth diapers–there could be something else going on. You may want to see a developmental specialist (If there’s not an Infant Developmental Movement Educator in your location, look for an Occupational Therapist, Physical Therapist, Orthopedic doctor, Cranial-Sacral Therapist, or another professional–but someone who works specifically with children).
“Some diapers can be big, especially cloth because of the layers of fabric, making Baby’s legs spread wide. This can actually affect healthy movement development.”
It is unclear from the article whether you mean this in general or only in relation to crawling, since you don’t mention the crawling for another paragraph.
This is important because the fact that the legs go wide is not necessarily bad – in fact, in relation to hip dysplasia and swaddling you should want to stress the importance of keeping the legs wide
http://hipdysplasia.org/developmental-dysplasia-of-the-hip/hip-healthy-(swaddling/)
With respect to crawling, and to walking, you may be right (see eg http://onlinelibrary.wiley.com/doi/10.1111/j.1467-7687.2012.01169.x/full).
Apologies, the link in my post above should have read http://hipdysplasia.org/developmental-dysplasia-of-the-hip/hip-healthy-swaddling/
Maarten
Hello,
Indeed, thank you for bringing this lack of clarity to my attention, and also for the link to the journal. I do know that wideness is a way to address hip dysplasia. I will clarify this.
So much on this blog is great and informative (I too am a Feldenkrais practitioner) – yet I find it strange that there is no question here about the use of diapers/nappies in the first place. Elimination Communication/Natural Infant Hygiene/Diaper free is not even mentioned – but it is what most people in the world still do, and what the West did until big companies spotted a way to make money – disposable nappies. No nappies = no restrictions, aside from the developmental and carer-child communication opportunities it affords.
Wonderful point, thanks so much for mentioning this. By the way, I do mention diaper-free time for all babies, which could, in itself, be its own blog post.
Yeah but there’s also the concern of holding the baby in upright position before they are able to reach that position in their own. I am very interested to hear what Eliza has to say on that (I left a bigger comment and personal experiences above).
Wow – I never even thought about this before (we use cloth diapers). Good to be aware of!
Thanks for reading! We really have to shop with our own eyes and awareness! Take care~
From a mom:
“Hi Eliza,
Thank you for writing a blog about this. I was always weary of [certain] diapers for my daughter because of the limitation of movement and it’s great to see well informed people blog about it.”
What a shame that this post comes across as so negative toward cloth diapers (or nappies here in the UK!). I’m fairly new to cloth nappies, but have a wide variety of different brands for my 3 month old daughter, all of which are slim fitting and do not restict movement. Cloth nappies are not all bulky terries and plastic pants nowadays! Scientific research has shown no difference at all in the age at which babies sit unaided, crawl, stand and walk when using disposable of cloth; surely if cloth restricted movement cloth using babies would reach these milestones later? Furthermore, when an infant is very young, cloth nappies support the hips in the optimal position for correct hip development.
There are many, many more benefits to using cloth diapers that are not mentioned here. I’m sure, however, that your readers will do more of their own research into deciding what is best for their babies before being dissuaded by this blog post.
Hello Victoria,
As I said, cloth can be a wonderful option, and–also as I said–these issues can happen with both cloth and disposable. I’m glad to hear you have found some that are slim–many I have seen are not. The age is not important; but the movements and the quality are.
I will look out for diapers that support hip development in newborns. What I have seen so far is diapers actually inhibiting hip flexion when too tight or too big.
I call parents to pay attention on a deeper, more detailed level than they may have known to do so before–and to do their own personal research on themselves and while observing their infants. This issue may not affect your daughter, but it affects way too many others unnecessarily. You can actually see what I’m talking about in some of the pictures diaper companies post (no matter which kind)–you’re probably not going to get this information from them! It’s about what to be aware of, not avoiding one kind or the other.
definately food for thought but also a lot of guesswork involved.
regards the ‘cloth v disposables’ argument in relation to back problems later in life, most back problems are not nappy (diaper) related but to do with the way we care for them as an adult.
I was a cloth bum baby & dont have back problems my brother however was a sposies baby & has severe back problems caused by incorect lifting.
