O1039: Do Non-disposable Diapers Have an Impact on Toilet Training Age or Prevalence of Bowel and Bladder Dysfunction in Children

Background: Cloth diapers are thought to make it easier for children to recognize when they are wet, which can facilitate the toilet training process. Disposable diapers are more absorbent, and thus can result in reduced feeling of wetness, impacting the maturation of the brain-bladder connection. We hypothesize that disposable diapers alter the normal sequence of toilet training. There is some research that suggests that the type of diaper used may have an effect on toilet training, though the impact of cloth diapers on toilet training is likely to vary depending on the child and the family's individual circumstances.

Methods: We identified and surveyed 2 groups of parents of children who had completed toilet training. A database of a local cloth diapers company (Mother Nature Diapers Services) and an online group for mothers of young children were used. A web-based survey was emailed in groups of 10 over 45 days for the Mother Nature group. A post with link to the survey was provided for the online group. The survey collected data on age of TT, use of DD and NDD at night, frequency of bowel movements and wetting accidents. Children with congenital anomalies of kidneys and urinary tract were excluded. Fisher’s Exact tests and non-parametric tests were performed, with p<.05 designated as statistically significant.

Results: Of 319 surveys distributed, 96 responses (30% response rate) were received and 95 were analyzed. Age of children ranged from 1.75 to 13 yr (mean 4.6 yr) with a 1.2:1 male to female ratio (n=51 male, n=44 female). Twenty-nine families used NDD, with 22 using both NDD and DD and 44 using only DD. Children in the DD group were younger than those in the combination and NDD groups (p < 0.001).
Toilet training was achieved earlier in both the NDD and combined group (median age < 24 mo) as compared to the DD group (median age 2 – 2.5 years), although not statistically significant (Table 1). Daytime wetting and nocturnal enuresis were not significantly different between groups (p = 0.08, 0.09, respectively). Frequency of daily bowel movements was higher in the NDD group at 93% versus 72% in the DD group (p=0.03).

Conclusion: We did not detect a difference in TT age based on method of diapering, but our data suggests that NDD use is associated with less bowel dysfunction. Limitations include small sample size, differences in age at time of response, recall bias, and retrospective nature of the study. Future implications include expanding our survey to include more companies/groups.