The Real Nappy Handbook - Buckinghamshire Partnerships

The Real Nappy Handbook
for parents and carers
‘Guiding you through your real nappy years’
The possibilities are endless
The possibilities are endless
Acknowledgements:
©The Real Nappy Handbook – for parents and Carers
text written by: Janice O’Flynn-Mundin March 2008
© Natural Infant Hygiene text written by:
Rachel Richardson, Knee High and Dry Ltd. August 2007
© Nappy Folding Instructions and additional extracts – courtesy of Eva Fernandes,
BORN: 0117 955 881
Photography:
© Matt Fowler Photography (www.mattphoto.co.uk)
Additional Photography:
© Janice O’Flynn-Mundin
© Recycle Now
Design:
© 600 Inhouse Design, County Hall, Walton St Aylesbury 01296 382717
Real Nappy Models:
Special thanks to all the Buckinghamshire real nappy babies, children and parents who gave their time and
enthusiasm to help model all the nappies featured in this guide.
Please reuse this guide by passing on to a friend or recycle by returning
to a paper recycling bin.
Printed On Recycled Paper!
No part of this publication may be reproduced by any means (including photography, or electronically by
fax, email or internet without the written permission of the authors.
Contents
Fact File No.
Title
Page No.
Fact File 1
Natural Infant Hygiene
5
Fact File 2
Real Nappy Library Kits
17
Fact File 3
Nappy Laundry Services
21
Fact File 4
Newborn Nappies
25
Fact File 5
Nappy Change Routines and
Treating Nappy Rash Episodes
39
Fact File 6
Equipment, Washing Instructions,
TOP TIPS and Troubleshooting
45
Fact File 7
How to Use Real Nappies at Night
55
Fact File 8
Daytime Toilet Training
67
Fact File 9
Night-time Toilet Training
85
Fact File 10
Suggested Real Nappies for Night-times
and during Toilet Training
99
Fact File 11
Taking Real Nappies on Holiday!
103
Fact File 12
Childminders, Nurseries and Nappies
107
Fact File 13
Alternative Disposable Nappies
115
What is
?
Buckinghamshire Real Nappy Initiative is an initiative within the
Recycle For Buckinghamshire campaign co-ordinated by the
Waste Partnership for Buckinghamshire.
The Waste Partnership for Buckinghamshire is made up of all the district and county councils in
Buckinghamshire: Aylesbury Vale District Council, Buckinghamshire County Council,
Chiltern District Council, South Buckinghamshire District Council and Wycombe District Council.
PLEASE NOTE:
The information, advice and guidance in this handbook is intended to guide parents and carers
during their child’s real nappy years to help make real nappy usage enjoyable and sustainable.
References to medical conditions and explanations are for reference only and should not be treated
as a substitute for qualified medical advice from your doctor or other qualified medical practitioner.
The reader is advised to consult a doctor or their health care professional regarding all aspects of
individual health care for their child/ren.
The information presented in this handbook is accurate and current to the best of the author’s
knowledge. Due to the constantly evolving nature of this subject matter the information is subject
to change. However, the authors, Buckinghamshire Real Nappy Initiative and the Waste Partnership
for Buckinghamshire, make no guarantee, and assume no responsibility for any errors, omissions or
changes in details given which have been presented in good faith.
Buckinghamshire Real Nappy Initiative contact details are:
Telephone number:0845 3708090
Email:[email protected]
Website:www.recycleforbuckinghamshire.co.uk
4
Fact File 1
Natural Infant Hygiene – Another Option
(also known as Elimination Communication, Infant Potty Training, or Early Start Potty Training)
© Written by Rachel Richardson, Knee High and Dry Ltd.
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for young babies
Contents:
1
2
3
4
5
6
What is Natural Infant Hygiene
Trends in Western Toilet Training Culture
A Comparison of Conventional Toilet Training and Nappy Use Vs Natural Infant Hygiene
Common Myths about Natural Infant Hygiene
Getting Started With Natural Infant Hygiene
References and Support Networks
5
1. What is Natural Infant Hygiene?
Natural Infant Hygiene (NIH) is a non-coercive
method of caring for a baby/toddler which focuses
on keeping them clean and dry, and aware of their
own bodily functions. If this approach is used there
is no need for ‘conventional’ toilet training, as the
child learns about toileting gradually, often starting
from birth. It is based on the principle that “like
other mammals, human babies are born with the
instinct not to soil themselves” (Gross-Loh 2007 p1).
While using Natural Infant Hygiene you can still use
training pants, nappies, or nothing at all, depending
on your lifestyle and the situation. Contrary to
common misconceptions, using this method does
not need to be stressful, messy or overly labourintensive. It can be done full-time or part-time, and
is not just reserved for stay-at-home parents or
people who live in rural areas!
2.Trends in Western Toilet
Training Culture
The current popular approach to toilet training in
western countries is to wait until the child shows
signs of ‘readiness’ and chooses to use a potty or
toilet; an idea that began in the 1940s appear to
have been the ‘norm’ from the 1960s onwards. This
section explores how this method came about, what
methods of toilet training were common before
this time, and some criticisms that have been made
about waiting until later to start.
In the 1920s and 1930s, toilet training was often
rigid and parent-centred, involving coercion and
punishment (Brazelton et al 1999). By the 1940s,
pediatricians began to agree that such approaches
could be unsuccessful and could cause behavioural
problems (Brazelton et al 1999), and in 1946
pediatrician Benjamin Spock recommended delaying
training until 7 to 9 months [which was considered
late at the time] (Sonna 2005). Later, in 1962, a
well-known study by paediatricic professor T. Berry
Brazelton was published in Pediatrics entitled
6
‘A Child-orientated Approach to Toilet Training’
(Brazelton,1962). Brazelton’s study recommended
waiting until the child initiated toilet training
themselves, usually after age 2, and from then on this
has been the most commonly approach used.
Brazelton’s approach, while popular, has come under
some criticism. While his approach may indeed
be more child-centred and gentle than approaches
common in the preceding decades, he does not
compare his suggested approach to non-coercive
early training (NIH) which appears to have been
used in western countries in the early 1900s but
forgotten about in the intervening decades (Boucke
2002, Sonna 2005).
In her book on Infant Potty Training, author Boucke
(2002) cites twenty-six different writings on the
subject of toilet training from the UK, France, Italy
and the USA, dating from 1870 to 1958 (Boucke
2002 pp.196-205). All of these describe methods
of supporting the infant over a pot from a young
age (two to six months), many making reference
to the use of cueing and conditioning, and some
also emphasizing the importance of using a gentle,
flexible, non-coercive approach and ensuring that
the baby is relaxed. Sonna (2005) also writes about
scientists in the early 1900s demonstrating that
a cue can condition an infant’s sphincter muscles
to relax and release waste, and refers to more
recent studies and literature which support this
(Ball et al 1985, Maizels 1993, Schaefer 1997, cited in
Sonna 2005). Interestingly though, one underlying
assumption of Brazelton’s paper is that children
do not have voluntary control of their sphincter
muscles until they are 18 months or older (Brazelton
1962). This not only conflicts with historical
accounts, but also with the experiences of today’s
parents around the globe who have toileted their
children earlier (http://groups.yahoo.com/group
NaturalInfantHygiene/).
Despite being advocated by the Western medical
establishment since his 1962 article was published,
Boucke (2002) also points out that there have never
been any true medical studies on starting toilet
training later. On the contrary, research carried
out since 1962 has shown that “toilet training
completion can be obtained much earlier and
without any side effects when an early initiation
is provided” (Rugolotto 2004 p180). Sonna too
describes how “a 1994 study in the Journal of
Developmental and Behavioural Pediatrics found
no data to support any specific signs of social or
emotional readiness for potty training” (Sonna 2005
p.9), and that “slow potty training progress and
chronic toileting problems are known to be related
to starting to potty train after age two…and failing
to take the child to the potty regularly” (p.xi). In
addition, the recommendations of a recent article
published in Continence UK are that “healthcare
professionals should educate parents to introduce
sitting on the potty/toilet early on as a normal part
of the child’s routine” and “the child should be
given regular prompts to sit on the potty/toilet
when a void (an elimination of urine or faeces)
is expected” (Roger 2007 p86). Despite all of this,
today’s standard toilet training recommendations
(including NHS and American Academy of Pediatrics
recommendations) still recommend waiting
for ‘readiness’.
Some specific problems have been linked to using
the ‘readiness’ approach and these are described
in more detail in the next section. Some of these
drawbacks, ironically, are highlighted by Brazelton’s
own 1962 study: It showed that of the children in
the study who wetted the bed until they were aged
3½, a third had early training (before the age of 2
years), and of those wetting and soiling after 5 years
of age, 12.5% had early training. But as Sonna (2005)
points out, this means that two thirds of bed-wetting
3½ year olds and 87.5% of wetting 5 year olds
had started training after the age of 2 years. Some
have benefited from later toilet training though:
Referring to the multibillion dollar disposable nappy
industry, professor of counseling psychology Linda
Sonna (2005) states that “delaying has been a boon
for the corporate bottom line.” Sonna adds, “It
has also turned what was once a natural learning
process into a stressful, frustrating and expensive
nightmare for countless families” (p.2). Interestingly,
Brazelton himself has had some involvement with
Pampers: In 1998 he was reportedly chairman
of the Pampers Parenting Institute (Larkin 1998,
Cincinnati Post) and in the same year appeared in
a TV commercial for their Jumbo size 6 nappy [for
children weighing approximately 35 to 70 pounds]
(http://en.wikipedia.org/wiki/Pampers). His book
‘Touchpoints’ is promoted on the Pampers website
at www.pampers.com.
Given the concerns mentioned and lack of research
associated with the ‘readiness’ approach, it is not
surprising that a Natural Infant Hygiene movement
has taken shape. Since the 1990s, facilitated
greatly by internet technology, the interest in
rediscovering traditional toileting methods has really
begun to gather pace. In 2004 the organisation
DiaperFreeBaby ( www.diaperfreebaby.org) was
formed to provide information and support to
parents wishing to try NIH. Gross-Loh (2007)
writes that since its formation, “…DiaperFreeBaby’s
membership has just ballooned. At the end of
it’s second year there were support groups or
practicing families in nearly every (US) state as well
as in fourteen countries, and growth has continued
to be exponential thanks to sustained public and
media interest” (p.6). Membership of the UK NIH
support group is also growing.
(http://groups.yahoo.com/group/ecuk/)
NIH author Laurie Boucke believes that “entrenched
and trendy theories about letting baby dictate when
to toilet train coupled with instilling fear in those
who go against the grain” (Boucke 2002 p206) has
sadly discouraged many people from learning about
or trying early toileting. It is hoped that this Fact
File might encourage parents to think more broadly
before deciding how to approach toileting with their
own children.
7
3.A Comparison of Conventional
Toilet Training and Nappy Use
vs Natural Infant Hygiene
Skin health and ‘Nappy rash’
As a result of the current popular toilet training
approach, combined with developments in
disposable nappy technology, it has become the
norm to leave a baby sitting in their own waste for
increasing periods of time. While nappy-rash once
only affected a small percentage of babies, it is now
commonplace (Sonna 2005). Most nappies are
designed to absorb urine which is then held close
to the child’s skin for a prolonged length of time,
until they are changed at the carer’s convenience.
If pediatricians’ recommendations of a minimum
of 6 changes per 24 hours are followed, children
can potentially spend up to 4 hours at a time in
urine-soaked nappies. Due to carers’ routines and
disposable nappy manufacturers advertising claims,
some children may even be left in urine for up to
12 hours at a time. This can increase the risk of
ammonia burns and bacterial, viral and fungal skin
infections, all of which could produce a skin reaction
commonly called ‘nappy rash’. In addition there
is an increased risk of urinary tract infections if
nappy change hygiene is not rigorous. Nappy rash
however is less likely to occur in naturally toileted
children, and NIH can also be a useful, natural
method for treating existing nappy rash or eczema
in the nappy region.
‘Colic’
NIH generally involves holding babies in the
squatting position or similar, which research
indicates is the easiest, healthiest position for
humans to empty the bowel (Saeed 2002). It is
possible that conventional nappy use and lack
of toileting contributes to symptoms in babies
described as ‘colic’. Accounts by parents using NIH
suggest that colic symptoms (and sometimes reflux)
8
are often noticeably reduced when they begin
toileting their babies, and also that some of the
previously ‘unexplained’ crying/fussing was actually
the baby signaling a full bladder (Gross-Loh2007,
http://groups.yahoo.com/group/ecuk/, http://groups.
yahoo.com/group/eliminationcommunication/, http://
groups.yahoo.com/group/NaturalInfantHygiene/)
So if you have tried conventional colic remedies for
your baby and they still have symptoms, you could
consider trying NIH to see if it relieves discomfort.
Bladder and Bowel control
If early toileting is not used and a child wears wet
nappies for prolonged periods during the first years
of life, they may become desensitized to the feeling
of wetness. This can make it harder for them to
identify the sensations of waste elimination when
conventional toilet training begins (Sonna 2005). A
study by Tarbox et al (2004) questioning whether
nappies could contribute to urinary incontinence,
found that extended nappy-wearing could increase
the rate of ‘misses’ and reduce the number of voids
in the toilet when out of nappies.
Early toileting encourages use of sphincter muscles,
and if a baby is not toileted they may risk losing
bladder and bowel control skills (Sonna, 2005., Bauer,
2001, Gross-Loh, 2007). Authors on the subject of
NIH believe that the reason why so much literature
coming from the medical profession indicates that
12-month-olds do not possess this control may be
because they actually had it, but lost it. Pediatrician
Barbara Gablehouse emphasizes that like other daily
activities, toileting is “a motor skill that your baby
needs to have an opportunity to practice” (cited in
Sonna 2005 p.ix). By using NIH, mastery of toileting
is gained as gradually as other developmental skills
with no sudden start to learning.
In contrast, conventional toilet training is started
later on. Some parents begin the training by
focusing on the child’s imminent need to urinate,
and the child learns to retain urine by contracting
pelvic floor muscles in order to make it to the
toilet (Bauer 2001). Other parents may start by
encouraging the child to recognize the sensations of
releasing urine, and the wetness that follows. Either
way, it is much later that the child learns sphincter
control and is able to release urine voluntarily
before the bladder is full (Bauer 2001). Natural
Infant Hygiene uses a newborn baby’s ability to
voluntarily relax sphincter muscles and urinate at
will, so that this ability is never lost (Bauer 2001).
Because the child grows up being able to eliminate
on cue, it would be rarer for them to reach the
stage where the bladder is very full, therefore they
will not be under pressure to retain urine in an
uncomfortable bladder while getting to the toilet. A
potential benefit of a child being able to empty the
bladder on cue would be for example being able
to do so before setting off on a car journey (Bauer
2001).
The way that bowel control is developed or
maintained is much the same as for urine.
Potential physiological problems
Toilet training “helps children learn to completely
empty their bladders—an ability that reduces
the risk of infection (Janson et al 2000; Sillen and
Hanson 2000)” (cited at www.parentingscience.com
August 2007), and there has been some concern
that delayed toilet training may be linked to urinary
tract problems: Observing the changes in toilet
training from 1940 to 2000 in Belgium (becoming
later and later), researchers Bakker and Wyndaele
(2000) noted that there has been an “apparent
increase in lower urinary tract dysfunction over that
period”. They carried out a study which concluded
that the lack of formal bladder training (which would
previously have taken place in the first 18 months
of life) may be responsible for this increase. A later
study by Bakker (2002) found that 10-14 year olds
with recurrent urinary tract infections started toilet
training significantly later than other children (cited
at www.parentingscience.com August 2007).
A 1997 study by Taubman found that when trained
using a conventional toileting training approach
(i.e. waiting for readiness), stool toileting refusal
occurred in one in five children. This can lead to
constipation, rectal impaction and faecal soiling
requiring medical intervention, and may result in the
child not being toilet trained by 42 months (which
Taubman notes can be a source of family stress).
No link was found between early toileting and stool
toileting refusal (Taubman 1997).
Parent-child relationship and approach to learning
NIH works with a baby’s natural body waste
rhythms and their natural desire to be dry. It
encourages direct two-way communication and
a developing relationship with the child around
toileting, and is a gentle progression towards
independent toileting in the months and years
to come. This is in contrast to conventional
toilet training which generally has an identifiable
starting point (usually after age two) when learned
behaviour, i.e. toileting in a nappy, has to be unlearnt.
The latter may be more likely to incur resistance,
particularly as children in this age group are known
for being contrary (Sonna 2005).
Toilet training does not need to be approached in
a different way to other learning. As Gablehouse
(2005) points out, “We don’t wait until our children
ask or give us clues that they are ready for a bath
or a ride in the car. We teach that these activities
occur in a specific place…tubs, car seats…” (cited
in Sonna 2005 p.viii).
9
4. Common Myths about Natural
Infant Hygiene
That your home will be dirty:
You can still put your baby in waterproof training
pants or even a dry nappy whilst still offering
regular potty opportunities. But any kind of
toilet learning involves some misses*, no matter
what age you start at. Children who are on solid
food produce waste that is much smellier than
young baby waste, and a mobile child adds other
practical challenges, so early learning has domestic
advantages! (‘Misses’ is the word used to describe
when a child ‘misses’ the toilet/potty as opposed to
using language like: ‘soiling’, ‘having an accident’ or
‘wetting themselves’ etc, so to remove any negativity or
expectation. Misses are seen as a natural occurrence.)
That it is too much work:
Whether using Natural Infant Hygiene or not,
your child’s toileting needs are going to take up
significant time, and like other aspects of caring for
a baby, Natural Infant Hygiene is a commitment. In
the short run it may seem more time-consuming
than leaving a wet nappy on, but the work involved
in Natural Infant Hygiene can be a very pleasant
experience allowing both the carers and child to be
actively involved in this step towards independence.
Some aspects of the workload are actually reduced
in the short and long term though. Establishing twoway communication about toileting from early on
can actually make things more predictable. Life can
then be more convenient without the impromptu
‘bottom explosions’ and the associated lugging
around of changing mat, wipes, spare clothing etc.
Also, many parents using nappies conventionally
recount daily, struggling when changing dirty nappies
on a wriggly, resistant toddler (and if a child achieves
toilet independence at age 3, as is now common, this
may mean up to 9000 changes (Gross-Loh 2007)!).
NIH on the other hand is more likely to involve
quick occasional changes of wet training pants, and
10
the experience of parents around the world is that
this usually ends at around 18 months to 2 years.
Of course, most people know somebody whose
child was quickly and easily toilet trained after
waiting until age two. However, one study found that
when toilet training was started after 24 months,
only 54% of children in the study population were
toilet trained before 3 years of age (Taubman 1997).
A current NHS handbook indicates that 1 in 4
three-year-olds and 1 in 6 five-year-olds in the UK
wet the bed (Department of Health 2001), a
statistic which is reflected by the nappy sizes on
today’s supermarket shelves.
That NIH puts pressure on a child
Parents considering waiting for signs of ‘readiness’ in
order to be child-centred will be reassured to know
that Natural Infant Hygiene “…is not about getting
your baby potty trained sooner than anyone else’s
child. It’s about the process of communication, not
the result. There’s no time frame, no deadline as to
when your child should be fully out of diapers…”
(Gross-Loh, 2007 p.9). In fact paediatrician Barbara
Gablehouse argues that by not toileting, “we force
our infants to learn to tolerate being wrapped in
their own body waste” (cited in Sonna 2005, p.viii).
Advocates of NIH believe in readiness too, it’s just
that they believe that a child is ready much sooner
than is commonly thought. By delaying toileting
there appears to be a greater chance that the child
will require nappies beyond toddlerhood, which can
attract stigma from peers and therefore a different
kind of pressure (Sonna 2005).
That you have to have the vigilance of a hawk
and special intuition
Natural Infant Hygiene relies as much on the baby
being able to go on cue than on you knowing when
they need to go. It is no more mysterious than
being able to tell when your own baby needs to
feed, sleep or be cuddled.
That it would be too difficult if you already have
other children
The experience of people trying this seems to be
that young children are often very intuitive and
more able to understand the new baby’s body
language than the parent (Gross-Loh 2007)! This is
not surprising, since they themselves were recently
pre-verbal and relied on this kind of communication.
Older siblings have been known to cue the baby
to eliminate when they see that they need to go
(It would seem logical from this that a baby and a
toddler could learn about toileting in tandem, if the
arrival of a new baby coincides with the toddler
starting conventional toilet training (and NIH is
used with the baby). No specific literature has
been found on this topic, so feedback from readers’
experiences is welcomed on this subject. Email any
feedback to: [email protected]”
That most people will find it offensive:
This does not seem to be the experience of most
parents practicing this in the UK
(http://groups.yahoo.com/group/ecuk/).
As long as it is carried out in a respectful way to
avoid offensive accidents (use of training pants,
portable potty etc can help), the general reaction
seems to be one of surprise/curiosity. Having a
concise way to explain what you are doing can help,
and of course like anything, the more people who
try this method, the more accepted it will become.
Using this method in public can be daunting initially,
a bit like breastfeeding or going out on your own
with your new baby for the first time. Confidence
comes with determination, practice and rewarding
experiences!
That you have to be a stay-at-home parent
While having a close, responsive relationship with
the child is important to NIH, the daily practicalities
are about communication, and other people can
learn to communicate with your child (GrossLoh 2007). It may just require a bit more time to
help the caregiver understand the principle and to
support them in learning. Fortunately the practice
of NIH is now becoming more widespread and
has received increasing media attention, so more
caregivers will have heard of it. Also, childcare
providers have a duty under the ‘National Standards
for Under 8’s day care and childminding’ to provide
equal opportunities (National Standard 9) to every
child in their care, so if a parent would like to
continue with NIH then the care provider should
support this (National Standard 12). If you would
like to view this document: ‘National Standards for
Under 8’s day care and childminding’, published
by the Dept. for Education and Skills contact
0845 602 2260 quoting: ISBN 1 844 78 060 0 /
DfES/0649/2003.
11
5.Getting Started With Natural
Infant Hygiene
• Cueing
During the nappy-free time, whenever you observe
the baby peeing or pooping, make a ‘cueing’ sound.
Most people use “pssss” for pee and a grunt for
When to start
poop. If you use these cues consistently, it is
The best time to start is from birth, or at least
possible to achieve ‘sphincter training’ in a young
before the age of 6 months. It is still possible to
baby (generally under 6 months) in a few weeks
incorporate these techniques after 6 months, and
(Sonna 2005). This means that the baby will become
many parents have done so successfully, but the
‘conditioned’ to relaxing the relevant sphincter
message is that earlier is better for success.
Disadvantages of starting later are that the baby may: muscles whenever you make the sound (provided
that they are in a comfortable position for ‘going’).
• have stopped signalling because their signals were
• Positioning
not being responded to.
• be crawling around so there may be more cleaning- If you suspect that your baby is ready for a pee or
poop, hold them over a potty, toilet (a child seat is
up involved during the initial nappy-free period.
not necessary) or any container. The positioning
• have become conditioned to eliminating in a
alone may help the baby to go, but if you have been
nappy and may find it harder to relax their
doing the cueing sound (as described above) for
muscles when unclothed.
several weeks, you might like to try making it while
How to Start:
you hold them. In the first few weeks it is better to
• Patterns and timing
only make the cueing sound while they are actually
To begin with, keep the baby out of nappies when at doing something, so as not to confuse them
home (you can sit/lay them on a towel) and observe.
You may want to set aside a quiet week for this, but A popular position to hold a young baby in is with
their back and head leaning against your stomach,
doing so is not essential. You will probably start to
notice how often they pee, or for example that they and your hands one under each of their thighs, with
their legs slightly apart. (For reference: please see
pee shortly after waking, or pee/poo after a feed.
front page of this fact file. Be careful not to pull their
Often babies will pee shortly after coming out of
cheeks apart though pottying in front of a mirror
a carrier, seat, or bath, or when a nappy/clothing is
can be useful to start with, and babies seem to
removed.
like this too!). It may be useful to sit on the toilet
The first couple of weeks may seem quite intense,
yourself while holding the baby (sitting facing the
but the hard work pays off later. Many people
toilet may be easier), so that you are comfortable
continue to use normal nappies when out and about as well. This way your thighs can form a mini ‘toilet
to begin with, but if you might be tempted to try
seat’ for the baby’s bottom to rest on too. Having
toileting when out, training pants or a pull-down
the baby lean against you supports their weight well
nappy will make this easier. This may depend on
and saves your back from strain. When holding a
the age of the baby, as very young babies pee much
baby over a potty, you can rest the backs of your
more frequently and training pants generally only
hands against the potty so that your arms are not
hold one pee. Some products have been specifically taking all of the baby’s weight.
designed for using NIH with babies, such as the
Not all babies like the same positions, and their
Bumboo Combi-Nappy available from
preference can change over time as well, so it
www.kneehighanddry.co.uk.
is all about being flexible and trying things out.
12
Sometimes it works better to cradle the baby in
your arms while you hold them over a bowl or
potty, especially if the baby is very young, or when
they are sleepy. To begin with it can be fiddly
changing positions, getting comfortable, managing
toilet paper (boxes of tissues are easier onehanded) etc, but like anything, it clicks with a bit of
practice. Books and websites on NIH usually show
pictures of different positions to try, and online
support forums are full of ideas.