My daughter never crawled despite my attempts to help her & she walked at 13m with no encouragement, you cant force a child to crawl however important a developmental step it may be. same if a child wants to walk early, my son crawled at 10m & walked at 11.5m (no help with etither) he kneel sits/stands and is in cloth nappies as the chemicals in sposies make him bleed, its no wonder really as they have been banned from womens sanitary products!!
Hello charminbear,
Not guesswork–this is what colleagues and I see and address: movement development being affected by diapers and many other factors. Regarding back problems: not all babies wearing cloth will have back issues, obviously, and lifting incorrectly can of course affect the back. But actually, generally speaking, most issues of pain (if not genetic or congenital), while triggered by something recent, have a correlation to something previous. After all, what sets up our habits for how we use ourselves in daily life as adults? Largely, either the foundations built during the first years or compensations picked up from previous injuries/issues.
It’s not about forcing crawling; it’s about being aware and preventing the things that can create compensations and block a baby’s reflexes from triggering the next natural movements.
And yes, may they ban those chemicals!
Thanks for your response. I’ve been reading through your blog bit by bit (too sleep deprived to absorb much at once) and much of what you’re saying is giving me food for thought.
Interesting…
In talking with my chiropractor, she indicated that some of the biggest problems with infant development is the number of kids who skip the crawling phase and go straight to walking lose out on developing the curvature of the lower spine which leads to lower back issues later in life. Thoughts?
Thanks for your comment. Yes indeed it’s a big issue, as crawling relates not only to hip and lower back development, but also the criss-crossing of info in the brain. There are several factors contributing like babies being prop-sat, prop-stood, spending less time on their bellies, and mis-informed advice floating around that says crawling is not important. I will have posts on crawling soon, please stay tuned! In the meantime, feel free to check out “A Guided Tour of Development” for how crawling fits into the whole scheme. http://consciousbabyblog.wordpress.com/2011/09/05/a-guided-tour-through-the-first-year-of-movement-development/
As a chiropractor that works with many kids the biggest issue is awareness. Watching for patterns and doing our best to assist them to be optimal. We certainly can’t “force” babies into being like “text books” but we can encourage them. The generally milestones are there for developemental both musculo-skeletal and neurologic. However, just because your kiddo missed one doesn’t mean they won’t catch it later. It is correct to say having baby in “natural flexion” (hips curled up) early on is optimal. (We are now seeing severe hip issues due to tight swaddleing) So cloth can be really helpful then. But…I think it is important to be mindful about the bulk. But most cloth diapers are pretty thin and movable now a days. One thing I also have notice is boys tend to W sit more frequently or sit with knees futher apart. (Cloth or not) So it leaves me to wonder if the anotomical difference makes this a bit more comfortable. NO this is not expert advice based on any research…just something I have noticed in 10 years of practice. Lastly, I wanted to comment on this statement from the article. These compensations can easily go unnoticed in a “healthy,” active child, but they linger in the body and can become problematic later in life (including back, hip, and knee problems). I think this is very true and where a pediatric chiropractor comes in handy. We can pick up on spinal misalignments and muscle imbalances. Addressing these issues early on is beneficial. I might even say that it is these issues not addressed that later do cause our “adult” issues. This may even start as early as in uetero positioning and the birthing process…maybe sooner even…genetics. I often see similar misaligment patterns in families. (go figure!) Anyway….food for thought. It is awareness and education that makes us all better parents!
Boom! Yes, the whole second half of what you wrote Gretchen! I am part of a family with generations of misalignment. I arrived via a challenging vaginal birth (due to misalignment), I have spent my entire adult life seeking body work and intentionally working to root out the deepest contributors to the back pain I have lived with. Now I ensure y children were raised as much as I knew how to do by the guidelines Eliza sets forth and with regular chiropractic maintenance AND, I think (hope) this is a big addition to help them break through the family curse, Aware Parenting (books authored by Dr Aletha I have experienced i myself that the emotional tension and physical tension go hand in hand. I have been “better” at practicing AwP with each one of my three kids and they’re chiropractic assessments are exactly correlated – the oldest holds the most tension and the youngest doesn’t really require any adjustment! I just thought this was an interesting example to share with you. Thank you for sharing your insights.