• Signalling
A baby’s need for a dry bed is as basic as their
need for food, warmth and human contact, so
signalling the need to eliminate is innate. Modern
parents typically try to comfort a fussing baby with
feeds, rocking, burping etc but ignore the need
for toileting. If a response is never received, the
baby may eventually stop signalling (authors on the
subject of NIH believe this usually happens at 4 – 6
months).
Common signs you could look out for at this
stage include:
•
•
•
•
•
•
•
nlatching from the breast or bottle
U
during feeding.
Thrashing around and grumbling.
Fussing when being held, or fidgeting in a
baby carrier.
Pausing or going quiet and concentrating.
Waking at night and fidgeting.
Objecting to sitting in car seat, stroller, sling.
Passing wind.
Every baby is unique though, and by watching
and listening, you will get to know your own
baby better.
Often parents know when their baby is about to
poop anyway, but worry that they would not have
enough time to remove clothing and get them to
the potty. Parents using NIH usually find though
that they quickly start to notice earlier signs that
they were not aware of before, and so provide a
potty opportunity long before the need becomes
urgent. Even if a baby looks ready to poop, they
will often pause while clothing is removed, knowing
that you are responding and they will be able to
relax and go once the brief interruption has passed.
As time goes on, you will start to know your baby’s
patterns and recognise some signals, and your baby
will become able to go on cue. So whenever you
have an inkling that your baby needs to go, you can
hold them over something and use the cueing sound.
• Clothing
There is plenty of normal baby clothing that is
suitable for Natural Infant Hygiene, but some
clothing is more suitable than others. Dungarees,
for example would not be easy to pull down for
toileting. Also, vests with poppers and all-in-one
sleepsuits are an unnecessary obstacle. Trousers
with a nice stretchy waistband are ideal, as are
dresses. In the early weeks when the baby needs to
have their bottom naked at home for observation,
some people use baby leg warmers for warmth. If
you use a baby carrier it’s useful to have one that’s
easy to take them in and out of, such as a stretchy
wrap or a soft-structured carrier.
To catch ‘misses’ (as they are generally referred
to among parents using this approach – possibly
the word ‘accidents’ is best kept for toilet training
an older child who understands that there is a
particular place for ‘going’) you can use training
pants, pull-up nappies, Bumboo combi-nappies
(which can be used as a washable pull-up or
training pants, available from www.kneehighanddry.
co.uk approx £12), or normal nappies. Try to avoid
training pants or nappies made of materials which
leave the baby feeling dry though, as this could be
counterproductive.
13
• Potties
Some potties are smaller than others, but you may
find that your baby is quite big anyway before they
actually want to sit on the potty as opposed to
being held over it. The Anatomical Potty (available
from www.potty-training.co.uk) appears quite large,
but actually has a wide ‘seat’ and good back support
so may be helpful for a smaller baby. But any potty
or receptacle can be used.
hen out and about, it can be handy to use a
W
foldable potty (such as the Pottette by Tommee
Tippee, approximately £7) which is lined with
disposable bags. This fits easily into a handbag
(if you use NIH you may not need a bulky
conventional changing bag as you will have a lot
less to carry). Some people may also carry a
compact, foldable toilet seat (such as the Toddleloo approximately £9) which can be placed over
any normal-sized toilet seat, but as young babies/
toddlers generally need to be supported by the
carer either on the normal toilet (or are held over
the toilet anyway) a seat-reducer is not usually
necessary.
• Natural Infant Hygiene at night
It is possible to use NIH at night, and many parents
are surprised to find that this is easier than the
daytimes (because fidgeting and waking at night
usually means one thing – potty time). It is possible
to breastfeed a baby while holding them over a
potty or bowl at the same time, and once mastered
this can be very quick and easy, and useful at night.
Mats, mattress protectors and pull-up nappies/
training pants can be used for misses…or people
devise their own systems.
• Changes in Toileting Patterns
Children’s toileting patterns change over time,
but disrupted toileting patterns or rejection of
the toilet/potty can be an indication of pain (e.g.
teething), illness (including urinary tract infection
14
or side effects of prescribed medication), food
intolerance/allergies or anxiety. It is important
therefore to be flexible and responsive. Often more
‘misses’ are noticed when the child gains a major
new skill (such as crawling or walking) which they
want to practice uninterrupted for a few weeks.
Or sometimes the child wants to try toileting in
a new place such as a different container, another
room, or outdoors – babies like to experiment
and exercise the power of choice! They are also
much more able to pee or poo when relaxed, and
sometimes if the carer is stressed, anxious, tired,
or the environment is unsettled, a baby can pick up
on this and their toileting will be affected. Parents
often report that using NIH brings them closer to
their children because they understand more of
what the child is experiencing or communicating
to them. Remember, the goal of NIH is to respond
to communications as far as possible and to keep
your baby clean, dry, and awareness of their bodily
functions. The goal is not to train the baby to ‘go’ in
the toilet or potty (this will come later as they gain
social understanding and want to imitate others).
Some days your baby may communicate that they
do not want to be toileted (for example if they
are tired or unwell, or peeing very frequently due
to a food reaction) and you may have to change
your baby often to keep them dry. Equally, if this
gets tiring you may decide to use conventional
nappying for a while. Generally this situation is only
temporary though, and the important thing is that
you respect your baby’s choice and do your best to
maintain good hygiene.
• Sign language
Many parents using NIH find that a useful tool
is to incorporate some sign language into their
communication with their baby. Simple signs
(you can use British Sign Language, American Sign
Language or make up your own signs) can
be an effective way for a baby
to communicate that they
need to toilet before they can say so verbally. It is
usually possible for children to start using signing
effectively somewhere between the ages of 8 and
12 months (Garcia 1999).
Please remember that a young child should
never be pressurised to eliminate waste, or to
do so in a specific place.
6. References and Support Networks
If you would like further information or details of forthcoming workshops on Natural Infant Hygiene, please
visit: www.urbanbabies.co.uk
American Academy of Pediatrics 2007 When is the right time to start toilet training? [online] Available from:
http://www.aap.org/publiced/BR_ToiletTrain (cited August 2007)
Bakker, E. and Wyndaele, J.J. 2000 Changes in the Toilet Training of Children during the Last 60 Years:
The Cause of an Increase in Lower Urinary Tract Dysfunction? British Journal of Urology International 86
pp248-252 [online] Available from: http://www.blackwell-synergy.com/doi/full/10.1046/j.1464410x.2000.0073
7.x?cookieSet=1
Bauer, I. 2001 Diaper Free – The Gentle Wisdom of Natural Infant Hygiene New York: Plume
Boucke, L. (2002) , 2nd Ed Infant Potty Training: A Gentle and Primeval Method Adapted to Modern Living
White-Boucke Publishing, Colorado USA
Brazelton, T.B., 1962 A child-oriented approach to toilet training Pediatrics 29 (1) pp121-128 [online]
Available from: http://pediatrics.aappublications.org/cgi/reprint/29/1/121
T. Berry Brazelton, MD*, Edward R. Christophersen, PhD, ABPP , Annette C. Frauman, RN, PhD§, Peter
A. Gorski, MD, MPA I , Jim M. Poole, MD, Ann C. Stadtler, MSN, CPNP#, and Carol L. Wright, BS** 1999
Instruction, Timeliness, and Medical Influences Affecting Toilet Training Pediatrics 103 (6) Supplement
pp1353-1358 [online] Available from: http://pediatrics.aappublications.org/cgi/content/full/103/6/S1/1353
DeVries M.W., DeVries M.R. 1977 Cultural relativity of toilet training readiness: a perspective from
East Africa Pediatrics 60 pp170 –177 [online] Available from:http://pediatrics.aappublications.org/cgi/
reprint/60/2/170
Garcia, J. 1999 Sign with your Baby Mukilteo, WA: Sign2Me
Gross-Loh, C. 2007 The Diaper Free Baby Los Angeles CA: Harper Collins
Larkin, P. (1998) P&G announces Pampers now a bigger disposable The Cincinnati Post 22 July 1998 [online]
Available from: http://www.cincypost.com/business/1998/pg072298.html
NHS 2001 Birth to Five -Your complete guide to parenthood and the first five years of your child’s life
London: Department of Health
Rogers, J. 2007 The influence of age, culture and beliefs on toilet training Continence UK 1 (1) pp.84-86
[online] Available from: http://www.continence-uk.com/journal/downloads/0101_review3.pdf
Rugolotto, S. 2004 Letter To the Editor -Toilet Training Pediatrics 113(1) pp180-181 [online] Available from:
http://pediatrics.aappublications.org/cgi/content/full/113/1/180?ck=nck
15
Smeets, P.M., Lancioni, G.E., Ball, T.S., et al 1985 Shaping self-initiated toileting in infants Journal of Applied
Behaviour Analysis 18 pp303 –308 [online] Available from: http://www.pubmedcentral.nih.gov/articlerender.
fcgi?artid=1308025
Sonna, L. 2005 Early Start Potty Training New York: McGraw-Hill
Saeed, R. 2002 Impact of Ethnic Habits on Defecographic Measurements Archives of Iranian Medicine Vol 5
(2) pp115-117 [online] Available from: http://squat.beinsa.info/defecography.htm
Tarbox, R.S.F, Williams, W.L., and Friman, P.C. 2004 Extended diaper wearing: effects on continence in and
out of the diaper Journal of Applied Behaviour Analysis 37 (1) pp.97-100 [online] Available from: http://www.
pubmedcentral.nih.gov/picrender.fcgi?artid=1284484&blobtype=pdf
Taubman B 1997 Toilet training and toileting refusal for stool only: a prospective study Pediatrics 99 pp54
–58 [online abstract] Available from: http://pediatrics.aappublications.org/cgi/content/abstract/99/1/54
White, C. and Boucke, L. 2006 ‘Potty Whispering: The gentle art of Infant Potty Training’ Lafeyette, Colorado
USA: White-Bouke Publishing
Parentingscience.com 2006 What the scientific evidence reveals about the timing of toilet training [online]
Available from: http://www.parentingscience.com/science-of-toilet-training.html [cited August 2007]
Proctor and Gamble 2007 Potty Training Center – suggested books and videos [online] Available from:
http://us.pampers.com/en_US/learning/page/tpc_potty_bvideos.do [cited August 2007]
EC in the UK: A UK-based group for discussing elimination communication, aka infant potty training aka
natural infant hygiene [online] Available (membership required) from: http://groups.yahoo.com/group/ecuk/
[cited February to August 2007]
Elimination Communication email group [online] Available (membership required) from: http://groups.
yahoo.com/group/eliminationcommunication/ [cited February to August 2007]
Natural Infant Hygiene email group [online] Available (membership required) from: http://groups.yahoo.
com/group/NaturalInfantHygiene/ [cited August 2007]
Wikipedia: Pampers [online] (Last updated 29 August 2007)Available from: http://en.wikipedia.org/wiki/
Pampers
DiaperFreeBaby.org (2004-2007) A network of free support groups promoting a natural approach to
responding to babies’ elimination needs [online] Available from http://www.diaperfreebaby.org
16
Fact File 2
REAL NAPPY LIBRARY KITS EXPLAINED
aS
rin
Ko
he n
tep
sL ol
l ip o
pN
A
appy
dvisor
Contents:
1
2
3
4
5
6
Real Nappy Library Kits
Real Nappy Advisers
How to I arrange to borrow a library kit?
Where to purchase Real Nappies after borrowing a library kit
Buckinghamshire Real Nappy Exchange
Non-Endorsement Statement of Real Nappy Services and Suppliers
17
Library kits are ideal for those who want to go a step further than just thinking about using real and
want to give real nappies a try before committing fully.
They are also perfect for established real nappy parents who want to try the next size up or the
latest designs.
This fact file tells you what they are and how to get hold of them.
1. Real Nappy Library Kits
In Buckinghamshire, parents, grandparents, foster
carers and childminders can access Real Nappy
Library Kits for free. Library kits contain a selection
of real nappies + accessories that cover the 4 basic
nappy systems available. They contain everything
you will need during your loan. The kits can be
borrowed for up to 4 weeks at a time (depending
on negotiation and availability). You can try out
the nappies in your own home environment: fitting
them on your child/ren, washing and drying them to
experience the full cycle of usage. This is the best
way to see how they work and will enable you to
decide whether real nappies will suit your
personal situation.
2. Real Nappy Advisers
The library kits are held and maintained by Real
Nappy Advisers who are located in and around
Bucks. Real Nappy Advisers are either:
• P
arents who have used real nappies on their
children and have set-up their own nappy
company or work on behalf of a national real
nappy supplier. They provide support, advice
and sell nappies/accessories directly to local
customers. Advisers provide their own real
nappy library kits to lend out for a small weekly
charge. This charge covers administration and
preparation of the kits before and after your loan
along with consumable items that you will use
during your loan. They also ask for a ‘holding,
returnable deposit’ which is taken prior to your
loan. This is held as security against the safe and
clean return of the library kit.
18
• O
R they are volunteer real nappy parents who
belong to the support group BARNS (Bucks
Area Reusable Nappy Support). BARNS are
a voluntary group who primarily provide real
nappy library kits for families to borrow. The
kits are available for free loan for up to 4 weeks
at a time, advice and support is given before and
during the loan. Real nappies and accessories
can also be purchased from an established real
nappy supplier via BARNS. Ongoing support is
also given to Bucks residents during the nappy
years. BARNS only ask for a ‘holding, returnable
deposit’, with no weekly charge but they do ask
for a questionnaire to be completed on return of
the kit.
• A
Laundry Real Nappy Adviser provided by a
Nappy Laundry Service. If you would like to try
out a laundry service instead of washing your
own nappies at home, a Laundry Real Nappy
Adviser can give you a free demonstration of
their nappies in your own home. Some laundries
provide a week’s free trial by negotiation with
no obligation to continue at the end of the week.
Please contact the laundry direct to arrange.
3.How do I arrange to borrow a
Library Kit?
PLEASE NOTE: You will be expected to travel
to collect/return the kits directly to the adviser.
However this is negotiable if traveling is difficult
for you, please do not hesitate to speak directly to
your local nappy adviser if this is an issue.
1. Select a Real Nappy Adviser from the contact
list provided in the free Nappy Information Pack
or visit www.recycleforbuckinghamshire.co.uk
for the updated list. Call or email your chosen
adviser. Please note that as advisers are parents
too, they may not return your call immediately
so please be patient!
2. On your collection of the kit, a Real Nappy
Adviser will spend approx. 1 hour showing
you the different types of nappies and how
to launder them. You will also go through an
inventory of items that you will be borrowing
and sign on receipt of the kit, so please ensure
that you allow time for this to happen.
4.Where to purchase Real Nappies
after borrowing a Library Kit
If you would like to switch to real nappies after
borrowing a library kit, you are not under any
obligation to purchase nappies directly from the
nappy adviser just because you have borrowed a
library kit from them. However you always have
the option to if you liked the service they offered
you! The Nappy Information Pack lists all the local,
national and internet real nappy suppliers so you can
‘shop around’ and source the nappies yourself.
The advantages of purchasing direct from your local
Real Nappy Adviser are that:
3. A ‘holding, returnable deposit’ will also be
taken as security against the safe return of the
library kit and a small weekly fee will be charged
(depending on adviser and how many weeks you
require) to cover consumables (contact Adviser
for full details). The loan of the library kit is free.
• T
hey are local to you, so this makes it easier
to view, select and check the fit of the nappies
before you buy. They are also nearby for picking
up the smaller consumables i.e. liners, boosters,
washable wipes, alternative disposable nappies
etc. saving you money on postage and packaging.
4. During the loan period, you will be expected to
home launder as advised. Please return the kit
in a clean condition. Any missing items will be
charged against the holding deposit, so please
ensure that all items on your inventory are
present prior to return. Any soiled nappies or
wraps that are returned at the end of the loan
will either be charged against your deposit or you
will be given a short time to take them home to
re-wash. Your adviser can give you lots of handy
tips to return the nappies to a pristine condition!!
• T
hey can advise you on exactly what you need
(saving expensive mistakes), put through your
order and arrange delivery of your nappies to
save you time.
For the contact details of real nappy suppliers please
see the sheet: ‘Where to See, borrow a library kit,
Purchase or Launder Real Nappies in Bucks’
This can be found in the Nappy Information Pack
and is also available on the website at:
www.recycleforbuckinghamshire.co.uk
5. Please allow at least 30 minutes on returning
the kit to your adviser as the kit will be checked
against your inventory and, if all is present, your
holding deposit will be returned. You can also
use this time to discuss your experience!
19
5.Buckinghamshire Real Nappy
Exchange
If you would like to purchase 2nd hand nappies
and accessories, we operate a free service called
Buckinghamshire Real Nappy Exchange. This enables
local parents to exchange/sell or donate their
nappies and accessories to interested families.
Visit www.recycleforbuckinghamshire.co.uk to view
the updated list of items on the exchange or to
download an Exchanger’s form if you have items to
sell or donate.
Buckinghamshire Real Nappy Initiative also actively
supports new business initiatives in our county
so is happy to work directly with Real Nappy
Advisers, laundry services and national suppliers.
We advertise all real nappy supplier contact details
in the free Nappy Information Pack so that you
can have all the local and national contacts in one
accessible place.
PLEASE NOTE:
Buckinghamshire Real Nappy Initiative doesn’t
endorse one service over and above another.
6.Non-Endorsement Statement of
Real Nappy Services and Suppliers
The Waste Partnership for Buckinghamshire (AVDC,
BCC, CDC, SBDC, WDC) value the impact that real
nappy library kits have at encouraging residents to
make the switch to real.
le
mp
Exa
o
fa
Re
al
Na
ppy
Li
brar
y Kit
© Written by Janice O’Flynn-Mundin, Buckinghamshire Real Nappy Initiative Updated February 2008
For a free Nappy Information Pack or additional Fact Files call: 0845 3708090 or email:
[email protected] or visit www.recycleforbuckinghamshire.co.uk to download.
20
Fact File 3
Nappy Laundry Services
Ex
am
efold n
o f Pr
e
l
p
appy system provided by
laund
ry s
er v
ices
ella
Isab
( 22
h
mt
s-
l es
Ay
bu
r
y)
an
d
Co
nst
anc
e (7m
n)
ths - Wooburn Gree
Contents:
1
2
3
4
So what do laundry services offer?
What equipment do they provide?
Troubleshooting Tips: Leaks!
EXTRAS! Additional services
Nappy laundry services are currently operating in Buckinghamshire.
Cost savings compared with disposable nappies are negligible, however what
you don’t save in money, you save in time and convenience along with all the
additional benefits that real nappies offer.
21
1. So what do laundry services offer?
On making an initial contact with a laundry service,
they will offer a free ‘no-obligation’ real nappy
demonstration. A Laundry Nappy Adviser will
visit you at your home at your convenience. The
demonstration will show you the type of nappies,
wraps and accessories that can be provided and
how to use the nappies on your baby/toddler.
They will also discuss with you the weekly costs
involved, if a minimum contract period is expected,
if any discounts apply, additional costs of wraps,
paper liners and/or accessories. They will also
advise you of your weekly collection/delivery day
should you take up the service. This is the time
to ask any questions, so that you are fully aware of
what the service offers and how it can be tailored
to your families needs, along with information on
how the nappies are used.
2. What equipment to they provide?
Laundries will generally provide the following
equipment:
Prefold FLAT nappies – these are flat, rectangular
shaped, absorbent cotton sheets, which have
extra padding in the middle section.You ‘pre-fold’
the nappy into a pad and insert it into a WRAP
(see below). The laundry should provide as many
prefolds as you need for each development stage of
your child. So for newborns – generally 50 prefolds
are provided per week. As baby grows, the amount
of prefolds will be reduced to approx. 42, as you
will be changing less frequently. You should still be
given enough prefolds to ensure that a minimum of
6 nappy changes are completed 24 hour period (as
recommended by paediatricians). If your child has
eczema, you might need to request extra prefolds
(at no extra cost) as children with this condition
generally need to be changed more frequently.
Discuss this with the laundry to ensure that your
needs will be met if this is the case. Note: even
22
though your prefolds may reduce in quantity, your
weekly charge will remain the same!
Wraps – these are the waterproof cover that fit
over the prefolds, to prevent moisture ‘wicking/
leaking’ on to baby’s clothes. Wraps also help to
keep the prefold in place and contain everything!
The laundry service will not wash the wraps for you,
so you will need to wash the wraps at home. The
wraps do not need to be washed after every nappy
change so you will have less of these compared with
your prefolds: generally between 4 & 8 depending on
the age of baby and your preference! (See Fact File
6 for instructions on how to care for your wraps.)
Laundry services differ in what they provide – some
provide all the wraps you need at no extra charge,
others will provide wraps for the newborn stage but
they expect you to buy larger sized wraps as your
baby grows, whilst others will provide a minimum
of 3 or 4 wraps but ask you to buy additional ones
if you need more than this. So remember to clarify
this point during your nappy demo.
A tall ‘Nappy Bin’ with a lid that seals and a sturdy
plastic bag to line the bin. This is where you will
store your dirty prefold nappies during the week!
Only prefolds should be stored in here, no washable
wipes are allowed and paper liners should be
removed and put in the toilet if soiled before the
prefold goes into the bin. On your collection day tie
the top of your bag to seal it from odours (generally
only an ammonia smell as baby’s poo should have
been removed with the paper liner and/or sluiced
into the toilet). Pop the nappy bag outside your
front door or in a designated area.
Your laundry service will generally provide you with
a label to attach to your bag stating ‘Dirty Nappies’
etc to prevent your local charity receiving a nasty
shock and valuable stock going missing!
Paper liners – as previously mentioned, these are
used to line the prefold to make it easier to remove
baby’s poos and put into the toilet, introducing
excrement into the sewerage system where it
should be! Most laundries will expect you to buy
these as extras. You can buy them direct from
the laundry or you can shop around. Be aware of
high street baby retailers, that generally only stock
liners that do not biodegrade and can not be put
into the toilet – which defeats the object of the
exercise – avoid these types if you can. If you are
breastfeeding, you generally won’t need to use liners
as poos are watery anyway. However, there are
slightly thicker liners that are exclusively used for
breastfeed poo and absorb them better –
these are available from Real Nappy Advisers as
opposed to the laundry services but it is down to
your preference.
absorbed more fully. Prefolds can be more difficult
to use at night with the standard wrap but, again, if
you use with a pocket wrap for nighttimes they will
work much better and are easier to change in the
middle of night.
Fleece liners – alternatively you can line your
prefolds with a fleece-only booster. You will have
• A
lternative disposable nappies disposable nappies
like Tushies and Moltex to compliment your real
to purchase these from a real nappy supplier as
laundries do not sell them. These must not be put
in your laundry collection bag though so you will
have to wash these with your wraps at home. The
benefits of fleece is that it allows urine to soak
through to the prefold underneath but the fleece
fibres stay dry. Poo sits on top of the fleece making
it easy to sluice off as the fibres refuse to absorb
it. If your child experiences eczema then fleece will
provide a dry air-cushion between baby’s bottom
and the wet prefold making it more comfortable.
If you prefer to use fleece all the time consider
purchasing fleece-lined ‘pocket/stuffable’ wraps that
you can stuff your prefold into (see below).
3. Troubleshooting Tips: LEAKS!
If you find the wrap supplied doesn’t suit your baby’s
shape and you are experiencing leaks, consider
purchasing ‘Pocket/stuffable wraps’. These are lined
with fleece and have a pocket which you can slip
your prefold into. These wraps fit more snugly than
the standard wrap and hold the prefold in place,
preventing it from moving around. Pocket wraps
are better suited for boys and heavy wetters as they
redirect the moisture towards the prefold to be
4. Extras! Additional Services And Accessories
• S ome laundries also offer wonderful baby
accessories from washable wipes to natural
nappy change creams, lotions, soaps, shampoos
and bubble baths that care for baby as well as the
environment.
nappies usage, can also be delivered direct to
your door.
• C
otton ‘swim nappies/pants’ to keep your local
swimming pool clean and reduce the need for
disposable swim nappies and potty training pants,
for when you come to the end of your nappy
years.
If you like the sound of using a nappy laundry, see
the information sheet:
‘Where to see, borrow a library kit, purchase
or launder real nappies in Bucks’ (in the Nappy
Information Pack or online at
www.recycleforbuckinghamshire.co.uk to find the
contact details of laundry services operating here.
Contact the laundry direct to confirm that they
will deliver to your area and arrange a free ‘noobligation’ demo.
© Written by Janice O’Flynn-Mundin,
Buckinghamshire Real Nappy Initiative
Updated February 2008
For a free Nappy Information Pack or additional
Fact Files call: 0845 3708090
or email: [email protected] or visit
www.recycleforbuckinghamshire.co.uk to download.
23
24
Fact File4
Newborn Nappies
e, 3
Ros
old, with her M
um
weeks
ap
and
Da
k
r
o
H
t
ospit
d,
T he S
al n
lling:
Ha
app
ode
nn
m
y(
y)
ah
wr
an d
bur
Eliot (Ayles
+
er
ost
bo
)
tem
sys
N
ew
b
or
nT
err
yn
app
y
Contents:
1Introduction
2. Which nappies to use immediately after the birth
3. Real Nappies to use up to approximately 12 Weeks
4. Birth-to-Potty Sets
5. Real Nappy Library Kits
6. Accessories to have in your nappy kit
7. How to fold Terry and Prefold nappies
25
Can I use real nappies right from birth?
Will the hospital allow it?
What will I need?
Let’s face it; the expectation is that disposable nappies will probably be
the first nappy your newborn wears!
But newborns can use real too…this fact file explores the possibility of using real nappies right from
birth, along with disposable options for this time.
1.Introduction
Newborns and real nappies go hand-in-hand –
natural cotton next to newborn skin. Yes, you can
take real nappies into hospital with you there is no
law that says you can’t! However, midwifes may not
be fully aware of how to use your type of real nappy
as there are so many different varieties!
This could be a lovely job to give to your birth
partner - properly primed, your birth partner could
take full responsibility of putting the very first
real nappy on your newborn, leaving you and the
midwife to the serious business of recovering!
But to start at the very beginning….There are
just 2 nappy options to consider during your last
few weeks of maternity to help you feel prepared
before the birth of your baby/ies:
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a) What type of nappy to use straight
after birth?
b) What type of nappies to use up to 12 weeks of age?
If you are interested in using real nappies in the long
term, you can concentrate on this more fully once
baby is here. Babies come in all sorts of shapes and
sizes and though the temptation may be to rush
out and buy a complete Birth-to-Potty set of real
nappies before baby is born, this could be a very
expensive mistake if your baby’s shape doesn’t suit
the set you’ve bought!
2. Which nappies to use immediately after the birth
Just consider nappy options that suit all newborns,
regardless of their initial size and shape, so that you
can feel prepared in time for the birth.
Disposables: For immediately after the birth and
whilst you are in hospital, disposable nappies might
be the realistic option to consider. Remember
disposable nappies were originally designed
to complement old-fashioned Terry nappies in
situations when parents were away from home,
for example: whilst in hospital, out visiting or
shopping, holidays etc. Midwifes are more familiar
with how to use disposable nappies so no need to
have an impromptu nappy training session during
labour! If you would like to use disposables but
would prefer to avoid the superabsorbent gels
and plastics they contain, then there is 1 type of
disposable nappy called Tushies that is just made of
wood pulp and very minimal plastic. Please refer
to Fact File 13 ‘Alternative Disposable Nappies’. If
you are concerned about the landfill impact of your
newborn’s disposable nappy, don’t be if you are
considering returning to using real once you
are home.
Real Nappies: If you would like to use real nappies
straight from birth whilst in the hospital setting
then consider a real nappy that is easy to use.
During your last few weeks it would be advisable
to meet with a *Real Nappy Adviser who can
show you the different types available to either
launder at home yourself or from a Nappy Laundry
Service. Obviously, you won’t know the size and
weight of your baby before s/he arrives. If you are
approaching full term then all newborn real nappies
should fit the average size baby (7lbs – 11lbs)
with ease. If you are expecting to have your baby
prematurely (possibly due to a planned caesarean
for example) or a smaller babe, then again, there are
real nappies available especially for smaller / prem
babies, your Real Nappy Adviser can also show you
the options available.
*Real Nappy Advisers have personal experience
of using real nappies and can give free advice/
support, some sell all the nappies/accessories locally.
There are also Laundry Real Nappy Advisers who
offer a laundry service direct to your door, they
provide free demos to you and can provide all the
equipment you need to get you started. Short or
long-term laundry services are available.
See Fact File 2 Nappy Library Kits Explained or Fact
File 3 Nappy Laundry Services for more details.
For immediately after the birth consider using:
A Wrap and Booster only A very quick solution for
the hospital/home setting immediately after birth is
to use a small wrap (e.g. Bambino Mio cost: £5-8
per wrap or Onelife Newborn wrap which has a
cut away to accommodate the unbilical cord £8
per wrap) with a cotton booster (approx cost £2-3
each) in it. Hospitals that use real nappies on their
wards exclusively, use this system as they are so
quick to put on, take off and wash. The booster can
be lined with a paper liner, making meconium easier
to dispose of in the toilet! A very, cheap and quick
option and it’s easy to use for midwifes and birth
partners.
Pocket nappies (BumGenius, Wonderoos, Happy
Heiny’s, Lollipop Rainbow, Fuzzi Bunz) stuffed with
either a booster, a prefold (see below) or a terry
nappy are all very good options for the hospital
situation as you can prepare them in advance, put
them in your hospital bag then either the midwife
or birth partner can put the nappy on just like
a disposable. They come in Velcro and popper
fastenings for ease of use. However, these nappies
are generally lined with fleece, which is a man-made
fibre – if you have concerns about allergies etc
don’t use fleece until after your child is weaned or
after you feel confident that fleece is not going to
produce a reaction e.g. after wearing fleece baby
clothes etc. If you would prefer to use a natural
cotton consider a Wrap and Cotton Booster
option (above), Motherease if you are expecting a
larger baby (below), or terrys/muslins, or a prefold
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(however terrys / muslins / prefolds might be more
difficult for the midwife/birth partner to use).
Motherease, One Size, One Life are other good
options to use but many parents have advised that
even on the smallest setting, this real nappy can
sometimes be too big for the ‘new’ newborn of a
lighter weight. Once baby approaches 8lb+ then
the nappy is ideal. Also, as it is a 2-part nappy (wrap
+ absorbent layer) it’s not as easy for anyone who
is new to using real nappies, so these can be slightly
fiddlier for midwifes and birth partners to use.
Home Births
If you are having a home birth, then it really is up to
you which nappy you prefer to use as you will have
access to everything you need! However, just as in
the hospital setting, show your birth partner how
to put the nappy on just incase the midwifes are
not familiar with the style.
Birth Partner
Prepare your birth partner well in advance
(preferably before labour starts!) of how the real
nappy should be put on – as they may well be the
one to put the very first nappy on your newborn
babe. Practice on a doll or teddy if you have never
had the opportunity of changing nappies before.
Again, a Real Nappy Adviser will be happy to show
you how to do this.
In Hospital After The Birth
Have enough nappies and wraps in your hospital
bag for up to 3 days stay. Recommended amount:
18 absorbent parts and 6-8 wraps. Also have some
paper liners or fleece liners if you prefer; 2 large
wet nappy bags: 1 to collect all the used nappies
whilst on the ward and 1 for your partner/family to
take home a full bag of dirties to wash for the next
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day (if needed to).You can just use sturdy plastic
bags that have no holes in, instead of a commercially
bought nappy bag.
If you are expected to stay on the ward for more
than 2 days, again consider using disposables for
ease. However if you would like to continue with
real nappies, then this is also possible with a little
forward planning and establishing a routine. If
you have someone who can collect the nappies
on a daily basis to collect dirties and drop off
clean ones, then it is just a matter of establishing a
routine. Real Nappy Laundry Services could also
be arranged if you are expecting to stay in hospital
longer than expected.
‘Meconium’
Newborns will produce ‘meconium’ at some point
after the birth. This is poo that looks like black tar
and generally goes everywhere, so a snug fitting
nappy is essential! Line your nappy with a paper
liner or use a nappy that is fleece lined to make the
removal of meconium slightly easier. Remember
fleece is a man-made fibre so if you prefer to stick
with natural cotton just use a paper liner instead.
After meconium has been produced, newborns
generally don’t produce much in the first day or so
but still remember to change the nappy every 3-4
hours. Paediatrians’ recommend a minimum of 6
changes every 24 hours – this includes disposable
nappies. Do not be tempted to leave the nappy on
for any longer than 4 hours unless medical needs
intervene of course!
3.Real Nappies to use up to approx.
12 Weeks
Boosters and Prefolds for the 1st couple of weeks
For the 1st couple of weeks, a quick newborn option is to use just long rectangular boosters (available from all suppliers) just ask for the best size that
fits into/can to be inserted into a newborn Motherease wrap if you can’t get to see them first - this
is how hospitals use real nappies with newborns.
Just put a liner over the top of the booster and
secure with the wrap - this option is just for the 1st
couple of weeks. Boosters are really quick to wash
and dry. Or use a newborn set of prefolds, folded
first, liner on top and popped into a Motherease or
Bambino Mio wrap – slightly bulkier though and can
rub on umbilical area. You will need between 15-20
boosters/prefolds to cover the first couple of weeks.
Again boosters/prefolds can be reused for so many
things in the future, so your purchase will not go to
waste.
Terry Nappies and Muslins
One of the best options for the new born period
(up to 8-12 weeks) is Terry nappies or muslins…
don’t be shocked! Once you learn the very quick
folds they are the perfect option. The reasons for
this are:
• They fit every shape and size of baby perfectly.
•Nappi Nippas are used instead of pins now, so
no chance of pricking baby or your fingers. The
nippas ensure the nappy stays snugly in place
which means no leaking!
• They are very cheap to buy (approx £2 each)
• Quick to wash and dry at home.
•Can be used for so many other things once baby
is in the next size of nappy, so no wastage. Can
be used as a booster for larger nappies or pocket
wraps as your child grows.
•They can be used with snug fitting wraps such as
Onelife wrap (newborn size with special cut away
to accommodate umbilical cord), which make an
excellent combination.
•Baby grows so quickly in size and weight that
they grow out of newborn terry nappies/muslins
by 12 weeks. Think carefully before you buy a
newborn sized ‘shaped’ real nappy, which are
more expensive, you will only be using them for
a matter or weeks, which could be a waste of
money in certain circumstances.
40cm Terry Nappies
Terry nappies come in ‘cm’ sizes the smallest is
40cm (this is the size that is perfect for approx 6lb9lb newborn babies for the first few weeks as it isn’t
bulky).You will need between 15-20: 20 will give
you 10 nappies per day for 2 days worth. At the end
of the day, pop in your soiled nappies to wash, then
hang them out to dry over night and so should be
ready to go again by lunchtime next day.
If you don’t want to buy a complete set of newborn
terrys for the 1st 2 weeks, you could always
supplement some of these newborn terrys with
a set of muslin squares instead (to cut down the
amount of newborn terry nappies you buy). Muslins
were originally used for this tiny newborn stage.
Both nappies (newborn terrys and muslins) can
always be reused once they are outgrown for so
many things ie. stuffing for older nappies to provide
extra absorbency right up to toddler training, sick
cloths to throw over your shoulder, as soft warm
mats to put on cold nappy change mat, mopping up
everything! So the expense won’t be wasted – they
will be also ready to go again for baby no.2/3/4!
Use a nappi nipper to secure terry/muslin, with a
newborn Onelife wrap with umbilical ‘cut out’ over
the top (see below).
50cm Terry Nappies
50cm is the next size from newborn - 12 weeks
old approx (depending on size and rapid growth).
Many parents use this size from day 1 to save
the newborn expense of buying a set of 20 tiny
newborn terrys etc but they will seem a bit bulky
initially for the 1st couple of weeks until baby fills
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out. Again a Motherease wrap with velcro is the
best wrap to use – the newborn ‘umbilical’ cut away
will probably be a bit tight to fit over a 50cm terry.
From 12 weeks onwards you can borrow a library
kit of nappies to try out the more fitted nappies to
take you up to toddlerhood. Again, if you buy 50cm
terrys these can be used for a variety of uses and
are there ready for your next baby!
60cm, 80cm + are from approx. 12 weeks onward,
right up to toddlerhood so will be very bulky on a
newborn - so unless you intend to use terry nappies
after the 12 week stage make sure you would like
to continue with them first. Again, Motherease
wraps are perfect and, for ease, have ‘popper button’
options if you use them on a toddler.
Onelife Newborn Wraps and Motherease Wraps
Onelife velcro wraps are excellent over terry
nappies. The best to use for the first 2 weeks
are the Onelife newborn with a ‘cut out’ to
accommodate the umbilical cord and ‘clamp’. Ask
your nappy supplier if they stock them (or purchase
from Lollipop), you will only need them for a couple
of weeks as baby will grow pretty quickly! Purchase
2-3 newborn wraps initially to see how you go, your
Real Nappy Adviser can best advise the quantity
needed for this stage. The other option is to order
Motherease ‘small’ velcro wrap which is the next
size up. Most parents use between 4-8 wraps
depending on your preference. Size 1 wraps can be
used from birth but they don’t have the umbilical
cord cut out, and although will fit snugly to prevent
leaks, they tend to look a little bit big on the
average size ‘newborn’ baby until they fill out.
Prefolds (Bambino Mio)
Another good option as they are similar to terrys
in that they are:
• They are very cheap to buy (approx
£2 each)
• Quick to wash and dry if home laundered.
•Can be used for so many other things once baby
is in the next size of nappy, so no wastage.
The prefolded cotton can be used as a booster
for larger nappies or pocket wraps as your
child grows.
•Can be used with snug fitting wraps such as
Bambino Mio, Popowraps and Motherease
Rikki wraps.
•Prefolds can be home laundered or you could
opt to use a Real Nappy Laundry Service
who will provide all the prefolds, wraps and
equipment you will need. You could use this
option for the 1st 3-6 months whilst you adapt
to your new baby situation or you can continue
right up until toilet training. Laundries offer a
convenient, efficient service. Laundry services
will drop off all the equipment you need a week
before your due date or as soon as they can
once you call to set up the service. Costs range
from approx. £8 - £12 per week. (See Fact File 3
Nappy Laundry Services for more details.)
4. Birth-to-Potty Sets of Real Nappies
Think carefully about buying a ‘complete’
Birth-to-Potty set of real nappies before or just
after baby is born.
Birth-to Potty packs may offer slightly different
options. For example: Bambino Mio offer a set
of FLAT prefolds and wraps in different sizes from
newborn up to toddlerhood. Whilst Motherease
offer a 2-part nappy that grows with your child
from Birth-to-Potty. So check out what is actually
being offered.
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Consider this option again at the 8-12 week
stage. Babies come in all shapes and sizes so
buying a complete set of 1 type of nappy may be
a disadvantage if your child’s shape doesn’t fit the
nappy as they grow. Cost savings may disappear if
you decide in the future not to continue with their
use, have to buy different/additional real nappies or
return to disposables.
5. Real Nappy Library Kits
Most real nappy parents purchase real nappies as
and when they need them, with a combination
of real nappies for different occasions. Most real
nappies (and there are nearly 100 designs now!)
revolve around the 4 basic nappy systems, so having
Nappy Buckets and Nappy Nets
Once your baby reaches 10-12 weeks, explore the
possibility of trying a real nappy library kit at this
stage. Your baby will have grown considerably since
they were born and would have filled out enough
to fit the larger, sized and pocket real nappies that
are available. This way, you can see what nappies fit
your baby’s shape, your lifestyle as you adapt to your
You wouldn’t buy 2½ years of disposables in advance, new routines and your finances. Savings can then
and the same goes for real nappies. Though 1 type of be made as you haven’t purchased nappies that you
nappy might suit your newborns shape now, it might
would/could never use.
not suit your toddler’s shape later. Equally, 1 style of
nappy might not suit all occasions, eg. The nappy is
great to use during the day, but is more awkward to
6.Accessories to have in your
use at nights or when out shopping.
nappy kit:
a combination of the 4 systems in your kit that will
cover different occasions i.e. the best nappy system
to use when going out and about; for childminder/
grandparent; night time nappies etc.
It is a good policy though to have approx. 6 – 8
‘Birth-to-Potty’ type nappies in your nappy kit, that
grow with your child, for instance Motherease, One
Life, One Size, Bumbles etc. (as opposed to ‘sized’
birth-to-potty sets i.e prefolds by Bambino Mio or
Tots Bots Size 1 + 2) so as your child grows and if
they reach an ‘in-between’ size, these nappies will
generally fit much better that the ‘sized’ nappies that
go up in weight ratios.
A cheap bucket with a very good sealing lid can be
bought from Mothercare for £5 – it’s a small size
one that will accommodate up to 2 days worth of
newborn nappies and 3-4 days for older babies/
children. Larger nappy buckets are available from
all Real Nappy Advisers or can be bought via the
internet. Or consider having 2 smaller buckets
instead of 1 large one, this helps to separate out
nappies from wraps or to separate soiled (pooed
on) nappies from ‘peed’ on nappies. Mothercare
nappy buckets aren’t round and have a flat side to
them so can be stored on a shelf or against a wall
– however there are a myriad of designs and sizes
to accommodate your preferences and all nappy
stockists and advisers stock them.
Don’t worry if all this sounds confusing – Real
Nappy Advisers are on hand to give you full,
impartial advice and they will be more than happy to
go through all the options. Real Nappy Library Kits
have a selection of Birth-to-Potty options in them
for parents to try out before buying, so you can be
really sure before committing to a purchase.
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Think about buying a nappy net to line your nappy
bucket – they are great (and cheap – no more than
£5 depending on size) and it means you don’t need
to handle stored dirty nappies. When your bucket is
full, lift out the nappy net containing the nappies and
prolonged contact with the air (urine is sterile
on leaving the body). If you have a good lidded
nappy bucket that seals itself when you close it,
the only odour experienced is when you add
another nappy to the bucket or when you are
put straight into the washing machine – remember
to open the top of the net to allow the nappies to
tumble out during the washing cycle. If you don’t,
the nappies won’t be washed adequately.
transferring nappies to the washing machine.
A full large nappy bucket is about the size of 1 full
load for your washing machine. Try to only wash
your nappies when you have a full load to maximise
the cost efficiency of using real nappies. If you find
you only have a half load or less but need to wash
them, put this small load on a cold rinse cycle first
to remove any ‘left over’ poo that you wasn’t able
to remove/sluice down the toilet, or to rinse away
the urine. Then add any cotton towels to make up
a full load and wash at 60º or if only urine soaked
nappies/wraps, put on a quick ‘rinse’ wash first then
make up the load with other 40º items and
wash together.
To Soak or Not to Soak….?
Is entirely up to you! We now have very good
washing machines that will remove the majority
of protein stains that the nappies are subjected to
and reach high temperatures to kill off bacteria and
viruses. The original reasons for soaking were to:
•Reduce the odours during storage as the water
will trap/prevent odours from escaping and the
fragrance of the soaking solution provides an
alternative smell. However, if you don’t soak,
you would have removed the bulk of baby’s
poo and put down the toilet (to be treated
in the sewerage system) prior to storing the
nappy in the bucket so the only odour you
will experience is ammonia. Ammonia is a
gas which is released from the urine during
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•Reduce staining soaking prevents stains ‘setting’
into the fabric fibres. However, if you are using fleece to line your nappies (only use fleece
once you have established baby isn’t allergic to
it), fleece just doesn’t stain as it repels any type
of moisture so you will find that soaking will not
prevent this happening on these types of nappies
anyway – so is potentially a wasted exercise. If
you have cotton nappies and don’t soak them,
you can, instead, rinse the cotton part under a
cold water tap/shower prior to putting in the
bucket if you feel that staining will occur after a
heavily soiled nappy – perhaps baby has experienced sickness/diarrhoea etc.
Cold water tightens the fibres so prevents the
proteins being absorbed into them. Then store the
nappy in the bucket until it is washed in the washing machine. Again, modern washing machines allow
you to choose higher temperatures so if you have
soiled on (pooed) nappies, wash these on a quick
cold wash first, then on a 60º wash. Then hang
outside either in the sunshine, as the sun will bleach
away any protein stains left or in the frost, during
winter, which also breaks up proteins that make the
stains. (Extra tip: Hanging them in the rain will soften the nappies beautifully if you don’t have a water
softener at home so no fabric softener needed.)
•To kill bacteria and viruses
Soaking solutions, either home made or
commercially bought, will kill any bacteria build
up on the nappy whilst it is being stored and
any viruses that are present in the faeces (poo).
Viruses are not present in urine. If ‘live’ viruses’
are present in any of the vaccinations that your
baby is given this can be ‘passed out’ of the baby
via it’s poo, so make sure you wash your hands
(invest in a nail brush if you haven’t already got
one) thoroughly before and after nappy changing
and handling dirty nappies – a nappy net helps to
reduce handling. Once in the washing machine,
dirty ‘pooed’ on nappies should be washed at
60º as this temperature will kill any bacteria or
viruses present anyway. If the nappies have only
been urinated on (pee) then nappies can be
washed at 40º instead. Hang them out to dry
and the sun will bleach them/or frost will kill IF
anything is left!
Nappy Hangers
Another accessory to consider, especially if you
are short of space, is a nappy hanger. These are
exactly the same as a ‘sock/underwear’ hanger to
use when drying these items. You can purchase
them for less than £5, from nappy suppliers, market
stalls or general ‘household’ stores and suppliers.
Hang them from a hook in the ceiling of your airing
cupboard/bathroom or in a warm part of your
home, they can even by hung from your washing
line to save space.
Vest Extenders
Vest extenders can be attached to the bottom
of babygrows and vests with poppers, to
accommodate larger nappies easily in today’s
‘slim-fitting’ baby clothes. Cost: approx £3-5 for a
set of 2/3 can be purchased from most real nappy
suppliers/advisers or direct from Perfectly Happy
People www.perfectlyhappypeople.co.uk
However, if you do prefer to soak, the downside
of prolonged soaking over months/years will
inevitably impact on the longevity of your nappies
and, particularly, your wraps. Just before washing
the nappies, tip the soaking solution down the toilet.
See Fact File 6 on Washing Instructions which lists the
ingredients of home made soaking solutions. Tea
tree should not be used as a soaking agent but can
be used in a diluted form to rinse your nappy bucket
between storage, as it is naturally antibacterial. All
real nappy stockists and advisers stock tea tree oil
and commercially accepted nappy sanitisers to use, if
you prefer to soak. A quick reminder about drying
wraps: never try them on a heated radiator as this
will lead to cracking and leaks!
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Wrap + Booster and Stork Nappy
40cm’ ‘Newborn’ terry with a nappi nippa fitted correctly
Prefold + wrap nappy (Bambino Mio/Cotton Bottoms)
in a Popolini wrap).
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BumGenius Pocket Nappy - fleece-lined
Popolini One Size Nappy with Onelife Wrap
(Similar designs: Motherease and Onelife)
Suggested Accessories
© Written by Janice O’Flynn-Mundin, Buckinghamshire Real Nappy Initiative Updated February 2008
For a free Nappy Information Pack or additional Fact Files call: 0845 3708090 or email:
[email protected] or visit www.recycleforbuckinghamshire.co.uk to download.
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Nappy Folding Instructions
Nappy Folding Instructions (courtesy of Eva Fernandes - BORN)
Your step by step guide to using terries and prefolds
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37
38
Fact File 5
NAPPY CHANGE ROUTINES AND
TREATING NAPPY RASH
Flynn (5mths) with h
i s da
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)
Contents:
1. Introduction
2. Nappy change routines and treating nappy rash episodes
3. Natural Infant Hygiene
4. What to have in your nappy change bag:
Away from home, for Childminders, Nurseries and Grandparents
39
Nappy change times are one of the most time consuming aspects of bring up baby! With up to 10
changes happening per 24hrs with a newborn and only reducing to 6 changes on a toddler, over a 2-3 year
period is true dedication.
You will undertake up to 5500 nappy changes during this time! Nappy change routines constantly change
on a daily/weekly or monthly basis in response to the age of your child, the nappy contents and any rashes
that may appear.
Rashes can cause much anxiety especially if you can’t work out why they have appeared. Hopefully this
fact file will give you an insight in to why rashes appear and how to prevent and manage them, along with
suggested nappy change routines to try out.
1.Introduction
The sole purpose of a ‘nappy’ is to CATCH,
CONTAIN and REMOVE. Nappies give parents the
convenience of managing baby’s involuntary body
functions (peeing and pooing) at a time to suit the
parents but not the baby.
The sole purpose of nappy changes is to remove all
traces of urine and faeces from your child’s skin, to
allow the skin to breathe in-between nappies and to
replace a clean, dry nappy to catch the next lot!
On release of urine, which is sterile (free from
bacteria) up until the point that it is exposed to
air, ammonia gas is produced and this sits on baby’s
skin. It is the strong concentration of ammonia, the
sensitivity of the child’s skin and the length of time
that the child spends in the nappy (regardless of the
type of nappy used) that will determine whether
nappy rash develops or not.
Regardless of the type of nappy used, either
disposable or real, a MINIMUM of 6 nappy changes
should be completed over each 24 hour period.
This is a recommendation by paediatricians (doctors
who specialise in child health). Parents and carers
who adopt Natural Infant Hygiene will remove any
nappy as soon as the child ‘misses’ (whether it pees
or poos) so the child is not sat for any length of
time in a soiled nappy.
40
Regardless of which routine you choose to adopt,
babies must be changed as soon as they have soiled
(pooed!) their nappy as ammonia concentration can
be stronger in faeces. If your child is just peeing,
their nappy must be changed every 3 or 4 (absolute
maximum) hours during the day to avoid nappy rash
developing. If your child has sensitive, dry skin or
eczema then you may need to change more often
depending on how their skin is at any given point
in time.
However, these are only guidelines and you can
change more often than this to enable your child
to be as comfortable as possible. However, try not
to leave the nappy on for more than 4 hours at any
time during the day as problems could occur and
your baby may be feeling uncomfortable without
being able to explain this to you. Nappies can be
left on longer at night and Fact File 7 How to Use
Real Nappies at Night explains how to do this
successfully.
2. Nappy change routines and
treating nappy rash episodes
with reference to The Real Nappy Guide by
Eva Fernandes
•Teething, weaning, illness and medication can cause
the pH balance of urine and faeces to become
more acidic which can irritate the skin.
• Thoroughly Cleanse: On discovering rash, remove
nappy and cleanse nappy area thoroughly with
plain, warm water and, if you have some, an olive
oil based soap (like Weleda’s Baby Calendular
Soap) as it will not dry out the skin like normal
soaps do. They also contain natural vitamins that
are beneficial to the skin. Olive oil/calendula
based baby soaps will remove all traces of urine/
faeces and ammonia build up fully, prevent further
irritation and allow the skin to cool and heal.
•DO NOT use commercial baby wipes during a nappy
rash episode, as most contain alcohol and will
really sting baby’s skin causing greater discomfort
and pain. Use a washable wipe, flannel, sponge
or cotton wool during the nappy rash episode
instead.
• R
egular showering and bathing during a nappy rash
episode: If you can, get a steady warm stream
of water from a showerhead to run over baby’s
nappy area, be sure to keep the temperature
constant. In countries where parents do this
(as part of their nappy change routine) the
occurrence of nappy rash is low. Alternatively
(and for bad, red, hot nappy rash) run a warm
bath with no bubble bath or detergents in it and
allow baby to bathe fully until heat, redness and
discomfort from rash subsides and baby is calm.
Again, for bad, red, hot nappy rash episodes, allow
at least 30 minutes to an hour after the bath (if
possible) for baby’s bottom to be totally aired.
Put on a soothing cream and clear any soiling as
it occurs before replacing a nappy.
• Regular bottom-airing: Air baby’s bottom inbetween changes for as long as possible. Airing
allows the skin to breathe, dry fully after
cleansing, renew and heal itself if nappy rash is
present. Let baby kick on a change mat under
an activity mobile on the floor for example or
encourage your toddler to crawl/walk about,
to allow time for air to get to the nappy area.
15 – 30 minutes is ideal, even longer than this is
perfect! This is one of the most effective parts
of a nappy change routine, especially on babies/
toddlers with eczema in this area or during
a nappy rash episode where the rash is red
and hot (looks like sunburn). Air bottom until
redness/heat disappears.
• C
hange nappy as soon as baby poo’s next time, to
reduce time ‘poo’ is in contact with the nappy
rash area. The ammonia contained in the poo
will aggravate existing nappy rash and cause
further redness and rashes, so delaying healing.
Nip this cycle in the bud by:
•Changing the nappy more frequently - every 1½
- 2 hours on discovering rash with a minimum
15-30mins of airing before putting a clean nappy
back on. Continue with this routine until the
redness and heat subsides. When the rash
completely disappears, return to normal changing
pattern but at least every 3-4 hours or as soon
as baby/toddler does a poo.
41
• Chamomile Tea: You could also try cleansing the
nappy change area with cooled chamomile tea.
Chamomile is soothing, gentle and promotes
healing within the skin. Some parents find that
placing a booster pad soaked in chamomile tea
in the nappy against the skin helps clear rashes.
WARNING: DO NOT use tea tree oil
as it is too harsh to use on the skin.
• C
alendula Cream: Try calendula nappy cream
instead. Calendula is the Latin name for the
marigold plant and is renowned for its cleansing,
soothing and skin healing properties. After
cleansing use a THIN barrier such as olive oil,
calendula nappy cream or vitamin E oil, gently
massaged onto the nappy area skin. This will
help to retain the skin’s moisture as nappy rash/
eczema dries the skin to the point of cracking
if left untreated. The cream or oil will also act
as a barrier to prevent urine from irritating the
skin and soothe skin that has been irritated.
However, barrier creams do not have to be
used all the time OR spread thickly (a popular
myth!) especially if cleansing/airing routines are
successful and baby is not susceptible to nappy
rash or eczema etc. (Visit: www.weleda.co.uk
for baby calendula products or contact your local
‘health/nature’ store for more info.)
• Egg Whites: Another ‘Nappy Rash’ top tip from
lots of parents and grandparents is to whisk up
2 egg whites until stiff and apply thinly to the
nappy rash area. Let it dry and then put the
nappy back on!
WARNING: Only try this after it has
been established during weaning that
your baby is not allergic to eggs.
42
• S ilk Liners: Use a raw silk liner right against
baby’s skin inside the nappy; silk has natural
healing properties. A silk liner used overnight
will often completely clear the nappy rash.
Again for children with eczema the
silk liner may stay too wet and irritate
the skin, however this is an option that other
parents have found to be beneficial. Real nappy
suppliers should stock the liners.
• F leece: If baby gets really sore and has repeated
episodes, it is particularly important to keep
baby as dry as possible. Air for as long as you
can in-between nappy changes, then apply a
thin barrier as above. To keep baby as dry as
possible when in the nappy, choose a ‘Stay-dry’
liner, polyester fleece liner or fleece lined real
nappies. Your nappy supplier can advise on all
the different types available. Fleece and ‘stay-dry’
liners/nappies allows urine to pass through to
the absorbent layer underneath – wicking it away
from the baby’s bottom. Because fleece repels
moisture it doesn’t allow it back so leaves an
air cushion effect between bottom and wetness.
Excellent for children who experience eczema
as it allows the skin to breathe and remain dry
without drawing out further skin moisture (so
preventing cracking) and reduces contact with
the urine.
WARNING: Only use fleece if you
have already established that your
child is not allergic to this man-made
material. If your child generally wears
fleece clothing without developing any
rashes then try them with fleece lined
nappies.
• R
eturn to Disposable nappies? Some parents who
use real nappies will use disposables when nappy
rash is bad, as disposables will allow extra dryness during the nappy rash episode, so allowing
the skin to heal. If this works for you then do it,
but do return to your real nappies afterwards!
WARNING: however, a word of caution
for children with eczema and nappy
rash at the same time. As mentioned before, disposable nappies can dry the skin further
during this time as they effectively absorb any
present moisture including natural skin oils. As
skin affected by eczema has difficulty in retaining
moisture under normal circumstances, disposables might encourage further skin moisture loss
during nappy rash episodes as the skin is further
compromised and may lead to cracking of the
skin. If you would like to use a disposable nappy
on a child with eczema + nappy rash, Tushies
disposable nappy is the only known brand to date
that doesn’t use super-absorbent gels, perfumes,
dyes or bleaches. Alternatively, use fleece-lined
real nappies (see section on fleece).
3.
Natural Infant Hygiene
If your child experiences eczema or continued
episodes of nappy rash regardless of the nappy that
is used, you might like to consider Natural Infant
Hygiene. This is a natural technique to care for
your child’s toileting needs without the exclusive
use of nappies, using them only as a backup rather
than depending on them fully. If you would like to
explore this option read Fact File 1 Natural Infant
Hygiene – Another Option….
4. What to have in your Nappy Change Bag
Prepare your Nappy Change Bag with:
What to include:
2 -3 real nappies - in your change bag at all times, ready for you to shoot out the
door at a moments notice! These will give you approx 9 hours for 1 child - before
you run out of nappies.
When away from
home for the day
hoose a Pocket or an All-In-One nappy design as these are quick to put on and take
C
off for everyone. If fleece-lined then no need for a paper liner, speeding up nappy
changes on the move. If Grandparents suffer with arthritis on the hands,
select Pocket or All-In-One nappies with Velcro fastenings instead of poppers.
OR
For Childminders,
nurseries or
grandparents
aterproof ‘used’ nappy bag, to store wet nappies – these can hold up to
W
4 nappies at a time.
Washable wipes and ‘pump-action’ water spray bottle
aterproof nappy change mat – for extra comfort lined with a cotton prefold/
W
muslin/terry and to catch spillages.
43
44
Fact File 6
Equipment, Washing Instructions,
TOP TIPS and Troubleshooting
40°/60°
Contents:
1.
2.
3.
4.
5.

Suggested equipment to have in your nappy kit
How to ‘process’ your nappies and wraps after a nappy change
Washing and Drying instructions
TOP TIPS and Troubleshooting
Optional Accessories
45
This fact file suggests what equipment to have in your nappy kit along with information on how to store,
rotate, wash and care for your real nappies.
The Troubleshooting TOP TIPS section details how to effectively manage any stained, smelly or hard
nappies, to keep them looking and feeling soft’n’fresh!
1. Suggested equipment to have in your nappy kit
Essential:
•
18-24 Absorbent Nappies
•
4-8 sized wraps
•
A lidded bucket to store used nappies
•
A nappy net
•Paper liners (flushable) or
Fleece liners (washable)
Optional Accessories:
•
Nappy Change Bag
•
Small ‘pump’ spray bottle
•
Small sock/underwear hanger
•
Vest extenders
•
Washable wipes
•
Waterproof changing mat
•Waterproof ‘wet’ nappy bag for journeys
away from the home
2. How to ‘process’ your nappies and wraps after a nappy change
Absorbent Nappies:
You will generally need between 18 and 24 ‘absorbent cores’ of nappies
at any one time. This can be made up of a mixture of boosters, shaped
or flat nappies depending on your preference.
How often do you wash them?
18 absorbent nappies will give you 3 days supply and 24 will give you 4
days supply, meaning you will launder them just once or twice a week,
without ever running out. If you have less than this, expect to launder
more frequently.
New nappies and absorbency
When you buy your new nappies, remember it can take 2-3 washes
before the nappy reaches full absorbency. The more they are washed
the better they absorb.
NEVER use fabric conditioner… NEVER use fabric conditioner of any kind on your nappies or wraps.
Conditioner will coat the fibres which reduces their absorbency.
For nappies that are fleece lined, paper liners are not used at all (see
below). Fleece is a water repellent and allows pee to soak through to
the absorbent core underneath and poo will sit on the top as the fleece
will not allow it to be absorbed into its fibres. When baby poos on this
type of nappy, simply hold the nappy over the toilet basin and allow the
poo to fall into the toilet and flush.
Fleece-lined nappies:
If poo is runny or hasn’t completely fallen off, sluice the nappy in the
toilet. To do this, simply lower the nappy into the toilet basin with the
fleece part facing towards the toilet flush stream and flush the toilet. If
your toilet is close enough to the bath with a detachable shower head,
use the shower-head to wash the poo off the fleece into the toilet basin.
Secure any Velcro tabs to prevent snagging during laundering, leave nappy
open (poppered nappies should be left undone) and put in the nappy net
+ bucket to be washed later: soiled at 60º, urine-soaked at 40º.
46
Biodegradable Paper Liners
Or
Washable Fleece Liners
If you don’t have a ‘fleece-lined’ nappy, you can line your nappy with
either a paper liner or a detached fleece-liner to make ‘poo’ removal
easier the next time you change the nappy. The liners act as one-way
barriers, allowing moisture to soak through to the absorbent cotton
underneath, stopping most of the wetness seeping back onto your
child’s skin. Fleece also acts like an air-cushion.
When you next change your child, poo can be lifted off more easily
with the paper liner and flushed down the toilet together - paper liners
are biodegradable. If using a fleece-liner, ‘sluice’ the liner in the water
stream as you flush the toilet to remove soiling but don’t let go of the
fleece! Pop the fleece-liner into the nappy bucket to wash with the
nappies ready to be reused when dry.
By adopting this practice, you will be introducing your child’s waste into
the toilet system to be treated as sewerage. It will also make washing
more hygienic and effective.
*Remember to line your
disposable nappies too!
If you return to using disposable nappies at any point, continue to line
your disposable nappy with a paper liner so you can remove the poo
and put it in the loo, prior to disposing of the nappy in the bin. Again, by
continuing to adopt this practice even when away from home, you are
disposing of faeces properly. If you use disposables at home you will
remove raw sewerage from your bin reducing odours during storage
prior to waste collection.
Wraps
You will need less wraps than nappies. This is because wraps are less
likely to be heavily soiled and so wash/dry really quickly. Most real
nappy parents only use between 4-8 wraps at any one time but this is
dependent on personal preference and on the age of the child: more
wraps are needed during the newborn stage with less being needed by
toddler-hood.
How to rotate and manage
the wraps
At nappy change time, separate the wrap from the soiled nappy.
*If the wrap only has ‘pee’ on it, either:
*(Pocket wraps should be
fully washed after every nappy
change so can’t be rotated in
this way – see below)
•wipe the inside of the waterproof wrap with a clean cloth or sponge
and towel-dry to remove any dampness. This wrap can then be
reused on the next clean nappy OR
•hand rinse the entire wrap under warm running water to
remove any pee (urine), towel-dry well, then air-dry (outside on the
line, inside on a clothes-horse, above the bath/shower or in an airing
cupboard but NOT on a radiator) – this wrap will be dried in a couple
of hours and should be ready in time for the next nappy change.
Keep a separate towel, old terry nappy or muslin set aside especially for
this job.
**If the wrap has been soiled with poo:
**(Pocket wraps should be
fully washed following every
nappy change, so follow these
instructions)
•remove any excess poo either with toilet tissue or allow the wrap to
be held in the water flush of the toilet (sluice). If your toilet is close
enough to a detachable shower head, use the shower to wash the
poo into the toilet basin. **Close the wrap securing the Velcro tabs
(poppered wraps can be left undone) turn Velcro wraps inside out
and put in the nappy net + bucket to be washed later at 60º.
47
Pocket wraps (Fleece-lined)
Lidded Nappy Bucket
If you prefer to use fleece-lined Pocket wraps all the time, you may find
you need more than the average amount of wraps detailed above. This
is because they can’t be rotated (see above) and have to be washed
after every use. However, once fully washed they dry in only a couple
of hours so are ready to be reused quickly.
Purchase a bucket with a good lid, which seals tightly closed to prevent
odours from escaping! Because you will have taken off the majority of
the poo and put it in the toilet where it should be, the only smell from
your dirty nappies will be ammonia.
Urine is sterile when it leaves the body, but as soon as it is exposed to
the air a natural gas called ammonia is released from the urine. The lid
will prevent this smell from escaping whilst you store the dirty nappies
and will only be noticeable when you add another nappy or when you
transfer the nappies to your washing machine.
To soak or not to soak?
Nappies can be put in the bucket without the need of soaking.
However if you prefer to soak you can use a commercial ‘nappy soak’
solution which is non-biological to prevent deterioration of the elastic
used in nappies/wraps. Or you can make your own ‘home-made’
soaking solution (see TOP TIPS for recipes).
Whichever solution you use, you must change the solution every day.
Keeping your bucket clean…
Nappy Net
If you wish to avoid bleaches, disinfectants or cleaning fluids (which
could be absorbed into the nappy fibres and ultimately irritate your
child’s skin), you can disinfect by wiping/rinsing your bucket with either
one of the following: bicarbonate of soda, white vinegar (to disinfect),
and/or 2 drops of diluted tea tree oil or lemon juice to deodorise.
Rinse thoroughly with water to remove any residue.
The nappy net is used to line the lidded nappy bucket and make the
transfer of soiled nappies from bucket to washing machine easier. Plus
you don’t have to handle the soiled nappies directly!
•Before you put your soiled nappies into the nappy net, make sure
that the poo has been effectively removed – this will
prevent excessive odours and staining of the nappies.
•Separate the cotton, absorbent part of the nappy from the wrap
(unless it is an All-In-One nappy in which case you can’t
separate it!).
•Wraps and nappies that have Velcro fastenings: make sure you fasten
the Velcro strips to the wrap/nappy then turn the whole wrap inside
out. This will stop the Velcro attaching itself to another nappy and
cause damage by ‘snagging’ other materials during the wash.
•Wraps and nappies that have poppers can be left undone in the wash.
•Fleece boosters can also be put in the nappy net, along with
washable wipes and even paper liners (that have only been peed on)
if you opt for these in the future.
When you’re ready to wash…. When you are ready to wash the nappies take the nappy bucket to
your washing machine, lift the net out and put everything in the washing
machine – net as well. Open the top of the net, do not pull the string
tight, you need the nappies to tumble out during the washing process
so that the nappies are cleaned thoroughly. If you leave the net shut
you may find that the nappies aren’t cleaned properly.
48
3. Washing And Drying Instructions
What laundry detergent
should you use?
Use a non-biological laundry liquid or powder to prevent your
nappies deteriorating over time. If using powder make sure that this
fully dissolves in the wash. If it doesn’t the powder could ‘clog’ cotton
fibres resulting in skin irritation on your child and hard nappies. Most
laundry detergents have ‘optical brighteners’ or bleaches which will
actively ‘whiten’ your nappies, even if you have purchased ‘natural’
unbleached ones.
If you would like to use an environmentally friendly laundry detergent,
you could try laundry eco-balls that use no detergents whatsoever or
Ecover - both help to reduce environmental impact during laundering.
Ecover has been manufactured in an ecologically sustainable way. It has
a plant-based formula with no petrochemicals or optical brighteners
to aggravate sensitive skin or degrade materials in the nappies. It has a
high level of biodegradability, has minimal impact on aquatic life, hasn’t
been tested on animals and is suitable for septic tanks.
How much laundry powder/
liquid do you need to wash
your nappies?
The amount you need is printed on the package. If you do not have
enough nappies to fill a complete washing load, reduce the amount of
powder accordingly otherwise you will end up with bubbles at the end
of the wash – the absorbency and the hardness of the nappies will be
affected if this is the case. If this happens, give the nappies an extra
rinse in water only to remove the excessive detergent.
Do not use fabric conditioner
Of any kind!
Fabric conditioner will reduce absorbency of the nappies over time,
as the conditioner coats the fibres making them waterproof! If the
nappies become slightly harder over time, there are a number of
‘softening’ tips that you can try.
Water softeners
If you have a water softener installed you will need even less laundry
liquid/powder.
Washing temperatures:
60º if soiled with poo
When you have a full load of nappies, select a 60º temperature wash if
all or some of the nappies/wraps have poo on them. This temperature
is high enough to kill any bacteria or viruses present.
40º if soiled only with pee
Select a 40º temperature if all the nappies/wraps only have pee
on them.
Full or half loads?
Ideally a full load of nappies, wraps, boosters and wipes is best to
effectively reduce your impact on the environment. However, if you
only have enough for half a load, give these a pre-wash to rinse away
any urine/poo, and then add extra items such as towels or bedding that
need to be washed at the same temperature. This way you will have a
full load, utilising your washing machine efficiently and keeping
un-necessary washes to a minimum.
49
Wraps need special care and attention to keep them waterproof. On
the wrap will be laundering instructions, do not exceed the maximum
washing temperature listed. Wash wraps in a non-biological laundry
powder/liquid to prevent deterioration of the waterproofing and elastic.
Washing wraps
Wraps are best hand-washed, towel-dried to remove excessive
moisture then air-dried either outside on the line, inside in an airing
cupboard or on a clothes horse etc. This will increase their lifespan.
If wraps are machine washed, remember to secure any Velcro tabs to
prevent snagging. Turn inside out for thorough cleaning. Tumble-dry
only when necessary and if the label specifies that it can be. NEVER
dry wraps on a radiator, this will lead to the waterproof coating
cracking and leaks!
Either line-dry the nappies/wraps outside in your garden or on a
balcony or inside on a clothes-horse; in an airing cupboard or above
the bath/shower. Use a nappy hanger where space is limited.
Wraps will be dry within 2 hours and most nappies should be dry in
12 hours. Thicker nighttime nappies like Tots Bots and Bumbles can
take up to 24 hours to dry.
How to dry your nappies
and wraps
Sunshine is the best antibacterial bleaching agent there is and is the
natural way to kill off any bacteria/ viruses (if any are left!). Over time,
sunshine naturally bleaches away any staining that is left.
DURING THE WINTER: Line-drying over night in the frost is a perfect
way to kill any bacteria/viruses left and has the added benefit of
softening up the nappies by breaking down lime-scale and detergent
build up. Equally stains will be broken down as well.
RAIN: Hanging them out in the rain also washes away lime-scale or
detergent build-up leaving the nappies softer.
Tumble dry the cotton part of the nappy only AND ONLY if absolutely
necessary i.e. you do not have a garden or space indoors is limited to
dry clothes.
50
Tumble drying
DO NOT tumble-dry wraps or pocket nappies or dry them on
a heated radiator under any circumstance, as this will crack the
waterproof layer. Wraps and pocket nappies will dry in a matter of
hours so please find space (perhaps above your bath or shower) to
hang these up to air dry.
Do not iron!
Real nappies and wraps DO NOT need to be ironed. Save your energy
as well as the environment
4. Top Tips And Troubleshooting
Hard nappies?
After time and no fabric softeners (fabric softeners are not
recommended as they coat the fibres of the nappy which reduce the
nappy’s absorbency), nappies may need softening up a little especially
as we live in a hard water area. When you originally buy new cotton/
hesian/bamboo nappies, they feel wonderfully soft but are not as fully
absorbent as they should be. 3 to 4 complete washes later, your
nappies will have reached fully absorbency power, enabling the fabric
to absorb to its full capacity. Over time with continued use of hard
water, laundry detergents used to clean them will eventually result in a
potential build up of lime scale and cleaning residue.
If this has happened to your nappies, first monitor how much washing
detergent you are putting in with each wash. At the end of the wash, if
you notice that foam is left over in the drum or on the glass door, then
you have put too much detergent in. Put the wash on to a ‘rinse only’
cycle, to rinse out the remaining foam – in the next wash, reduce the
amount of detergent by a third. If you use washing tablets, then it is a
fixed amount of detergent and it is difficult to break up the tablets –
perhaps consider a change to laundry liquid or powder where you can
control the amount of liquid used in each wash.
Try a small cupful of clear vinegar in the fabric softener compartment;
this will help soften the nappies in the final rinse. Don’t worry your
nappies won’t smell of vinegar – unless you use too much of course!
Top tips to soften your nappies
Whilst we don’t encourage the use of tumble dryers, on occasion,
soften nappies by tumble-drying them when still a little damp. If you
don’t have a tumble dryer then give nappies a shake before you hang
them up to dry, or rub the nappy together in your hands when dry (as
if scrubbing a stain out by hand) this breaks down lime scale build up in
the nappies.
During winter, a top tip from grandparents is to hang your nappies out
in the frost on the line! This again breaks up the lime scale and kills
any viruses/bacteria that happen to be left after the wash!! Equally,
hanging your nappies out in the rain has a similar action of rinsing the
lime scale away.
Water softeners
Children with eczema
Installing a water softener will naturally soften your nappies and
reduce the amount of laundry liquid/powder you use. As water
softeners soften all the water in the house (except the drinking water
supply), children with eczema may benefit too. This is because the soft
water prevents lime-scale build-up in the water, which in turn prevents
the skin from drying out and cracking.
Water softeners can be expensive to buy, so you will need to weigh-up
the benefits/disadvantages for your family. Some companies provide a
free months trial of the softeners with no obligation, so if you feel that
a water softener may be of use to your family try to find a company
that offers this option to ‘try before you buy’. Some companies also
offer the option to rent a system and portable systems are available to
take with you if you move house.
51
Most parents won’t experience this but for those who do, this is
generally caused by a build up of ammonia from urine. Poo should be
removed immediately following a nappy change – excrement should
be put in the toilet to be treated in the sewerage system. Urine is
sterile (free of bacteria) on leaving the body, however on hitting the
air bacteria starts to colonise it and the gas ammonia is released
causing the ammonia smell which strengths over time. Here are
some top tips to deal with smelly nappies!
Smelly nappies?!
Stained nappies?
•Nappies need to be dried and aired for longer or soaked in a
bucket full of water with 2-3 tablespoonfuls of clear (or white)
vinegar or a few drops of tea tree oil. Alternatively the vinegar or
tea tree can be added to the final rinse (put in the fabric softener
compartment of the machine).
•OR nappies can be washed on a cold cycle first to get rid of urine
thoroughly before the usual hot wash, which can set the smell. The
pre-wash cycle is not always a cold cycle so don’t use this instead.
•Add half a lemon to the wash! Or put a few drops of lavender
and/or tea tree oil on a hanky and pop in the tumble dryer.
•After washing, hang out on a clothes line or horse outside
either in the sunshine, rain or frost to add that fresh
outdoor smell!
By using a nappy liner, either a paper liner or a fleece liner in the nappy,
will catch most of baby’s/toddler’s poos and stop it coming into contact
with the nappy and prevent staining. The paper liner can then be
flushed, along with the excrement into the toilet (allowing the waste
to be treated in the sewerage system where it belongs!). Fleece liners
also work very well at preventing poo from coming into contact with
the nappy, and because fleece repels moisture the fleece liner and the
poos can be sluiced into the toilet efficiently. Remember to keep hold
of the fleece liner and prevent it from going down the toilet! Fleece
lined nappies very rarely stain as fleece doesn’t allow anything to be
absorbed into the fibres.
However, protein staining can sometimes occur on cotton, bamboo or
hesian nappies and the best way of getting stains out is to hang nappies
out on a sunny day and the stains literally disappear. Sunlight is the
best natural bleach there is: not just dissolving protein stains away but
killing off any bacteria or viruses that remain after the wash. Daylight
on a cloudy day will work but takes longer. Stains that remain will
usually wash out in time.
To stop stains from setting, you can try squirting lemon juice on stains
before storing in your nappy bucket or rinse the nappy/wrap in COLD
water (not warm or hot as this will open the fibres and set the stain).
Alternatively, you can soak nappies during storage prior to washing if
you prefer – see below.
52
To soak or not to soak?
If you want to, you can soak your nappies to help prevent stains
setting, although this is not essential. Modern washing machines reach
the optimum temperature needed to effectively remove stains and
sanitised nappies. However, if there has been illness such as diarrhoea
you may wish to disinfect the nappies during storage prior to washing.
Commercial nappy sanitisers are available, select one that is nonbiological to help prevent deterioration in your nappies.
Remember to change the solution every day and keep the bucket stored out
of reach of any mobile child.
If you wish to avoid commercial sanitiser, here are suggestions for a
home-made disinfectant.
Remember to change the solution every day and keep the bucket
stored out of reach of any mobile child.
Add ONE of the following to a full bucket of water to dilute:
Disinfecting nappies before
washing
•
•
•
•
1 tbs bicarbonate of soda
2-3 tbs white vinegar
1 tbs of Nappy Fresh
2 tbs lemon juice
Before putting your nappies into the washing machine, pour out the
water into the toilet.
Soaking/disinfecting your nappies first can mean that you wash at a
lower temperature.
5. Optional Accessories
Washable wipes
Washable wipes are available to buy. These wipes can be washed with
your nappies. They are made from cotton and contain no chemicals.
Cotton, washable wipes make an inexpensive, effective alternative
to harsh, expensive Wet Wipes that contain many chemicals and
ultimately end up in the bin. Even cotton wool can be expensive to
buy as the months go on and it’s very annoying when your last batch
starts to run out.
If your child has eczema or sensitive skin, washable wipes allows you to
control what goes on their skin. As they move away from babyhood
and cotton wools aren’t big enough to wipe a larger area so washable
wipes are a handy alternative.
To use with washable wipes when away from home. If there are no
nappy change facilities, carry a small ‘pump’ spray bottle filled with
warm water. Spray onto a washable wipe, which becomes a wet wipe
Small ‘pump-action’ spray bottle instantly – don’t just use for bottoms! Superdrug sell empty
‘pump-action’ spray bottles or recycle an old, glass one (make sure
there is NO residue left from previous product as it could affect your
child’s skin).
53
Nappy Hangers
(sock/underwear hanger)
A handy accessory to have, especially where drying space is limited.
A Nappy Hanger has a hook to attach to the ceiling at the top of an
airing cupboard or above the bath/shower and has small pegs to attach
a drying nappy/wrap to. Most hangers can hold more than 10 nappies/
wraps at a time. They can be purchased from any hardware store, via
real nappy advisers or nappy suppliers.
Waterproof ‘wet’ nappy bags
When you are away from home, you can still use real nappies. Just
change your child as normal, remove poo and put in the loo then store
used nappies in a waterproof, fabric nappy bag. Return home, place in
your nappy bucket ready for the next wash. Cost: approx £5
Vest extenders
Vest extenders are just stretch-cotton with poppers to attach to the
bottom of baby vest making them longer, so nappies are comfortably
accommodated. An easy solution to a common problem of slim-fitting
baby clothes. Can be purchased from nappy suppliers or Perfectly
Happy People: www.perfectlyhappypeople.co.uk direct. Cost: approx
£3 for 2.
Clothes to fit real nappies
•Look for stretchy trousers like jogging pants, especially those with
extendable waist bands. Tesco baby/child clothing nearly all have
extendable waist bands (at time of print). Failing this, go up 1 size
and fold the bottom of trousers up.
•Skirts and dresses look wonderful with real nappies underneath and
easily accommodate real nappies. Tights can go over real nappies
too, just buy the next size up.
•Another option is to use slim-fitting real nappies such as Pocket
nappies which have no padding on the hips.
Nappy change bag
What to include:
When away from home for the
day
Or
For childminders
or grandparents
• 2 -3 real nappies - in your change bag at all times, ready for you
to shoot out the door at a moments notice! These will give you
approx 9 hours for 1 child - before you run out of nappies.
•Choose a Pocket or an All-In-One nappy design as these are
quick to put on and take off for everyone. If fleece-lined then no
need for a paper liner, speeding up nappy changes on the move. If
Grandparents suffer with arthiritis on the hands, select Pocket or
All-In-One nappies with Velcro fastenings instead of poppers.
•Waterproof ‘used’ nappy bag, to store wet nappies – these can hold
up to 4 nappies at a time.
• Washable wipes and ‘pump-action’ water spray bottle
• W
aterproof nappy change mat – for extra comfort lined with a
cotton prefold/muslin/terry.
54
Fact File 7
How to use Real Nappies at night
Isaac (11mths - Aylesbury) and
hine
Josep
(18
h
mt
s-
Fa
rnh
ts
s Bo
am C
ommon) in *Tot
Sun
ny (
5mt
h
s - Ay
lesbury
) in a *Bumble
* Note: waterproof wraps are needed over these nappies
Contents:
1. Introduction
2. Which Real Nappy designs are best to use at night?
3. Night-time Disposable Nappy Routine
4. Night-time Routines for Real Nappies
5. Boosting!
6. NIGHT-TIME NAPPY CHANGE ROUTINES FROM NEWBORN ONWARDS:
• Newborn Night Nappy Change Routine
• 2-Step Night Nappy Change Routine
7.Conclusions
55
Using real nappies at night can be one of the most elusive parts of confident real nappy usage! Indeed,
even the most determined real nappy parents could find themselves reaching for a disposable nappy
during the sleep deprivation years.
However, it is more than possible to use real nappies at night. Whilst certain designs of real nappies are
better to use than others, once you have established which nappy to use, try out these night-time nappy
techniques to keep your child comfortable throughout the night.
1. Introduction
Current, common practice by real nappy parents,
indicate that the majority of parents return to using
disposable nappies at night. This is for a couple
of reasons:
‘I use real nappies quite happily during the day, but I
don’t like using them at night as they make my son too
wet, they leak, he wakes up and I do as a result. So I
resort to disposables instead at night.’
1.Mainly because they are not sure how to use real
nappies at night.
This is a very common experience encountered
by parents who are new to using real nappies. This
problem is mainly caused by either:
2.Having tried real nappies at night initially, they
experienced leaking or nappy rash.
3.Alternative disposables have become more available,
so are used at the night instead, keeping real nappies
for exclusive daytime use only.
Continued real nappy use at night can aid children
during night-time toilet training. So could a return
to disposables at night help to delay night-time
toilet training in real nappy children just like their
disposable nappy peers? This question is looked
at in more detail in Fact File 9 Night-time Toilet
Training, but whilst the ideal may be to continue
using real nappies the reality is lots of real nappy
parents find them difficult to use at night initially,
mainly because they try to use them in exactly the
same way as a night disposable nappy:
56
• N
ot understanding a child’s natural ‘night-time’
urinating patterns.
• Concerns about disturbing a child’s sleep patterns.
• U
sing a real nappy in exactly the same way as a
night disposable nappy.
• Not knowing about night-time real nappy techniques.
• A
nd, ultimately, using the wrong type of night-time
real nappy.
As a result, a lack of confidence develops in the
nappy itself so a reluctant return to disposables for
exclusive night-time use follows.
This fact file covers how to use real nappies at
night at the different ‘sleep’ stages that children go
through. Read in tandem with Fact File 10 which
has a suggested list of real nappies that are best
suited for nights.
2. Which Real Nappy designs are 3.
best to use at night?
Real nappies are perfect to be used at night, but we
must remember, the ‘absorbent’ parts are only made
of cotton, bamboo or hessian! These are all natural
fibres that will contain only so much moisture and
no more. They do not have the capacity to continue
to absorb once they have reached their limit, and
moisture will continue to travel anywhere it has to
until something soaks it up or until it evaporates!
Man-made ‘microfibre’ nappies do allow slightly
more moisture to be absorbed, however, if used
with the following techniques, any type of real nappy
will absorb and contain urine without any leakages
throughout the night.
Real nappies lined with fleece, remove the excessive
wetness experience and create an air cushion effect
between your child’s bottom and the wet, absorbent
pad keeping them feeling dry and comfortable.
However, some designs of real nappies are better
than others to use for night time use and at
different stages of your child’s sleep development.
The best types of real nappies to use at night have the
following qualities: have extra fabric layers for extra
absorbency; fit your child snugly and comfortably
around the waist and legs; are quick and easy to
fit during the night; and for older children: can be
pulled up and down if needed.
Fact File 10 suggests designs of real nappies that
are particularly good to use during the night if you
find your current night-time nappy is not suitable
because it becomes too wet and uncomfortable for
your child or you are experiencing leaks.
Night-time Disposable
Nappy Routine
Disposable nappies are packed with superabsorbent
polymer gels that can absorb 100 times their
original size and weight in urine. This means that
disposables can and do contain up to 3-5 litres of
urine with ease encouraging parents to use them
for up to 12 hours at night. Disposable nappies
manufacturers also advertise the fact that their
nappies can be worn for up to 12 hours, this is
despite paediatrian’s recommendations that nappies
should be changed a minimum of 6 times a day
(every 4 hours).
So most disposable nappy parents give the last
feed of the evening (including newborns), pop on
a disposable and the urine-soaked nappy is not
changed again until the morning when their child
wakes. They contain every drop of urine that child
passed throughout the night, including their last
‘processed’ feeds from the night before. Soiled
(pooed in) disposable nappies should still be
changed immediately even if it is during the night, so
for newborns, check before and after night-feeds.
For newborns If you opt of a disposable at night
instead of a real nappy, remember to line the nappy
with a paper liner (or a washable fleece liner) to
remove the poo and put down the loo, just as you
normally do with real nappies during the day. This
will remove odours from your bin and continue this
‘best practice’ even at night.
57
4.Night-time Routines for
Real Nappies
Night-time real nappy routines naturally change as
your newborn grows into a child, adapting to their
sleeping and urinating patterns. It also encourages
you to develop an understanding of their evolving
patterns which will come into ‘good use’ as you
approach night-time toilet training in the future.
Newborns:
Initially, real nappies are changed throughout the
night when you wake to feed your newborn. As
newborns continue to feed throughout the night,
their body will continue to produce pee and poo, so
nappies need to be changed in response to this. The
added benefit of continued night nappy-changing at
this stage allows you to monitor a newborns ‘body
waste’ throughout the night and can help parents to
quickly detect if a newborn isn’t feeding adequately
or is becoming dehydrated. As disposable nappies
feel dry even when wet it can be very hard to know
whether a newborn has urinated or not. With real
nappies parents can quickly see and feel if urine is
present. Any type of real nappy can be used at this
stage as the nappies are being changed regularly
throughout the night; however, the best types to
opt for are those that you can put on quickly with
minimal fuss.
58
Babies and children who sleep through the nights:
Once a baby begins to sleep through, the types of
night nappies can be changed or adapted to suit
this stage. Initially, for younger babies from approx.
12 weeks until 8/9 months extra ‘boosting’ (see
below) can be added to your chosen night nappy.
From approx 9/10 months up to night-time toilet
training, well fitting, highly absorbent nappies and
wraps should be worn, used in tandem with either:
additional ‘boosting’ or by using the ‘2–Step Night
Nappy Change’ routine (see below).
Children who are at the Night-time Toilet Training stage:
Fact File 9 Night-time Toilet Training explores this
stage in more detail. Essentially, ‘real’ toilet training
pants can be used to follow-on from real nappies
prior to starting toilet training which help aid nighttime toilet training in the future. The ‘2-Step Nappy
Change’ routine can be replaced with the ‘lifting’
technique instead, to lead on seamlessly into nighttime toilet training stages illustrated in Fact File 9.
5. Boosting!
‘Boosting’ is where you add extra layers of
absorbent cotton, hemp or microfibre to the inside
of your nappy to increase the absorption of urine
over night. You can adjust how many boosters you
add or take out, as your child approaches night-time
toilet training. ‘Layers’ can be in the form of extra
‘booster pads’, Terrys, muslin or prefolds that are
put inside the night-time nappy.
Whilst this works for some children, care has to be
taken not to ‘over-stuff’ the nappy, as this will make
it uncomfortable for your child to lie on. If extra
boosting causes red lines around the legs and waist
OR the bulkiness causes the child to lie down
unnaturally putting excessive strain on growing limbs
and/or the spine then the nappy has been stuffed
too much.
Equally, if too much boosting has been used, it could
also stop the wrap working properly causing leaks
or make the wrap too tight for your child causing
red lines to appear on their legs or waist. Make sure
no boosters are sticking out of the wrap which will
allow moisture to ‘leak’ out onto night clothes and
bedding.
OOSTING FOR BOYS: make sure the
B
extra padding is where their penis is, as
this is where they will wet the most. Fold
1 booster in two which concentrates the
padding at the front, so reducing the padding
at the back making it more comfortable –
remember to point their penis downwards.
OOSTING FOR GIRLS: make sure the
B
extra padding is in the centre of the nappy
as this is where they will wet the most.
Either lay 1 extra booster in the nappy or
fold the existing booster back on itself to
double the thickness in the centre of the
nappy.
If extra boosting causes your child to feel
uncomfortable or they experience leakage; or if you
would prefer a traditional approach that reduces
the amount of time a night time nappy is left on
your child, try one of the following routines:
Newborn Night Nappy Change Routine
2-Step Nappy Change Routine
Real Nappy Advisers can show you how to fit a
night-time nappy correctly if you are unsure.
59
6. Night-time Nappy Change Routines From Newborn Onwards
For newborns and babies who are still waking to
milk feed or drink water during the night.
Newborn Night Nappy Change Routine
2-3 night nappies and wraps are needed per night.
6-8 night nappies will provide a 3 night cycle:
allowing for washing and drying times
1st Night Nappy Change
1.
Prepare your baby for bed and put on their 1st night-time real nappy as usual (or instead of a
disposable nappy).
Prepare 1 or 2 real nappies ready for the next nappy change
(depending on how many changes you are expecting to do, following a night-feed).
NOTES: Choose night-nappies that are quick to put on with the minimum amount of fuss.
For Newborns up to 12 weeks either a Wrap + Booster or Prefold systems are suitable. Terrys
require folding but if you are confident at doing this in the middle of the night then these are
suitable too.
12 weeks + Fleece-lined Pocket nappies or All-In-Ones are perfect for night-time use because they
can be put on quickly in one go or with 1 hand if you change nappies during feeding.
2.
2-Part nappies like the Bimble, Bumble, Tots Bots, Little Lambs have excellent absorbency and
fit snugly. Motherease/Onelife/Popolini One Size can be used without a booster, but need to
be folded down to size. Ensure that your child isn’t allergic to fleece prior to using fleece-lined
nappies or wraps.
Prefolds in standard wraps are not the best nappy for night-time use from 12 weeks onwards. Prefolds
do not provide any absorbency on the hips and are heavily reliant on gravity. As baby begins to
move more during the night, gaps in the wraps can lead to leaks. However you could insert your
prefold into a pocket nappy wrap instead, which will hold the prefold in place so is really quick to
put on/take off, will redirect urine flow to the absorbent core and prevent leakages seeping out the
side of the leg/groin area.
60
3.
Give your baby their last evening feed before laying them down to sleep.
4.
Wait 2 or preferably 3 hours after their last feed. If they haven’t gone to sleep or are waiting for
their next feed time, continue with either Step 5 or 6 (depending on preference):
5.
(Option 1) 2nd Night-time Nappy Change
•Go into baby’s room, lights down low, minimal talking – just to reassure if necessary if baby is
still awake.
• Have your prepared nappy to hand.
• Feed if needed (if feed is due).
•Quickly and quietly take off the old nappy, which will be urine soaking with the last feed and
replace it with your 2nd nappy.
•If your baby has pooed or if your baby experiences nappy rash/eczema remember to remove all
traces of urine/poo before putting on a clean nappy.
•Use a washable wipe at this time, which has been soaked in warm water only, to wash baby
down quickly and efficiently.
• Dry with a dry wipe/towel to prevent damp skin irritation once the 2nd nappy is on.
• Apply nappy cream (if necessary), before putting your new nappy on.
NOTE: Sleeping babies who have soiled nappies If baby isn’t awake when you go in and they have
pooed: to avoid waking baby, don’t use a cold wipe of any description as you could shock and wake
them. Understandably, you could have a grumpy baby on your hands and night-time nappy changes
will not be pleasant for them.
(Option 2) 2nd Night-time Nappy Change
Feeding babies: If you are still feeding at night you could wait to change the nappy at their expected
feed time instead of waiting for 2-3 hours to lapse after the 1st night-time nappy was put on (if they
don’t normally feed so soon after going to bed).
• Just before baby feeds, undo lower clothing so there is easy access to nappy.
•Gently place the new nappy open on your lap or if feeding in bed, place the clean 2nd night
nappy where your baby will lie next to you.
• Sit or lie baby on the 2nd nappy and begin to feed.
6.
• Whilst feeding, gently take off the wet nappy - the 2nd nappy is already underneath.
•If your baby doesn’t wake for another feed, this nappy will see your baby through until morning,
containing only this last feed and a few dribbles, so shouldn’t leak at all. If you find it leaks,
choose a more absorbent style of nappy or add a booster.
7.
Selecting a nappy that is easy to put on with one hand makes this quite easy to do but if you can’t
manage to secure the nappy whilst you feed, just hold it closed over baby’s tummy preventing
unexpected spurts until feed time is over, then secure the nappy fully. If you are lucky enough to have
a sleepy 2nd pair of hands to help you, then your partner can do the nappy change whilst you feed.
NOTE: If baby has done a poo, a complete nappy change will have to take place and all traces of
poo/urine should be removed to prevent nappy rash and discomfort.
3rd Night-time Nappy Change (if needed)
• The 2nd nappy will remain dry until the body processes their last feed.
•At their next feed, remove 2nd nappy containing the last feed and replace with the 3rd night
nappy. This nappy will remain dry until the body processes this feed.
•However, as you are now approaching morning ready to wake up for the day, your baby will only
have been in a wet nappy for a short time. Plus – no leaks.
•As soon as they wake, feed, and then have a complete nappy change. Thoroughly cleanse and
have bottom-airing time for as long as possible then change into a daytime real nappy.
61
NOTES:
Water Drinking babies: If baby doesn’t milk feed during the night but regularly wakes for a drink
of water, then expect to continue changing nappies throughout the night until they stop drinking at
night. This is because when baby wakes to have a drink, the body becomes sufficiently aroused to
start urine production and eliminate the last drink! See Fact File 9 Night-time Toilet Training which
explains in depth how the body processes urine during the day and night.
It can become a vicious cycle. Avoid giving fruit juices or squash at night as juices will only
encourage the body to produce even more urine than normal – so, if this is the case, expect
more real nappy changes, which will be needed to avoid leaks throughout the night OR return to
disposables (which will cope with the extra fluid produced).
Note: fruit juices/squashes during the night will also have a detrimental effect on your baby’s
developing gums and baby teeth – speak to your Health Visitor or dentist if this of concern to you
or if a habit has begun to develop
This system works well because you are following a ‘milk feeding/drinking’ then ‘peeing’ pattern during
those early nights and months. Baby is regularly feeding and drinking throughout the night and has natural
waking periods too. As a consequence urine production still continues similar to daytimes, so urine needs
to be regularly released throughout the night to maintain hydration levels in the body. This pattern begins
to change when baby finally stops night feeds and sleeps through the night until morning. When this happen
try the 2-Step Nappy Change Routine.
62
2-Step Nappy Change Routine
Babies or young children who are sleeping
throughout the night.
From approx. 12 weeks up to Night-time Toilet
Training.
2 night nappies and wraps are needed per night.
6 night nappies will provide a 3 night cycle: allowing
for washing and drying times.
1st Night Nappy Change
1.
• Prepare your baby for bed.
• Put on their 1st night nappy as usual (or instead of a disposable nappy).
Prepare 2 real nappies: 1 ready for the next nappy change with 1 as a ‘spare’.
NOTES: Choose night nappies that are quick to put on a sleeping child with the minimum
amount of fuss.
12 weeks + Fleece-lined Pocket nappies or All-In-Ones are perfect for night-time use because they
can be put on quickly in one go.
2.
2-part nappies like the Bimble, Bumble, Tots Bots, Little Lambs have excellent absorbency and fit
snugly. Motherease/Onelife/Popolini One Size can be used without a booster, but need to be
folded down to size; from 8 months + add the ‘pop-in’ booster. Ensure that your child isn’t allergic
to fleece prior to using fleece-lined nappies.
Prefolds in standard wraps are not the best nappy for night-time use from 12 weeks onwards.
Prefolds do not provide any absorbency on the hips and are heavily reliant on gravity. As growing
babies and toddlers tend to move around more during the night, gaps in the wraps can lead to
leaks. However you could insert your prefold into a pocket nappy wrap instead, which will hold it
in place making a quicker change, redirect urine flow to the absorbent core and prevent leakages
out the side of the leg/groin area. Some pocket wraps can also be pulled up and down.
3.
Give your child their last evening feed before laying them down to sleep.
4.
•Wait 2 or preferably 3 hours after they have fallen asleep OR just before you go to bed.
You are waiting for the deep part of their sleep – if you recognise that your child’s sleep tends
to be deep earlier or slightly later than the suggested 2-3 hours, then adjust the suggested time
to suit your child’s pattern.
• Then go to Step 5:
Your child should not wake up at all during the 2-Step Nappy Change routine,
if you adopt a regular pattern and change them during the deepest part of
their sleep’
63
2nd Night Nappy Change
•Go into your child’s room, lights down low, minimal talking – just to reassure if your child
is still awake.
• Have your 2nd night nappy to hand.
•Quickly and quietly take off the wet nappy, which will be soaking with the last feed and replace it
with your clean 2nd nappy.
•If you prefer, or if your baby experiences nappy rash/eczema you can use a washable wipe at this
time, which has been soaked in warm water only. Wash child down quickly; dry with a dry wipe/
towel to avoid damp skin irritation once the 2nd nappy is on.
5.
.
•To avoid waking baby, don’t use a cold wipe of any description as you could shock and wake
them. Understandably, you could have a grumpy child on your hands and night-time nappy
changes will not be pleasant for them.
•In the morning, as soon as they wake, feed, and then have a complete nappy change. Thoroughly
cleanse and have bottom-airing time for as long as possible then change into a daytime real nappy.
NOTE: This 2nd night nappy will be your last nappy change until morning! The nappy should remain
relatively dry throughout the night just catching the odd dribble as urine production will be minimal
if they remain completely asleep. You have already removed the majority of the urine produced
when you took off the 1st nappy. So your child won’t be sleeping in a sodden urine-soaked nappy all
night waiting for their next change in the morning.
So the nappy should not leak at all, as it contains manageable levels of urine.
Was your child more comfortable? As your child begins to wake in the morning, urine production will
naturally start again. On waking, one of the first things that happens is urine is produced and released, just
like adults who run to the loo on waking. If you happen to wake earlier than your child, quietly check their
nappy. You might be pleasantly surprised to find it is practically dry. If it is very wet, they have beaten you
to it and are beginning to wake up or they have woken earlier than you but have managed to drift back to
sleep again. Either way, they have only recently wet the nappy so have been reasonably dry and comfortable
throughout the night.
Night drinking and illness episodes: If your child is in the habit of waking for drinks of water or they are
ill (naturally resulting in waking and drinking during the night), you might need to adopt the routine for
newborns / feeding babies above, as extra ‘boosting’ or the 2-Step Night Nappy Change routine may not
work as effectively due to the increased urine production.
64
7.Conclusions
The reason why these 2 routines work so well is
because they work with the body’s natural rhythms.
On giving the last milk feed before bed (but not
fruit juice/squash as these routines will not work),
the child’s body processes the feed, produces urine
and then eliminates the last excess of the feed.
This can take 2 to 3 hours to complete. The body
doesn’t like to store urine whilst it is sleeping. A
nappy change at this time, will remove the wet
nappy containing the last feed.
•If you prefer to adopt Natural Infant Hygiene,
instead of putting on a nappy (or before putting
on a nappy), offer a potty/toilet opportunity
after each feed or when you feel it is needed
throughout the night.
See Fact File 1 Natural Infant Hygiene for more details.
•Once babies sleep through the night and are not
milk feeding, most will not actually poo, although
some still do on the odd occasion or during
an illness. If this should happen, obviously a
complete nappy change will need to be given to
prevent nappy rash and discomfort.
Even babies reduce the amount of urine produced
at night once they have stopped waking for nighttime milk feeds/water drinking. As adults we
produce no urine at night (unless you’re pregnant)
so the need to visit the loo during the night is not
needed. Hormones control our urine production
through the day and night and as your baby
develops towards toddler-hood, essential hormones
and nerve pathways strengthen, so gradually they
‘learn’ this welcomed skill!
See Fact Files 8+9 Day + Night-time Toilet Training for
more details.
© Written by Janice O’Flynn-Mundin, Buckinghamshire Real Nappy Initiative Updated February 2008
For a free Nappy Information Pack or additional Fact Files call: 0845 3708090 or email:
[email protected] or visit www.recycleforbuckinghamshire.co.uk to download.
65
66
Fact File 8
Daytime Toilet Training
e
p
cK
Ma in Ha
nz
Contents:
ay
a
Finl Jessic
ie
(4y
py
rs)
w i th
th
He
his sister, Matilda (2½) bo
iny
’s P
y)
u ll - u
p Training Pants (Aylesbur
(2
0m
ths
) in
(3
sister
Kushie T
½)
raining pants, with
in E
enee U
ndies (Prestwood)
1. Introduction:
Traditional and Current Experiences of Toilet Training
2. How Does a Child Develop Toilet Independence?
3.TRIGGERS
4. How Do Hormones affect Daytime Toileting?
5. Nerve Pathway Development
6. Disposable Nappies and Daytime Toilet Training
7. Why are Real nappies and Training pants a useful aid for Daytime Toilet Training?
8. Frequently Asked Questions
9. Daytime Toilet Training Guide: For Real Nappy Children
Stage 1 Toileting Preparation from Birth onwards
Stage 2 Final Preparations before Starting Toilet Training
Stage 3 DAY 1 – DAY 7: Starting Toilet Training
Stage 4 Nappy Free:Venturing Out
Stage 5 Toilet Training V’s Distractions!
Stage 6 When does Daytime Toilet Training End?
10. What do I do if my child has difficulty in achieving toilet independence?
11. Referrals to a Local Specialist
12. Further Sources of Support
67
1. Introduction: Traditional and Current Experiences of Toilet Training
Whilst there are entire books dedicated to this subject, none specifically focuses on the experience of
children who use real nappies prior to this stage. Parents who switch over from disposables can also
explore how real nappies can aid their child’s independent toileting.
In our current ‘modern’ society, it is generally
expected and accepted that children will begin to
toilet train from the age of 2 years onwards, with
night-time toilet training occurring at around the
time of 3 years onwards. However, this wasn’t
always the case and, as detailed in Fact File 1 Natural
Infant Hygiene (NIH), this trend of delaying toilet
training only started in the mid 1960’s following a
study by Professor Brazelton (Brazelton 1962).
With the advent of disposable nappies at the
beginning of the 1970’s, which provided a
convenient solution for the new generation of
parents to ‘catch’ and ‘contain’ a growing child’s
waste, meant practices of natural toileting hygiene
began to ‘relax’ from this point onwards. More upto-date studies are now beginning to question this
advice and highlight the consequences that Western,
predominantly ‘disposable’ nappy children and
today’s parents are experiencing, especially when it
comes to weaning children off disposables during
the toilet training stage.
However, the experiences of real nappy children
or children whose parents adopted ‘Natural Infant
Hygiene’ (NIH) demonstrate that children can and
do develop independent toileting gradually and
generally before 2 years of age. (NIH is the historic
and traditional method of focusing on keeping
babies clean and dry whilst being aware of their
bodily functions. The child learns about toileting
gradually, often starting from birth – see Fact File 1)
Real nappy parents can experience contradictory
information and advice that focus on the need to
begin toilet training from 2 or 3 years onwards.
This can cause conflict especially when their
children are indicating that they are becoming aware
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of their toileting needs earlier than this. Much of
today’s toilet training advice, information or guidance
has developed as result of Brazelton’s study and
30 years of disposable nappy usage. Information
relating to NIH and ‘terry’ nappy usage has been
forgotten by the health profession and authors on
toilet training techniques, so is not being updated in
relation to current NIH/Real nappy practices. As a
consequence, information is not being tailored for
parents wishing to adopt these methods.
But for ‘daytime’ toilet independence, even real
nappy children can experience difficulties with this
despite their use of real nappies. It is becoming
established that current, common practice by real
nappy parents, indicate that parents return to using
‘pull-up’ disposable nappies for this stage. This is for
a number of reasons:
1.1st time parents or experienced parents, who
haven’t toilet trained a real nappy child before,
are also learning about this stage as they work
through it together.
2.Real nappy parents receive conflicting ‘toilet
training’ advice from health professionals or
peer ‘disposable nappy’ parents who don’t
appreciate the subtle differences real nappy
children experience.
3.They aren’t aware that ‘pull-up’ real nappies
are available for this stage too. Designed
to encourage children to become more
independent, whilst continuing with real.
4.The option of using Alternative disposable
nappies during the toilet training stage because
of a ‘perceived’ convenience, but with minimal
wastage as the child begins to rely less on
nappies.
Therefore is the return to ‘pull-up’ disposable
nappies at the toilet training stage, encouraging real
nappy children to experience similar difficulties like
their disposable nappy peers?
This fact file harnesses the long forgotten
techniques of our great-grandparents, grandparents
and in some cases our parents who adopted
either NIH or cloth nappy approaches, which
enabled children to achieve toilet independence
at the naturally expected age. BUT it brings
these techniques up-to-date, applying them to the
‘millennium’ real nappies that we have today.
Real Nappies can be used throughout the toilet
training stage to aid toilet independence. This fact
file will show you how.
2. How Does a Child Develop Toilet
Independence?
Following on from Fact File 1 Natural Infant Hygiene
(NIH) and Fact File 9 Night-time Toilet Training, we
need to explore how a baby/toddler/child becomes
aware of their toileting needs and their ability to
toilet independently.
As previously mentioned in Fact File 1, it is known
that very young babies begin to recognise the
sensations of toilet movements very early on.
Based on the principle that “like other mammals,
human babies are born with the instinct not to soil
themselves” (Gross-Loh 2007). If this approach
is used there is no need for ‘conventional’ toilet
training, as the child learns about toileting gradually,
often starting from birth.
However, for children who wear any type of nappy
(disposable or real), this natural instinct eventually
switches itself off:
(With reference to Fact File 1: Natural Infant Hygiene)
Despite being advocated by the Western medical
establishment since his [Brazelton’s] 1962 article
was published, Boucke (2002) also points out that
there have never been any true medical studies
on starting toilet training later. On the contrary,
research carried out since 1962 has shown that
“toilet training completion can be obtained much
earlier and without any side effects when an early
initiation is provided” (Rugolotto 2004 p180).
Sonna too describes how “a 1994 study in
the Journal of Developmental and Behavioural
Paediatrics found no data to support any specific
signs of social or emotional readiness for potty
training” (Sonna 2005 p.9), and that “slow potty
training progress and chronic toileting problems are
known to be related to starting to potty train after
age two…and failing to take the child to the potty
regularly” (p.xi). In addition, the recommendations
of a recent article published in Continence UK
are that “healthcare professionals should educate
parents to introduce sitting on the potty/toilet
early on as a normal part of the child’s routine”
and “the child should be given regular prompts to
sit on the potty/toilet when a void (an elimination
of urine or faeces) is expected” (Roger 2007 p86).
Despite all of this, today’s standard toilet training
recommendations (including NHS and American
Academy of Pediatrics recommendations) still
recommend waiting for ‘readiness’.
Bladder and Bowel control
If early toileting is not used and a child wears wet
nappies for prolonged periods during the first years
of life, they may become desensitised to the feeling
of wetness. This can make it harder for them to
identify the sensations of waste elimination when
conventional toilet training begins (Sonna 2005). A
study by Tarbox et al (2004) questioning whether
nappies could contribute to urinary incontinence,
found that extended nappy-wearing could increase
the rate of ‘misses’ and reduce the number of voids
(an elimination of urine or faeces) in the toilet
when out of nappies.
Early toileting encourages use of sphincter
muscles, and if a baby is not toileted they may risk
losing bladder and bowel control skills (Sonna,
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2005., Bauer, 2001, Gross-Loh, 2007). Authors
on the subject of NIH believe that the reason
why so much literature coming from the medical
profession indicates that 12-month-olds do not
possess this control may be because they actually
had it, but lost it. Paediatrician Barbara Gablehouse
emphasizes that like other daily activities, toileting
is “a motor skill that your baby needs to have an
opportunity to practice” (cited in Sonna 2005
p.ix). By using NIH, mastery of toileting is gained
as gradually as other developmental skills with no
sudden start to learning.
In contrast, conventional toilet training is started
later on, which, on hindsight, aims to recapture this
lost ability:
•Some parents begin the training by focusing on
the child’s imminent need to urinate, and the
child learns to retain urine by contracting pelvic
floor muscles in order to make it to the toilet
(Bauer 2001).
•Other parents may start by encouraging the
child to recognise the sensations of releasing
urine, and the wetness that follows.
Either way, it is much later that the child learns
sphincter control and is able to release urine
voluntarily before the bladder is full (Bauer 2001).
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Parent-child relationship and approach to learning
NIH works with a baby’s natural body waste
rhythms and their natural desire to be dry. It
encourages direct two-way communication and
a developing relationship with the child around
toileting, and is a gentle progression towards
independent toileting in the months and years
to come.
This is in contrast to conventional toilet training
which generally has an identifiable starting point
(usually after the age of 2 years) when learned
behaviour, i.e. toileting in a nappy, has to be unlearnt.
The latter may be more likely to incur resistance,
particularly as children in this age group are known
for being contrary (Sonna 2005).
Toilet training does not need to be approached in
a different way to other learning. As Gablehouse
(2005) points out, “We don’t wait until our children
ask or give us clues that they are ready for a bath
or a ride in the car. We teach that these activities
occur in a specific place…tubs, car seats…” (cited
in Sonna 2005 p.viii).
3.Triggers
So even young babies have the ability to recognise
urine/bowel movements even it they don’t have the
ability to control them as yet. However, even for
real or disposable nappy children, this ability can be
recaptured through ‘learned/conditioned’ responses
as babies, toddlers and children are genetically
‘primed’ to learn this desirable ability naturally.
For children who wear nappies, here are the
‘triggers’ needed to encourage the ‘learned/
conditioned’ development in conjunction with
the natural development of hormonal and nerve
pathways during day and night-time toilet training.
These are:
Trigger 1
Hormones released as a child matures (messages are sent to and from the kidneys/
bladder/bowel to the brain). They are essential for the natural development of
independent toileting. In particular, the natural increase of the ADH hormone during the
night (Anti-Diuretic Hormone also known as vasopressin), reduces the amount of water
lost in the urine and helps control the body’s overall water balance.
Trigger 2
Recognising the sensations inside the bladder/bowel.
Trigger 3
Recognising the sensations of releasing urine/faeces.
Trigger 4
Feeling wetness around the pelvic (bottom) area.
Trigger 5
Visual – seeing what is happening when they go to the toilet
Trigger 6
Parental communication, encouragement and opportunity
4. How Do Hormones Affect Daytime
Toileting?
ADH (Anti-Diuretic Hormone) along with Atrial
Natriuretic Peptide and Aldosterone, regulate the
volume, acidity and salt concentration of urine. As
water is continually being taken into the body via
food and drink and by chemical reactions within
cells; or lost in urine, faeces and sweat etc., ADH in
particular helps to maintain the optimum amount of
water in the body at any one time.
ADH production is controlled by the hypothalamus
(an area in the centre of the brain), which detects
changes in the concentration and volume of the
blood. During the day, ADH production is minimal
as the body is constantly eating and drinking which
provides the body with essential nutrients and
water. As a result the blood becomes heavily diluted
with water and any excessive water is lost from the
body in urine, faeces, sweat and via the breath as
•When the blood contains a lot of water (as it
should throughout the day) less ADH is produced water vapour.
and urination happens frequently.
•When the blood contains too little water in it (as
should be the case overnight when we don’t eat
or drink), ADH levels increase to prevent further
water lost through urination.
Once a child is sleeping throughout the night,
less food and water is consumed so equally the
production of ADH will be increased to prevent
water loss throughout the night – urine production
is dramatically reduced or stops altogether.
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5.Nerve Pathway Development
(The Nervous System)
Whilst these hormones will be working from
before a baby is born, the nerve pathways also
develop to enable a child to recognise the
sensations of urine/fecal (poo) release. If a baby
has been allowed to adopt NIH from birth, then
this combination of hormones and nerve pathway
development encourages the baby to recognise the
sensations experienced to encourage gentle natural
toileting from birth to toddlerhood.
For children who wear nappies from an early
age, whilst the hormones will also be naturally
working to regulate the urine production, the
nerve pathways may become ‘desensitised’ over
a period of time prior to toddlerhood. However,
as a child grows and experiences visual as well as
physical sensations, the nerve pathways begin to
re-strengthen these earlier connections. Dedicated
‘Toilet Training,’ parent observations or increased
communication skills from the child to the parent
can finally bring about independent toileting.
6. Disposable Nappies and Daytime
Toilet Training
Many parents, especially those who are new to using
real nappies or toilet training, may be daunted by
the whole process and rely on the array of ‘pull-up’
disposable nappies available. However when you
approach toilet training, a child needs to become
aware of the need to go to the toilet. Comfortable
disposable nappies that absorb every drop of urine
quickly, means there is no trigger for the child to
make the connection between wanting to go to
the toilet and the sensation of wetness when they
release it. As mentioned above, the nerve pathways
need to re-connect with a previously lost ability so
the ‘wetness’ sensation is crucial.
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This fact file will explore how to use real nappies and
training pants effectively to provide children with the
triggers needed to encourage toilet independence.
7.Why are Real nappies and
Training pants a useful aid for
Toilet Training?
Bearing in mind hormonal and nerve pathway
natural development, it can be hard to pinpoint the
exact time a child in nappies will make the initial
connection. However, the triggers of ‘visual’ or
‘feeling’ sensations, communication/encouragement
and opportunity are controlled predominantly by
parents/carers. So the type of nappy used during this
stage is important, as mixed-messages can confuse a
child who is re-learning independent toileting:
•Disposable nappies contain Superabsorbent Gels
(SAPs) that absorb urine very quickly, locking
away the moisture from the skin – this reduces
the feeling of wetness so removes this ‘wetness
sensation’ trigger from the child. The child feels
comfortable on urinating, the parents feel secure
that no leakage will result so the child is
left undisturbed. Eventually/hopefully a succession
of dry disposable nappies will finally encourage
a parent to rely less on the nappies, so the
child will develop greater confidence in their
new toileting skills. Whilst this seems a gentle
approach, a successful outcome isn’t always the
case for every child. Sometimes the older the
child, the more reliant on nappies they and the
parent can become.
•Real nappies do not have SAPs in them, so
only the material fibres absorb the urine. This
absorption takes time, meaning that a child who
is approaching toilet training begins to make the
connection of ‘wetness’ soon after they release
the urine. This provides the ‘wetness’ sensation
which can then aid the nerve pathways to reconnect the sensations with mental stimulation.
8. Frequently Asked Questions
‘Do I hold back my toddler until he is 2 before I start to
potty train, even though he seems to be ready now?’
Real nappy parents can feel confident in the
knowledge that they can continue to toilet train
a real nappy child when the time is right for them
all as a family – early or otherwise. The following
toilet training guide describes the signs to look out
for, so that you can begin to identify when a child
is indicating that they are becoming aware of their
toilet needs.
‘My child has special needs which means toilet training
might be delayed or may never happen. I prefer to use
real nappies but only disposable nappies are currently
provided once my child reaches 4. What real nappy
options are available for us?’
Real ‘training nappy pants’ are currently available
that are designed for older children. They are
similar to pocket/stuffable nappies but can be pulled
up and down just like pants. However, whilst they
look like pants they can contain urine and poo just
like nappies making changing easier. For daytime
use in particular, these can be used instead of your
normal nappies once your child reaches the age
of 2½/3 years old. For nights, thicker absorbent
nappies designed for 3 years + with pull-up wraps
can be used – these can even be tailor-made to suit
individual shapes and sizes. Your child will then be
able to continue to use ‘real’ washable products
up to the point when they do toilet train or right
through to adulthood if needed.
‘My toddler potty trained early even though she was
always in disposables, however, would real nappies help
her to toilet train at night?’
As a parent you have managed to listen to your
child, recognise the signs and provide opportunities
for her to learn. Even though it is recognised that
disposable nappies can delay toilet training it is still
possible to successfully toilet train disposable nappy
children earlier than would be expected. If nearly
all the triggers are there, and the wetness trigger
isn’t, children will still begin to develop awareness
when the opportunity allows. Providing lots of
‘visual trigger’ opportunities to replace the loss of
the ‘wetness sensations’ will stimulate the learning
connections in disposable nappy children.
Whilst she managed to become independent in the
day, using real nappies at night might help her to
complete toilet training fully. Please read Fact File 9
Night-time Toilet Training for more details.
Real nappies can be adapted to aid toilet training especially if you are switching over from disposable
nappies. Choose a suitable real nappy/ training pants during this stage for your child: a ‘suggestion’ list
of real nappies suitable for this time can be found in Fact File 10.
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9. Daytime Toilet Training Guide
For Real Nappy Children
Toileting learning opportunities for babies right
from birth right up to childhood, are everywhere
during your day-to-day life with each other.
Stage 1
1.
Here are some tips to consider, which can help
prepare you and your child/ren for when the time
comes – whenever that happens to be!
Toileting Preparation from Birth onwards
Incorporate ‘bottom airing’ into your everyday nappy routine from birth. This provides
baby/child with opportunities to experience peeing/pooing visually.
Provide associated words or sounds to these visual triggers as they happen during nappy
changing or bath time. Use words or sounds that your family will be comfortable and
familiar with.
2.
E.g. pee-pee/ wee / poo / ssssshhh etc. Even babies smile or giggle when the connection
is made. As your child’s verbal skills develop they will be able to communicate these
associated words back to you. During toilet training this is very useful and will give each of
you confidence and greater understanding.
3.
During bath times, use a favourite squeezy bath toy (which sucks in and squirts water) to
make the association with peeing and the words/sounds you like to use. Toddlers love this
game of making their toy pee – you could even hold it over the toilet, potty or a toy potty
to extend the excitement!
4.
Take baby/toddler/child along with you and close family members, when you go to the
toilet. Children learn best from observing what is happening around them. Use your
associated words too.
5.
If you’re not adopting Natural Infant Hygiene (see Fact File 1), from 12 months onwards,
show your child the potty (or whatever you decide to use) and have it close by at all times.
Opportunities will naturally arise as your child begins to show an interest in the potty or
toilet. Use your associated words when they sit on the potty/toilet.
6.
During ‘bottom-airing’ times, as your child grows, have the potty or toilet nearby. As they
show interest, sitting and playing near or on the potty/toilet, they may accidentally pee/poo
into it. Give lots of praise and use the associated words/sounds again. If the pee/poo only
manages to land next to it, still give lots of praise. Clean up without a fuss and pop any pee/
poo in the loo using humour, to point out it belongs in there! Carry on as normal.
SIGNS TO LOOK OUT FOR:
7.
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Continue this stage until you begin to recognise that your child is becoming more familiar
with the games, sounds and words used for peeing/pooing. Also that they are ‘hitting’
rather than missing the potty/toilet more often than not; are copying the sounds/words that
you are using when they are peeing/pooing in their nappy or when they hit the potty or
toilet. If you notice that they are disappearing into a quiet corner or sitting on or near the
potty/toilet when going to the loo, these are signs that they may be ready to progress to
the next stage. BUT only if you are ready as well!!
Stage 2
Final Preparations Before Starting Toilet Training
Next decide when you are ready to go to the next stage
1.
This is important to consider as it takes the two of you to do this together. Full
concentration, encouragement and dedicated opportunity are needed. So, when you are
ready to go to the next stage, consider the following:
Choose your toilet training area – depending on your circumstances this can be a difficult
one. Consider where your child is based during the day: where they like to play, what
your daily ‘home’ routine is like.
Only for the first day or two, your child will need to remain in this area throughout the
day whilst they practice the 1st day of independent toileting skills. Have plenty of things to
occupy their minds. Ideally an uncarpeted floor is more suitable for ease of cleaning.
2.
If you don’t have an area like this, you could provide a covering of a waterproof/lined rug,
lino or an old carpet with plastic underneath it so it is comfortable underfoot without
being slippery and protects your main carpet. If you have a downstairs toilet that’s easily
accessible, then this can be incorporated into the toilet training area. If the toilet is
upstairs or elsewhere either consider having your training area near by or introduce the
toilet at a later date after the initial days have happened successfully.
Another reason why parents delay toilet training until the child is older, is because they do
not have a dedicated area where children can be free to have ‘misses’ without the anxiety
of making a mess. Children can easily pick up a sense of frustration or anxiety that the
parent feels if they miss the potty/toilet. So if this is going to present an issue to you then
consider carefully ‘when’, ‘where’ and ‘if’ there is an area where you both can feel relaxed
in before going to the next stage.
Choose a week or preferably 2 weeks, when you are free from prior appointments, visits,
engagements, work or school commitments.
3.
Parents sometimes choose to take a holiday at home for a week or 2 to allow them
to fully concentrate on the toilet training in hand. Spring, summer or early autumn is
naturally the best time for real nappy parents, as there is going to extra washing initially –
but winter toilet training can happen equally successfully. Remember, you would normally
be washing the nappies at any time of year anyway so it doesn’t feel too different - just a
change of the type of garments.
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Choose snug fitting pants/knickers for your child
4.
Don’t use ‘boxer pants’ for boys at this stage as poos are not contained at all so will
become very messy if you opt for these. Consider trying ‘Bambino Mio trainer pants’ or
a similar product, which are designed especially for this stage, they come in 3 sizes from
approx 18 months up to 35+lbs. They are similar to normal pants/knickers except that the
cotton weave is tighter and they have an additional thin waterproof liner contained in the
fabric of the gusset, which you can’t see.
Using these types of pants will give you and your child extra confidence when you
eventually venture out & about, because in addition to containing the poo it prevents the
pee from running down the legs into socks & shoes giving you time to locate the nearest
toilet for a quick change. Your child will feel the wetness and will make a more immediate
association than with nappies
No Real Or Disposable Nappies At All!!!
On your opted week/s, start the week as you mean to go on: No Nappies from this point on.
5.
This is the next crucial step. Children need to have plenty of opportunity to see and feel all
6 triggers happening together, with lots of practice in-between. Sometimes getting it right
but sometimes getting it wrong. It’s just the same when we learn a new skill – remember
the last thing that you had to learn…
odelling Bambino Mio Training Pants (Bourne
End)
Theo (3yrs) m
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Stage 3
Day 1 – Day 7: Starting Toilet Training
Day 1 Of Toilet Training
1.
Explain what is happening to your child so they understand that today they are not going to
have a nappy on and that they can have ago at using the potty or toilet to pee/poo in.
Day 1
Ideally for the 1st day, allow your child to wear nothing from the waist down. Try washable
summer sandals, plastic jelly shoes etc if you would like to put something on their feet to
give them some grip. They are quick to wipe down or wash if they become wet.
2.
Show the potty/toilet (whichever you prefer) and have it nearby.
You can use your squeezy toy to play a game of using the potty/toilet, you could tell a story
or sing songs whilst your child sits on the potty - always a good one to try a couple of
times – as sooner or later something is bound to happen – and if it does give lots of praise
and excitement!
Day 1 to Day 7
3.
This is the one time when more drinks are actively encouraged especially ones that make
the body pee more! Water and milk are quickly absorbed into the body without excessive
waste; however diluted fruit juices will encourage your child to pee more. Which means:
more chances to practice! Ensure that teeth are thoroughly cleaned.
Note: when you are both ready to venture out & about, the opposite action is needed:
only give water or milk and no fruit juices or squash. This will ensure that your child has all
the fluid s/he needs but doesn’t encourage excessive peeing.
Be prepared for ‘misses’! ‘Misses’ is the word used to describe when a child ‘misses’ the potty/toilet as opposed to
using language like: ‘soiling’, ‘having an accident’ or ‘wetting themselves’ etc, so to remove
any negativity or expectation. Misses are seen as a natural occurrence.
4.
Have everything you need to hand to mop up/clean up efficiently and quickly without any
major comments. You could say ‘oops! – lets pop that in the potty/toilet’ in a happy, positive
voice or use a phrase that you are familiar with that you use for similar occasions. Use
encouraging words and praise, remember the familiar words for pee and poo to make the
communication connection.
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Hygienic Independent Toileting Habits
Remember to instil good hygienic toileting habits from Day 1, such as:
•Using toilet tissue to wipe themselves after going to the toilet. For Girls: wipe from front
to back to prevent bacteria from faeces (poo) entering the vagina or urethra.
5.
•For Older Boys: once they can reach the toilet bowl standing (with or without a step),
show boys how to urinate standing up. This is best achieved if they can see older boys
or male family members doing this, as children learn best from copying.
•Washing hands with soap before but especially after going to the toilet. This effectively
prevents bacteria, viruses and worms from contaminating food or being put into their
mouths or others after toileting.
Daytime Sleep for Day 1 + 2
If your child has a daytime sleep, either encourage them gently to use the potty/toilet
before they go to sleep OR wait until after they have peed before putting them to bed whichever is best.
6.
•Once asleep (for the 1st couple of days only), slip on a pull-up nappy. This will catch
anything whilst they sleep. Put a potty close to the cot/bed ready for when they wake.
•Once they wake, gently remove the nappy. Note whether it is wet or dry. Gently offer
the potty/toilet but don’t worry if they don’t use it immediately. Carry on your day as
before.
See Fact File 10 for suggested real ‘pull-up’ nappies to use during toilet training
Day 2/3 onwards
On the following days, start to use the pants/knickers that you have bought and dress your
child as normal. Make a fuss of the pants, say that they are very special or these are just
like mummy’s/daddy’s/grandma’s etc; whatever you feel comfortable with.
•Dress girls in dresses/skirts, which are less likely to become soiled if accidents happen –
just the knickers will need to be changed. If weather is cooler, still use dresses/skirts but
add tights over the knickers and have a good supply of them to change into.
7.
•Dress boys in quick drying shorts with ‘elasticated’ waist bands (over the close fitting
pants), so that washing and drying is quick and the shorts are ready for the next day. You
could also use a longer fitting t-shirt so that it is similar to girls in their dresses/skirts,
soiling should then be kept to a minimum. If weather is cooler, dress boys in quickdrying trousers with ‘elasticated waist bands, instead and have a ready supply to change
into or you could try tights or little long-johns when indoors.
•Avoid any clothing that is difficult to remove prior to and after toileting. E.g. dungarees,
belts, tight fitting trousers, buttons, lots of layers etc.
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Daytime Sleep for Day 3 onwards
Once the initial days of training are over, offer only water or milk 1 hour before your child
goes for their daytime sleep. Again, gently offer the potty/toilet just before they go to bed.
If your child is old enough, explain that they can wear their ‘daytime sleep’ pants and ‘pull’
the pull-up nappies on them to show them how they work.
•If you have a young toddler, just take off the nappy when they wake up.
•If your child is old enough to sleep in a bed, place a potty on a towel with some tissue
beside it and explain that they can use it at anytime and when they wake up.
8.
•If your child is old enough to use the toilet, suggest that they pop to the toilet on waking
as most people will want to ‘go’ after having a sleep and this is very natural.
Note:
1. Was the nappy wet on waking? If it was, continuing putting daytime nappies on.
2.Did they wake during their sleep to go to the toilet? Monitor, as they are becoming
aware of the need to go. If happening regularly, consider not putting on a daytime nappy
before sleep.
3.Did they sleep through to their normal time, without a wet nappy? If this is happening
regularly, consider not putting on a daytime nappy before sleep.
Removing daytime nappies might happen really quickly or they might take some time to go,
either way by monitoring how your child’s naturally developing, will ensure that you don’t
use nappies unnecessarily, when they no longer need them.
When is the initial toilet training stage complete?
You might be surprised to find that your child has become very confident at peeing in the
potty/toilet in just a few days. Pooing may take longer – from a few days to a few weeks as
this tends to take a little while to get use to initially.
9.
The younger your child is, for example: 15-24 months, pooing in the potty/toilet might take
a little longer to achieve. This may be down to their nervous system still developing. If this
is the case, you may have more ‘ pooing misses’ but if you provide regular trips to the potty/
toilet after eating or when you know your toddler normally goes for a poo then this can
minimise the need for cleaning up/changing etc.
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Note: Beware of returning to nappies at this stage
Once your child has started toilet training, especially in these early days, try not to be
tempted to return to nappies except during their daytime sleep. Returning to nappies after
a child has made a connection of where to go to the toilet will be very confusing to them.
This is because your communication and praise has been around toileting in a potty or
toilet not in a nappy.
10.
•To suddenly expect a child to go to the toilet in a nappy can be distressing to children
especially when they like going on a potty/toilet.
•Equally, returning to nappies can encourage a child to ‘regress’/go backwards and make
them insist that they only toilet in their nappy.
•If parents then decide that they want them to return to toileting on a potty/toilet,
training can then become very difficult and frustrating, creating anxiety for all
the family.
Successful toilet training could be delayed as a result with a child developing phobias and
anxiety about the whole issue in the future.
Venturing Out: Day 7 onwards
Ideally, after 1 week of initial toilet training at home, you and your child might feel confident
enough to venture away from home.
•This is one of those times that you might think about reaching for a nappy. No need,
Stage 4 explains how to make trips out Nappy Free.
11.
•You might be tempted to leave the home before Day 7, just be prepared for ‘learning on
the hoof’ which might not suit you or your child. 7 days ‘free’ practice instils confidence
in their growing toileting skills, before experiencing ‘nappy free’ outings.
•If your trip out is unavoidable, try to be as flexible and patient as possible. Venturing out
before a degree of confidence has been achieved could unsettle your child. Follow the
guidance in Stage 4 to help develop your child’s confidence in any ‘unplanned’ outings
you have to do.
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Nappy Free – Day 7 Onwards:Venturing Out
Stage 4
Once your child starts to use the potty/toilet confidently, you may be ready to venture out
& about. Here are some tips to make you feel ‘nappy FREE’ and liberated!
Remember to only have water or milk available for your child when you are out & about
1.
If you know you are going out, limit drinks to only water or milk 1 hour before leaving
home. No fruit juices or squashes to prevent excessive peeing when you out. If your child
only accepts flavoured drinks, just be more prepared for extra toilet stops and have plenty
of changes of clothes (especially on long journeys/trips out). Or use this as an opportunity
to nip this habit in the bud. Children will drink water/milk if they are thirsty, flavoured
drinks are purely for pleasure.
• Encourage your child to go to the toilet before you leave
2.
•Put trainer pants on which have a waterproof liner in the gusset, on your child before
you go out - if this helps you both feel more confident.
• Have a couple of changes of clothing in your change bag.
Plan your trip out
• Know where you are going and where toilets are close by.
• As soon as you reach your destination, take your child to the toilet.
• Plan toilet stops when on a longer than normal car journey however:
•For your 1st trips out in a car or walking try to reach your destination within 20
minutes, just in time for the next loo visit.
3.
•Don’t expect your child to automatically revert to toileting in a nappy on a car journey,
this can be very unsettling and confusing.
Portable potties (such as the Potette by Tommee Tippee approx. £7) are now available that
fold up into your bag so can be used during your car or train journey. If you have to stop
the car for an unexpected potty stop, pull off the main road so that you are all safe. Try to
plan regular toilet stops into your journey.
Toddle-Loo Also available are compact, foldable toilet seats called ‘Toddle-loos’ (approx. £9
- you can slip in to your bag). These fit onto any public toilet seat to prevent a smaller child
slipping down into the large toilet and becoming frightened – plus it also prevents back
strain in parents! Excellent to use when visiting friends or relatives who do not own toilet
seat reducers.
Note:
4.
Younger toddlers generally pee every 20-30minutes, and the length in-between increases,
as they get older. By observing your child during the day, you will soon learn the length of
time so can be aware of when they are due to go again, when you are out & about.
You might just find that the extra ‘edge’ and vigilance you have when you’re out makes this
stage easier than imagined, with less ‘misses’ happening.
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Toilet Training V’s Distractions!
Stage 5
Over time, as the novelty wears off, you may feel that your child ‘regresses’/is going
backwards.
•Suddenly, without warning, the confident use of the potty/toilet stops or they are having
more misses than usual.
1.
•Your initial encouragement and excitement of the success of your child’s toileting,
may turn into discouragement, anger and frustration as all that hard work disappears
before you.
Don’t despair! This is perfectly natural: You have both reached this next important stage.
Your child, having mastered the art of bladder control, now has to learn to put the rest of
his/her stimulating lifestyle together. They have to remember, in the midst of discovering
new exciting things, the sensation of wanting to go to the toilet, alerting you to fact that
they need to go and getting to the potty/toilet on time.
2.
All this whilst the television is on or their friends have just arrived! It’s a tough one and T.V
or the friends are going to win – hands down.
This can be the most frustrating time and all your reserves and patience will be tried. It can
also take sometime to get past this stage. Rest assured they will – eventually!
Disposable Temptation?
This is the next time when you might be greatly tempted to return to nappies for the
following reasons:
1.You might feel that your child isn’t as ready as you thought they were, because they are
having more misses than usual.
3.
2. You feel tired and can’t keep up with it all.
3. Your fedup of the constant washing of wet clothes.
However, returning to nappies at this crucial stage may certainly undo all the learning that
has happened. It can be very confusing for children, especially in the early stages, if they
return to nappies. This is because they are picking up mixed messages of what they need
to do. Even though they have mastered the initial art of toileting they still have to practice
putting it altogether.
Finally Success…
4.
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However, as time goes on, suddenly, without warning, everything finally comes together at
last. They can finally tear themselves away to pop to the toilet, knowing that everything will
still be there when they come back!
Notes on Returning to Disposable Nappies
•If, for what ever reason, you decide to return to nappies consider using real ones
instead as this will at least retain the ‘wetness’ and ‘visual’ triggers.
5.
•If, later on, you then decide to return to toilet training, your child may take a little while
to regain the understanding and confidence once again.
•Go over stages 1-4, adopting the same language as before and be consistent, with lots
of praise!
Notes on Illness
Sudden illness at any point can sometimes result in ‘what appears’ to be a regression back
to nappies, even if your child has successfully toilet trained some time ago. This can also
happen at night, if your child is generally dry.
6.
•Consider returning to pull-up real nappies during the illness so that they continue to
experience the wetness and visual triggers.
•Don’t worry, they won’t forget everything they’ve learnt; their body is just concentrating
on getting better.
•Wait for the illness to pass and when you all get back to your normal routines, return to
the above stages to help regain confidence and understanding.
When does Daytime Toilet Training End?
Stage 6
Daytime toilet independence isn’t truly over until your child is going to the toilet
unprompted, is able to go by themselves, is managing undressing/dressing along with
incorporating hygienic toileting habits.
Finally…
1.
For toddlers who began daytime toilet training before the 2-year mark, will naturally take
longer to reach this stage. This is because they also have to learn how to manage their
clothing and grow longer legs to get onto the toilet!
Hygienic Independent Toileting Habits
2.
Remember to instil good hygienic toileting habits from Day 1, such as washing hands before
but especially after going to the toilet.
Night-time Toilet Training
3.
Many children confidently toilet train throughout the day and manage to train at night at
the same time. However many manage the day first, with night-times following at some
point in the future.
See Fact File 9 Night-time Toilet Training, which has tips for progressing from real nappies to
independent toileting at night.
There is no right or wrong way to toilet train. Every child is unique. You, your child and your family have to be happy
to start it at a time that is right for you. If at first it doesn’t work out, wait a while and try again later.
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10. What do I do if my child has
difficulty in achieving
toilet independence?
Real nappies can be started at any age even if a child
has never used real nappies before. If your child is
in disposable nappies currently it might be that they
keep them so dry that the more natural ‘wetness’
experience of real nappies could aid the beginning of
daytime toilet training.
However, many children find daytime toilet training
hard to master for a number of reasons, so don’t be
hard on yourself or your child if toilet independence
fails to materialise or earlier successful experiences
fall by the wayside. Continue with the above stages
but seek further professional advice from your
Health Visitor and GP in the first instance.
This fact file doesn’t have the scope to explore the
potential reasons why some children do not become
toilet independent. If you feel that you and your
child are having difficulties, please don’t hesitate
to contact your local health professionals who are
trained to recognise, advise and guide you and your
child through the process of eliminating possible
physical causes which could delay day or night-time
toilet independence.
11. Referrals to a Local Specialist
In Buckinghamshire there is a dedicated clinic with
specialist health professionals who can assess your
child’s situation.Your GP or Health Visitor can make
a direct referral on your behalf. However, unless
there is a serious physical reason that needs urgent
medical attention, most referrals will only be made
once your child has reached 6-7 years of age. This
is because your GP or Health Visitor recognise that
most children will be toilet independent by this age.
12. Further Sources Of Support
ERIC:
If you would like further information or support,
there is also a national organisation called ERIC
(Education and Resources for Improving Childhood
Incontinence) who operate a Helpline on:
0845 370 8008 (Monday to Friday 10.00am –
4.00pm), or you can visit: www.enuresis.org.uk
NHS DIRECT:
Or contact NHS Direct on 0845 4647 or visit www.
nhsdirect.nhs.uk for further information or guidance.
© Written by Janice O’Flynn-Mundin, Buckinghamshire Real Nappy Initiative Updated February 2008
For a free Nappy Information Pack or additional Fact Files call: 0845 3708090 or email:
[email protected] or visit www.recycleforbuckinghamshire.co.uk to download.
84
Fact File 9
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Night-time Toilet Training
Contents:
1. Introduction: Traditional And Current Experiences Of Night-time Toilet Training
2. How Does A Child Develop Independent Toileting?
3.Triggers
4. How Do Hormones Affect Night-time Toileting?
5. How Do ‘Drinks Before Bedtime’ And ‘Drinks Throughout The Night’
Affect Night-time Toileting?
6. Disposable Nappies And Night-time Toilet Training
7. Why Are Real Nappies And Training Nappies A Useful Aid
8. Eight Steps For Successful Night-time Toilet Training
9. When Is Night-time Toilet Training Finally Finished?
10.What Can I Do If My Child Doesn’t Manage To Toilet Train At Night
11.Referrals To A Local Specialist
12.Nhs Direct: Guide To Bedwetting
85
There are many tips and indeed complete books that have been written about toilet training in general,
but none focus specifically on how real nappies can help children through this stage.
Night-time nappies tend to be the last to go and, for some, this can be the most difficult and demanding
stage towards total toilet independence.
This fact file explores this stage in more depth, the developments a child experiences and how real
nappies can be used to aid independent toileting at night.
1. Introduction:
Traditional and Current Experiences of Night-time Toilet Training
In our current ‘modern’ society, it is generally
expected and accepted that children will begin to
toilet train from the age of 2 years onwards, with
night-time toilet training occurring at around the
time of 3 years onwards. However, this wasn’t
always the case and, as detailed in Fact File 1 Natural
Infant Hygiene, this trend of delaying toilet training
was only started in the mid 1960’s following a study
by Professor Brazelton (Brazelton 1962).
With the advent of disposable nappies at the
beginning of the 1970’s, which provided a convenient
solution for the new generation of parents to
‘catch’ and ‘contain’ a growing child’s waste, meant
practices of natural toileting hygiene began to
‘relax’ from this point onwards. More up-to-date
studies are now beginning to question this advice
and highlight the consequences that Western,
predominantly ‘disposable’ nappy children and
today’s parents are experiencing especially when it
comes to weaning children off disposables during
the toilet training stage.
However, the experiences of real nappy children
or children whose parents adopted ‘Natural Infant
Hygiene’ (NIH - the historic and traditional method
of focusing on keeping babies clean and dry whilst
being aware of their bodily functions. The child
learns about toileting gradually, often starting from
86
birth – see Fact File 1) demonstrate that children
can and do develop independent toileting gradually
and generally before 2 years of age.
Real nappy parents can experience contradictory
information and advice that focus on the need to
begin toilet training from 2 or 3 years onwards. This
can cause conflict especially when their children
are indicating that they are becoming aware of
their toileting needs. Much of today’s toilet training
advice, information or guidance has developed
as result of 30 years of disposable nappy usage.
Information relating to NIH and ‘terry’ nappy usage
has been forgotten by the health profession and
authors on toilet training techniques, so is not being
updated in relation to the modern NIH/Real nappy
approaches and, consequently, is not being passed on
to parents wishing to adopt these methods.
But for ‘night-time’ toilet independence, even real nappy
children can experience difficulties with this despite
their use of real nappies. It is becoming established that
current, common practice by real nappy parents, indicate
that the majority of parents return to using disposable
nappies at night. This is for a couple of reasons:
1.Mainly because they are not sure how to use
real nappies for night-time use
2.Having used real nappies at night, they
experienced leaking or nappy rash.
3.The option of using Alternative disposables have
become more available, so are used in tandem
with Real providing the convenience of greater
absorbency during the nights, but with minimal
wastage.
Therefore is the return to disposables at night aiding
real nappy children to experience similar difficulties
like their disposable nappy peers?
This fact file harnesses the long forgotten
techniques of our great-grandparents, grandparents
and in some cases our parents who adopted either
NIH or cloth nappy approaches which enabled
children to be independently toileted at the naturally
expected age. BUT it brings these techniques up-todate applying them to the ‘millennium’ real nappies
that we have today.
Real Nappies can be used successfully at night and as
an aid to independent night-time toilet training and this
fact file will show you how.
2.How Does a Child Develop
Independent Toileting?
Following on from Fact File 1 Natural Infant
Hygiene and Fact File 8 Daytime Toilet Training, we
need to explore how a baby/toddler/child becomes
aware of their toileting needs and their ability to
control toileting.
As previously mentioned in Fact File 1, it is known
that very young babies begin to recognise the
sensations of toilet movements very early on.
Based on the principle that “like other mammals,
human babies are born with the instinct not to soil
themselves” (Gross-Loh 2007). If this approach
is used there is no need for ‘conventional’ toilet
training, as the child learns about toileting gradually,
often starting from birth.
However, for children who wear any type of nappy
(disposable or real), this natural instinct eventually
switches itself off:
(With reference to Fact File 1)
Bladder and Bowel control
If early toileting is not used and a child wears wet
nappies for prolonged periods during the first years
of life, they may become desensitised to the feeling
of wetness. This can make it harder for them to
identify the sensations of waste elimination when
conventional toilet training begins (Sonna 2005). A
study by Tarbox et al (2004) questioning whether
nappies could contribute to urinary incontinence,
found that extended nappy-wearing could increase
the rate of ‘misses’ and reduce the number of voids
(an elimination of urine or faeces) in the toilet
when out of nappies.
Early toileting encourages use of sphincter muscles,
and if a baby is not toileted they may risk losing
bladder and bowel control skills (Sonna, 2005.,
Bauer, 2001, Gross-Loh, 2007). Authors on the
subject of NIH believe that the reason why so much
literature coming from the medical profession
indicates that 12-month-olds do not possess
this control may be because they actually had
it, but lost it. Paediatrician Barbara Gablehouse
emphasizes that like other daily activities, toileting
is “a motor skill that your baby needs to have an
opportunity to practice” (cited in Sonna 2005
p.ix). By using NIH, mastery of toileting is gained
as gradually as other developmental skills with no
sudden start to learning.
In contrast, conventional toilet training is started
later on, which, on hindsight, aims to recapture this
lost ability:
•Some parents begin the training by focusing on
the child’s imminent need to urinate, and the
child learns to retain urine by contracting pelvic
floor muscles in order to make it to the toilet
(Bauer 2001).
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•Other parents may start by encouraging the
child to recognise the sensations of releasing
urine, and the wetness that follows.
Either way, it is much later that the child learns
sphincter control and is able to release urine
voluntarily before the bladder is full (Bauer 2001).
Parent-child relationship and approach to learning
NIH works with a baby’s natural body waste
rhythms and their natural desire to be dry. It
encourages direct two-way communication and
a developing relationship with the child around
toileting, and is a gentle progression towards
independent toileting in the months and years to
come. This is in contrast to conventional toilet
training which generally has an identifiable starting
point (usually after the age of 2 years) when learned
behaviour, i.e. toileting in a nappy, has to be unlearnt.
The latter may be more likely to incur resistance,
particularly as children in this age group are known
for being contrary (Sonna 2005).
Toilet training does not need to be approached in
a different way to other learning. As Gablehouse
(2005) points out, “We don’t wait until our children
ask or give us clues that they are ready for a bath
or a ride in the car. We teach that these activities
occur in a specific place…tubs, car seats…” (cited
in Sonna 2005 p.viii).
3. Triggers
So even young babies have the ability to recognise
urine/bowel movements even it they don’t have the
ability to control them as yet. However, even for
real or disposable nappy children, this ability can be
recaptured through ‘learned/conditioned’ responses
as babies, toddlers and children are genetically
‘primed’ to learn this desirable ability naturally.
Trigger 2
Hormones released as a child matures (messages are sent to and from the kidneys/
bladder/bowel to the brain). They are essential for the natural development of
independent toileting. In particular, the natural increase of the ADH hormone during the
night (Anti-Diuretic Hormone also known as vasopressin), reduces the amount of water
lost in the urine and helps control the body’s overall water balance.
Recognising the sensations inside the bladder/bowel.
Trigger 3
Recognising the sensations of releasing urine/faeces.
Trigger 4
Trigger 5
Trigger 6
Feeling wetness around the pelvic (bottom) area.
Visual – seeing what is happening when they go to the toilet
Parental communication, encouragement and opportunity
Trigger 1
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For children who wear nappies, here are the
‘triggers’ needed to encourage the ‘learned/
conditioned’ development in conjunction with
the natural development of hormonal and nerve
pathways during day and night-time toilet training.
These are:
4. How Do Hormones Affect Nighttime Toileting?
The ADH hormone along with a number of others,
act on the kidneys to ensure that the body’s water,
salt and acid-base is kept balanced within the blood
and tissue fluids. As water is either continually
being taken into the body via food and drink and
by chemical reactions within cells; or lost in urine,
faeces and sweat etc., ADH in particular helps to
maintain the optimum amount of water in the body
at any one time.
•When the blood contains too little water in it (as
should be the case overnight when we don’t eat
or drink), ADH levels increase to prevent further
water lost through urination.
•When the blood contains a lot of water (as it
should throughout the day) less ADH is produced
and urination happens frequently.
ADH production is controlled by the hypothalamus
(an area in the centre of the brain) and is the reason
why most adults do not urinate at night. Once a
child is sleeping throughout the night, less food
and water is consumed so equally the production
of ADH will be increased to prevent water
loss throughout the night – urine production is
dramatically reduced or stops altogether.
However, if a child continues to feed (milk) or
drink fluids (especially juices or squash), the body
has to continue to process this and eliminate it to
help regulate water, sodium and potassium levels.
The body also doesn’t like to store waste for large
periods of time, so the need to go to the toilet
before going to bed is a natural response to
prevent unnecessary storage. Therefore, continued
night-time feeding/drink will mean ADH is reduced
and urination continues throughout the night
causing wetting.
Also of interest to note is that as the body starts
to wake up the next morning ADH levels drop
and urine production kicks in again, resulting in the
urgent need to pee on getting out of bed!
5. How do ‘drinks before
bedtime’/’drinks throughout the
night’
affect night-time toileting?
Depending on ‘how old’ a child is, ‘what type’ of
drink is given and ‘how long’ before bed, a feed of
milk or drink before sleeping at night will affect
urination at night:
ewborn – 6 month old babies who feed
N
throughout the night will continue to pee and poo
throughout the night as the body has to process the
regular supply of feed. ADH levels will be reduced
as a result so urination will continue just the same
as during the day.
nce a baby/child is sleeping throughout the night
O
regularly, without waking up, they will process
any left over drink that was given before bed and
urinate within 2-4 hours of having it. If the last
drink was given at tea-time for example (5-6pm),
the body will have approx 1-3 hours (depending on
what time they physically go to sleep) to process
it before deep sleep. Therefore urine containing
excessive fluid from this drink will be ‘peed’ out
before or just after putting the last night-time
nappy on or when the child goes on the potty/toilet
before bed.
If the drink was given less than an hour before bed,
then the body needs time to process and eliminate
it, generally resulting in a very wet nappy or bed
within 2-3 of initial sleep.
ADH levels will increase AFTER the last drink has
been processed, so little or no urine should be
produced throughout the night. In the morning,
ADH levels drop and urine production begins for
the day.
If a child wakes up at night and has a drink, then
ADH levels drop and urination begins, as the drink
needs to be processed! Children that regularly
have drinks in the night will experience continued
urine production just like a newborn baby, until this
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cycle is broken.
Hopefully, by understanding the effects of ‘hormones’,
‘drinks before bedtime/during the night’ will help you
throughout the night-time toilet training process.
6. Disposable Nappies and Nighttime Toilet Training
Many parents especially those who are new to using
real nappies, find it hard to make real nappies work
successfully at night. However when you approach
night-time toilet training, a child needs to become
aware of the need to go to the toilet and wake up
if necessary. Comfortable disposable nappies that
absorb every drop of urine quickly throughout the
night, means there is no trigger for the child to
make the connection between wanting to go to
the toilet and the sensation of wetness when they
release it in their sleep.
The reasons for returning to disposables are:
• T
o avoid nappy rash at night. If night-time real
nappies are treated like a night-time disposable
nappy i.e. the real nappy is put on before bedtime
and is not removed for 12 hours, then rashes
will occur. Real nappies heavily soaked for 12
hours with the last night-time drink (see ‘drinks
before bedtime’ above) will mean that urine
becomes exposed to the air and bacteria which
encourages the release of ammonia. Prolonged
ammonia exposure causes a skin reaction and
nappy rash to develop. Real nappies should not
be left on a child, heavily soaked in urine for 12
hours overnight.
• L eaking. Disposables contain Superabsorbent
Gels (SAPs) which absorb every drop of urine
produced over night; they can easily hold up to
3-4 litres - far more than a child will produce
over night. If ‘night’ real nappies are put on for
12 hours at a time without removing the last
night-time drink (which is processed as urine
approx 2-3 hours of falling asleep), then they
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will generally leak! If the last night-time drink/
urine is removed, the real nappy will be dry
for the majority of the night so leaking doesn’t
occur. Real nappies are made of clothing fibres
which will only hold so much moisture at a time.
Certain types of real nappies are designed to be
more absorbent at night than others (see Fact
File 10 Suggested real nappies for night-time
or during toilet training). However, the last
‘processed drink’ elimination of urine before the
body goes into a deep sleep will be heavy – it has
to be. And whilst a real nappy will absorb this
fully, any additional pee’s throughout the night
and/or the 1st morning pee (which is also heavy)
may not be contained. The body has to ensure
that the minimal amount of urine is stored
overnight in the bladder to avoid infection, so
eliminates as much as it can before ADH levels
increase, stopping urination to help maintain
body water levels over night.
Fact File 7 shows you how to use real nappies at nighttime which works with the body’s natural rhythms, so
preventing nappy rash developing. This doesn’t mean
repeated nappy changes throughout the night! By using
your knowledge of night-time hormones, urine production
and drinking habits means that night-time real nappies
will be dry for the majority of the night, rashes and
leaking do not occur as a result.
This fact file will also show you how real nappies
and training pants should be used effectively to
provide children with the triggers needed to
encourage night-time toilet training.
7.Why are Real nappies and
Training nappies a useful aid for Night-time Toilet Training?
Bearing in mind hormonal responses and reduced
intake of fluid during the night, urine production will
eventually slow down or stop over time. Whilst this
process is naturally occurring in the background it
can be hard to pinpoint the exact time this occurs.
The final triggers of visual or feeling sensations and
communication/encouragement and opportunity
are controlled predominantly by parents/carers.
•Disposable nappies absorb urine very quickly,
locking away the moisture from the skin –
this reduces feeling of wetness so removes
this trigger from the child. The child feels
comfortable on urinating, the parents feel secure
that no leakage will result so the child is left
undisturbed. Eventually/hopefully a succession
of dry nappies on waking in the morning
finally trigger that night-time toilet training is
completed. Whilst this seems a gentle approach,
unfortunately this isn’t the case for every child
and the older the child becomes the more
reliant on disposables they, or their parents
could become
•Real nappies do not have SAPs in them, so
only the material fibres absorb the urine. This
absorption takes time, meaning that a child who
is approaching night-time toilet training begins to
make the connection of ‘wetness’ soon after they
release the urine during sleep. This provides the
‘feeling wetness sensation’ which can then aid
the learning process.
Real nappies can be adapted to aid the night-time
toilet training especially if you are switching over
from disposable nappies. Choose a suitable nighttime real nappy/ training pants for your child, a
‘suggestion’ list of night-time nappies can be found
in Fact File 10.
8. Eight Steps For Successful
Night-time Toilet Training
Following on from Daytime toilet training, Nighttime toilet training can sometimes happen at the
same time as daytime Toilet Training. Generally
though, night-time nappies are the last to go.
As with Daytime Toilet Training, you, as well as your
child, need to be ready to try Night-time Toilet
Training. Again, look to start when you don’t have
too much going on around you and avoid if the
following is happening: a house move, arrival of a
new baby, going on holiday and appointments early
in the morning etc.
Some parents start Night-time Toilet Training
gradually building up to coincide with a holiday at
home or when extra pairs of hands are around to
help out during the day.
Boosting
‘Boosting’ is where you add extra layers of
absorbent cotton, hemp or microfibre to increase
the absorption of urine over night. You can adjust
how many boosters you add or take out, as your
child begins to make the connection. ‘Layers’ can be
in the form of extra ‘booster pads’, Terrys/ muslin or
prefolds that are put inside the night-time nappy.
Whilst this works for some children, care has to
be taken not to ‘over-stuff’ the nappy, as this will
make it uncomfortable for your child to lie on. If
extra boosting causes red lines around the legs and
waist OR the bulkiness causes the child to lie down
unnaturally putting excessive strain on growing limbs
and spine then the nappy has been stuffed too much
making the wrap too tight.
If too much boosting has been used, it could also
stop the wrap working properly causing leaks.
Make sure no boosters are sticking out of the wrap
which will allow moisture to ‘seep’ out. Real Nappy
Advisers can show you how to fit a night-time nappy
correctly.
• B
OOSTING FOR BOYS: make sure the extra
padding is where their penis is, as this is where
they will wet the most. Fold 1 booster in two
which concentrates the padding at the front, so
reducing the padding at the back making it more
comfortable – remember to point their penis
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downwards.
• B
OOSTING FOR GIRLS: make sure the extra
padding is in the centre of the nappy as this is
where they will wet the most. Either lay 1 extra
booster in the nappy or fold the existing booster
back on itself to double the thickness in the
centre of the nappy.
Which are the best types of nappies to use during
night-time toilet training?
Fact File 10 has suggestions of the best type of real
nappies to use for this stage. Have a look at this
before starting. If you prefer to use disposable
nappies, the steps below can be used in exactly the
same way.
To Lift or Not To Lift?
Is really up to you! Some parents do not like to
lift their child when they are asleep for fear that it
would wake their child up; some think it is cruel
to disturb and coax their child to ‘perform’. For
some children, they can sleep right through the night
without urinating at all, so there really is no need to
lift them anyway.
However, for parents with heavy wetters, heavy
sleepers or older children who are still learning,
lifting can be very beneficial, as it can help a parent
to understand the urinating patterns of their child.
The body is a creature of habit so observation
during lifting can help to establish your child’s natural
patterns. As long as you adopt a regular routine, are
calm and have everything prepared, your child will
remain in a ‘semi-roused’ sleep so won’t wake fully.
Disturbance is then kept to a minimum so prevents
disruption to the whole household if the bed is wet
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unexpectedly in the middle of the night.
The key is: to know your child, understand their
toileting patterns, provide them
with easy access to toileting with
comforting encouragement
and praise.
Your role is: to ‘help’ your child develop a new
skill or to instil confidence in your
child if toilet training has been
delayed for any reason.
REMINDER FROM DAYTIME TOILET TRAINING:
Hygienic Independent Toileting Habits:
Remember to instil good hygienic toileting habits
even during night-time visits to the toilet, such as:
•Using toilet tissue to wipe themselves after going
to the toilet. For Girls: wipe from front to back
to prevent bacteria from faeces (poo) entering
the vagina or urethra.
•For Older Boys: once they can reach the toilet
bowl standing (with or without a step), show boys
how to urinate standing up. This is best achieved
if they can see older boys or male family members
doing this, as children learn best from copying.
•When your child is old enough: washing hands
with soap after going to the toilet
at night.
So, whenever you are both ready to explore
night-time toilet training; try incorporating the
following steps into your night-time routine.
STEP 1
Give your child a last drink 2-3
hours before bedtime
•Warm or cold milk or water – no fruit juices, squash
or even hot chocolate as they will act like a diuretic i.e.
encourage the body to produce more urine than normal.
•Generally this will be with their last meal i.e. teatime. If they
want a drink before bed restrict to water only. Again habits
can be formed and if you find it difficult to break this cycle
please speak to your health visitor for further advice.
•At this stage you are trying to encourage a routine where
the body has time to process and eliminate the last drink
and meal before going to bed.
STEP 2
Bedtime routine – dress, teeth, book,
visit to toilet/potty, put on nighttime
nappy then bed!
•Place a clean potty beside your child’s cot/bed and some
toilet tissue – ready for later! Show the potty to your child
and say they can use it whenever they like.
• TIP: Pop a towel under the potty to catch ‘misses’
STEP 3
•The Night-time real nappy that you opt for at this stage is
Prepare 2 Night-time nappies. Put
one of them on your child. Put the
2nd close by ready for later.
important. This may be the time to look at ‘pull-up’ nappies
that have the full absorbency of a pocket/stuffed nappy but
the advantage of acting exactly like pants plus your child can
control pulling them up and down as they become more
confident with nighttime toilet training. Happy Heinys Trainer
nappies are the only pull-up varieties currently available.
•See Fact File 10 for examples of Night-time Real Nappies
STEP 4
2 or 3 hours after you have left
them to sleep, go back into child’s
room.
•Lights down low, no talking at all at this stage as you don’t
want to arouse them from sleeping.
•During the sleep phases, the hormone responsible for
reducing urine production increases. In young babies
and children it is this hormonal action that stops urine
production completely over night.
•However, whilst urine production over night doesn’t stop
completely in young children, it does slow down if there
is nothing in the system to process i.e. the last night-time
drink.
• As soon as we wake urine production starts again.
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•If you are lifting them/guiding them make sure you support
them at the same time as they will be very sleepy. Pull down
the nappy and gently encourage them to sit on the potty/toilet.
When your child is on, gently whisper ‘time for pee pee/toilet/
Take the old nappy off* then go to
sshhhh’ or whatever you normally use during the day when
STEP 6
they toilet trained.
•This is a subconscious external trigger and timing is crucial! If
Or
you talk or say these magic words before your child is on the
potty/toilet, they may sprinkle before they need to and a bed
If you have a pull-up nappy, lift your
will need to be changed!
child and gently sit them on the potty/ •The key is not to fully wake your child, they will be in a semilead them to the toilet - see notes
state of sleep but aware enough to control the release of
opposite
urine. Relieved, wipe with tissue, pull the nappy back up if dry
or change into the 2nd clean nappy, then they can return to
bed and sleep.
•By doing this step, your child has ‘peed’ out their last drink.
The body always processes the last drink within a couple of
hours of having it to prevent the body storing it over night.
Urea production slows down (for younger babies) and with
maturity stops during sleep, so your child shouldn’t pee that
much now until morning. On waking in the morning, urea
production starts again. So just like adults, the first thing
they’ll do – is have a pee! So they will not have slept in a
heavily sodden nappy all night containing their last drink from
the night before – as disposable nappy children do.
STEP 6
•If it was, make a mental note of the time you went into your
Note:
child and tomorrow night, go in 15 minutes earlier. You need
to establish your child’s natural ‘holding’ threshold and learn
*Was the nappy wet before you lifted
when is the best time to go in and lift onto the potty.
your child / took off the nappy?
•If the nappy was wet, take it off whilst your child is on the
potty, wipe with a tissue (or if you need to, a wet wipe ensure wipe is warm, so you don’t shock your child and make
them wake up fully). Put your child back into bed to resume
their sleep.
•Gently put a new nappy on, this will remain relatively dry
throughout the night now, catching only minor trickles. On
waking, your child will start to pee again immediately, so they
won’t have slept in a soaked nappy all night.
STEP 5
Instead of changing the nappy for a
new one either:
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STEP 7
•Good - continue with this length of time before lifting
tomorrow night. Although, if you found that even after putting
Note:
your child on the potty s/he didn’t pee, you might need to
slightly lengthen the time before lifting. With practice, each
*Was the nappy dry on lifting your
night you will be able to adjust to your child’s pattern.
child / took off the nappy?
•After peeing on the potty, wipe with tissue and because the
nappy was dry, you can reuse the nappy they were previously in.
•This nappy should now see your child right through until
morning. This nappy will remain relatively dry throughout the
night now, catching only minor trickles. On waking, your child
will start to pee again immediately, so won’t have slept in a
soaked nappy all night.
STEP 8
•Don’t remove the potty to be stored elsewhere after lifting
your child in the evening. Over time your child will be able to
Younger children
use the potty unaided and help give them confidence to use it
should they wake in the night.
Clean the potty out and leave it beside •Many children develop phobias about walking across to the
your child’s cot/bed along with some
bathroom even if they successfully recognise that they want to
tissue
go to the toilet. Having the potty near by during these early
days and months will help to develop their confidence and
reduce the time taken.
•Once established and confident toileting at night has been
achieved you can then encourage your child to use the toilet
in the bathroom.
STEP 8
•If your child is too old to use a potty, either ‘lift’ or guide walk
your child to the bathroom toilet. They may well be sleepy
Older children
so take care that they don’t knock into anything or fall down
the stairs.
TIP:
•For older children who are toilet training, have an easy
Leave a comforting guiding light on in
accessible night light or lamp that they can switch on or
the hall or bathroom to help deter
alternatively, leave a hall or bathroom (low-energy!) light on.
phobias.
This can help to prevent phobias developing about leaving
their bedroom to find the toilet in the middle of the night.
Keep a supply of clean clothing/
•Older children: Keep a ready supply of clean bedding,
bedding near-by…
nightwear and pants near-by for your child to use if they soil
themselves in the middle of the night – if they feel in control
of being able to change the soiled clothing/bedding (if they
want to), they may feel more confident at managing the
situation without the need to disturb you.
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MENTAL NOTES TO SELF: Once this routine has become established you can begin to note the following:
•If it is, consider not putting on a nighttime nappy at all between when
your child goes to bed and lifting to be put on the potty. This will allow
you to monitor further your child’s natural holding capacity. If you
find the bed is wet, then you will need to review and go back to either
Is your child’s nappy
putting a nappy on or going in earlier to lift.
regularly dry before you lift
•Eventually, you might notice that the nappy is dry no matter how long
and put them on the potty?
you leave before lifting, if this is the case, don’t lift your child at all the
next night
•If it is, consider leaving off the 2nd nappy. If you start to observe that your
child is continually dry in the mornings without being lifted, then their
hormonal and nerve pathways have matured. Urea production at night
has stopped and Night-time Toilet Training is coming to an end.
•Be prepared to be woken by a wet child in the middle of the night. If
you do leave the 2nd nappy off, this will allow you to monitor your child’s
developing pattern. If your child wakes because of a wet bed, have sheets
MENTAL NOTE TO
to hand (that have been prepared in advance) to quickly strip the bed and
YOURSELF:
remake it without fuss. Consider using waterproof mattress or coverings
to make it easy to wipe, dry and remake the bed.
Is your child’s nappy
•Give gentle comfort, encouragement to your child but don’t tell him/her
regularly dry in the
off, as this could make them frightened and bewildered at this stage.
morning?
•Remember that although they have just wet the bed, they have woken
up as a result! This is part of the learning stage and is a positive sign–
also remember that before they were happy to sleep in a wet nappy –
something has changed.
•Subconsciously, they will eventually learn to recognise the feeling of the
bladder filling up, with release of urine, the nice warm sensation and
then the cold realisation of being wet. Very similar to the daytime toilet
training experience!
• Drier nappies on lifting at night and in the morning
•Your child waking themselves to go to the potty at their normal routine
time of 2/3 hours after going to bed
MENTAL NOTE TO
•Getting up before you and going on their potty themselves – proudly
YOURSELF:
waking you with their full potty!
•As they get older, hearing the magic sound of tip toes across the landing
Gradually, over time, you
floor (hesitation at your bedroom door – hold breath) then continuing
may notice:
onto the bathroom on their own and returning to bed and finally but
not least, not waking at all and eventually not needing to pee throughout
the night!
MENTAL NOTE TO
YOURSELF:
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Regression
Remember! Just as with day time toilet training,
you may experience a slight regression after you
think they have finally mastered night times. E.g.
just when they have been dry at night for weeks or
even months they go back to wetting the bed. This
is very natural especially in younger children. If this
happens, again try not to get cross even though
you may feel frustrated that all your hard work and
sleepless nights have gone out the window –
it hasn’t.
Sometimes the novelty of learning a new skill wears
off, or something has changed recently in your
child’s life like for example:
• a house move
• holiday
• new baby
• they have recently been ill
• went to bed later then their usual routine
• given a drink to close to bed time.
Just take time to see if anything has changed and go
back a step if necessary, to again allow your child
make the connection with their body’s toileting
needs to remind them of what they need to do.
9.When is Night-time Toilet Training
Finally Finished?
Night-time toilet training is finally complete when
your child either sleeps throughout the night
without the need to urinate OR when your child
has the ability to wake themselves up to go to the
toilet confidently on their own. Remember though,
there may be the odd occasion where your child
wakes up with a wet bed at night or in the morning,
10. W
hat Can I Do If My Child Doesn’t
Manage to Toilet Train at Night
‘My 6 year old son is dry in the day but I have always
used disposable nappies on him at night. Could I
start to use real nappies instead and would they
help him to toilet train at night?’
Real nappies can be started at any age even if they
have never used real nappies before. If your child is
in disposable nappies at night it might be that they
keep him so dry that the more natural ‘wetness’
experience of real nappies could help to encourage
night-time toilet training.
However, many children find night-time toilet
training hard to master for a number of reasons,
so don’t be hard on yourself or your child if toilet
training fails to materialise or earlier successful
experiences fall by the wayside. Continue with the
above routine but seek further professional advice
from your Health Visitor and GP in the first instance.
This fact file doesn’t have the scope to explore the
potential reasons for not being able to complete
night or daytime toilet training. If you feel that you
and your child are having difficulties, please don’t
hesitate to contact your local health professionals
who are trained to recognise, advise and guide you
and your child through the process of eliminating
possible causes of Nocturnal Enuresis to give it it’s
technical name.
maybe you can remember that sensation yourself!
It’s just a matter of practice and time. Make it easy
for everyone, by keeping spare sets of night clothes
and bedding close to hand – just in case!
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11. Referrals to a Local Specialist
12. NHS Direct: Guide to Bedwetting
In Buckinghamshire there is a dedicated clinic with
specialist health professionals who can assess your
child’s situation.Your GP or Health Visitor can make
a direct referral on your behalf. However, unless
there is a serious physical reason that needs urgent
medical attention, most referrals will only be made
once your child has reached 6-7 years of age. This
is because your GP or Health Visitor recognise that
most children will fully toilet train by this age.
The following extract has been taken from NHS
Direct’s Guide to Bedwetting:
If you would like further information or support,
there is also a national organisation called ERIC
(Education and Resources for Improving Childhood
Incontinence) who operate a Helpline on:
0845 370 8008 (Monday to Friday 10.00am –
4.00pm), or you can visit: www.enuresis.org.uk for
further information.
“Bedwetting when asleep is very common in children,
especially those under the age of about six or seven. It is
also known as nocturnal enuresis.
Bedwetting usually resolves itself by the age of about
seven or slightly later. About 1 in 7 children aged five,
and 1 in 20 children aged ten wet the bed. It is more
common in boys than girls.
Bedwetting can also affect children older than six or
seven.With advice from your GP, parents can try various
techniques to sort out the problem.”
Contact NHS Direct on 0845 4647 or visit
www.nhsdirect.nhs.uk for further information on
symptoms, possible causes and treatments available
for Nocturnal Enuresis.
© Written by Janice O’Flynn-Mundin, Buckinghamshire Real Nappy Initiative Updated February 2008
For a free Nappy Information Pack or additional Fact Files call: 0845 3708090 or email:
[email protected] or visit www.recycleforbuckinghamshire.co.uk to download.
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Fact File 10
SUGGESTED REAL NAPPIES FOR
NIGHTTIMES AND DURING TOILET TRAINING
Josephine (18mths)
and
(
ac
Isa
11
m
th
s
)w
ear
ing
*Tots
Bots, Imogen (2yrs) in a Lollipop Pocket nappy.
*Note: waterproof wraps needed over these nappies
99
The lists below are examples of nappies that are currently available on the market at present. These
are the type of real nappies that real nappy parents have found useful in these situations. Trying them
out is the best way to see if they will work in your family environment and on your child! Real Nappy
Library kits are available around the county with examples of these nappies.
How Many Night-time Nappies to Have in Your Kit
Once you have chosen your night-time nappies,
consider having between 4 and 6 at any one time.
This will give you either 2 or 3 nights worth, with
2 nappies per night (especially needed if you are
following the 2-step night nappy change detailed in
Fact File 7 + 9). As some of the nappies (especially
the Tots, Bumble, Bumpy and Huggle) are more
absorbent they can take slightly longer to dry than
day nappies, so by having 6 will allow you time to
wash and fully dry them before night 3.
Night-time Nappies
Use any type of nappy that you are happy with as you may
be changing regularly anyway as part of your night-time
feed routine:
• Terrys
• Prefolds (Bambino Mio/Cotton Bottoms)
Newborns until they sleep through
• 2 -Part Shaped (Motherease, One Life, Popolini, Tots, Little
Lambs etc)
• Pocket
• All-In-Ones
Pocket and All-In-One nappies tend to be easier as they can
be put on in one go and with 1 hand if your feeding. With
the rest, you have 2 parts of the nappy to put on which you
might find awkward or they disrupt baby too much.
Fuzzi Bunz
Happy Heiny’s
Examples of Pocket Nappies:
Bumgenius Birth-to-Potty
Nature Babies Stuffables
Examples of All-In-Ones(AIO):
Lollipop Rainbow
Popolino EasyFix
Nappy Nation AIO
If ‘boosting’ your normal nighttime nappy hasn’t worked,
(i.e. adding additional booster pads, larger prefolds/terrys,
Once baby sleeps through up until the point microfibres into the nappy) try using the 2-Step Night
of nighttime toilet training
Nappy Routine as described in Fact File 7. The types of
nappies that are useful with these routines are the ones
that are quick to put on and take off and have thicker
absorbency..
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Motherease with a wrap
(incs. One Life/One Size)
For light to normal wetting
Pocket/Stuffable nappies
(as mentioned above)
Bumble or a Huggle with a Motherease
wrap
Tots Bots/Bamboozels
with a Motherease wrap
Light, normal and potentially heavy wetters if the fit is
perfect on your child, with no gaps particularly around the
thighs, when extra boosters are inserted.
Very good for all but particularly normal to heavy wetters
up to approx. 3 yrs of age. (Huggle has 3+ sizes as well, see
below)
Good for light, normal and heavy wetters, but as heavy
wetters approach the end of Size 2 and if they experience
leaking, perhaps explore using a Bumble or a ‘toddler/older’
child nappies (aged 2/3 years onwards)
Nappies to try on approaching Day + Nighttime Toilet Training
•Once your child is starting to toilet train during
the day and there are signs that nighttime toilet
training can be explored, you may find that
2-part nappies (terrys, prefolds, Motherease
etc) are more awkward to use and disrupt the
sleeping pattern.
•Look for nappies that are quick to put on and
take off, with not too many poppers, especially
where children like to run around (during day) or
sleep on their front (night, daytime sleeps) as it
makes it difficult to secure the nappy when your
child is flipping over mid-sleep to lie comfortably
on their belly!
•If your child likes to sleep on their back then
poppers shouldn’t present a problem as you
should have time and space to do them up
properly. If they are not secured properly leaks
might happen.
•If you are currently using a 2-part nappy system,
look for a nappy and wrap that can be slipped
on and off, where the waistband has generous
elasticity. Then you can drop the nappy down
easily, to sit your child on the potty/toilet when
you lift them.
•It will also make it easy for your child to become
independent if they can also lift the nappy up
and down themselves during the day or when
they wake to go to the toilet during the night or
first thing in the morning before waking you up.
Good examples of this are:
The Huggle by Minky
2-Part Nappy System
Approx. £9
Available locally via: Nappymania
Or search internet
The Bumpy by Easy Peasy
Nappies
2-Part Nappy System
Approx. £9
For Nighttimes:
Excellent for heavy wetters and older children (larger toddlers
& 3 years+)
Available locally via: Nappymania
Easy Peasy via internet
used with poppers, the generous elastic waist allows them to be
pulled up and down as well.
For Nighttimes:
Excellent for heavy wetters and older children (larger toddlers
& 3 year+)
Can be used with a nappi nipper but are available with poppers. If
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Pull-Up Real Nappy
Happy Heiny’s
Trainer Nappy
Available locally via:
Cumfy Bumfy
Approx £10-12.
All sizes right up to 7/8 years of
age.
Currently, the only true ‘Pull-Up’ nappy on the market is a pocket
nappy called the Happy Heiny’s Trainer Nappy. Prefolds, booster pads,
terrys, even towels can be stuffed into the pocket. This nappy is slimfitting as there is no padding on the hips. It has poppers on each side
of the hips for quick access if needed, an elasticated waistband which
allows the nappy to be pulled up and down like pants. They look like
pants in a variety of plain and vibrant colours.
Excellent for toilet training during the day. Good for light to medium
wetters at night and for those children who are using the potty/toilet
at night. Heavy wetters may need extra boosting, but this nappy has
to fit your child’s shape well, to work successfully during the night – if
there are any gaps in the leg/thigh area then leaks could occur, so do
not ‘over-stuff’ with boosters.
Day Time and Out & About during Toilet Training
On the lead up to daytime toilet training Happy Heiny Trainer Nappies are very useful and is a good
introduction to using pants with the potty or toilet. However, once you decide on a date for toilet training
it is recommended that no nappy is used at all during the day to avoid confusion. If your child still has a
sleep during the day, then a Happy Heiny Trainer could be a good solution to slip on as they go to sleep. As
they wake up the trainer will slip down easily if they use the potty/toilet immediately on waking.
Once you start to venture out and about after toilet training has begun, for security and confidence (for
you and your child), the Happy Heiny’s Trainer could be an option to fall back on but might send out the
wrong message to your child. So consider:
Bright Bots or Bambino Mio
Trainer pants
£3-£5 a pair
Available via: Bambino Mio or
Lollipop
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Trainer pants which are not nappies, but are exactly like pants.
They have a discreet waterproof layer in the gusset to prevent pee
rolling down into shoes and socks! They fit so snugly and have a
thicker weave cotton, that they will also contain a poo. These are
for the odd ‘miss’ only and allow you a short time to find a toilet or
somewhere to mop up!
Bright Bots are still available but you have to hunt for them on the
internet. Bambino Mio Trainer Pants (available from Bambino Mio or
Lollipop) look exactly the same.
Fact File 11
TAKING REAL NAPPIES ON HOLIDAY!
Finlay (2
0mth
s) w
e
er
arin
gP
oly
O
tt
in
mm
wi
sS
g Sh
orts
Holidays are time to relax, put your feet up and enjoy! However, realistically,
when you have children in nappies it doesn’t really happen….and if you use
real nappies, how do you make it as efficient as possible!
This fact file explores the options available and hopefully will help to make the
process just abit easier!
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Disposables V’s Real
This is where you need to weigh-up the pros
and cons of all nappies. Yes, you can take real
nappies on holiday with you, as opposed to
hopefully purchasing disposable nappies whilst on
holiday abroad or in the UK (depending on your
destination) and saving packing space. If you take
disposables with you, then they will take up as
much, if not more, space than your real nappies.
Will you have access to laundry facilities? If so,
you could adopt your same nappy washing routine
whilst away? Wash and dry the bulk of the nappies
before you come home so you have clean nappies
packed and ready to use at home (no bag of soiled
ones!). Then you will only have your travel change
bag with clean and soiled on the way home.
If you don’t have access to laundry facilities and
prefer not to take home a whole bag of soiled ones
then disposables are the perfect option - remember
this was the purpose of disposables in the first
place, to be used in times like these. Also you have
already vastly reduced the amount of waste whilst
at home so reduced the impact on the environment.
Generally your child will have spent less time in
disposables, and as long as they feel comfortable
and are happy to use them whilst on holiday, have
a break from washing….that’s what holidays are
about!!
If you do decide to use disposable nappies, remember to
remove the poo and pop in the loo, just as you normally
do, before disposing of the nappy.
Alternative Disposable Nappy Options:
If you are concerned about the chemicals in
disposables, there is one disposable nappy that has
no superabsorbent gels, perfumes, dyes, minimal
plastic (on the securing tag and outside coating
only) and is wood pulp only, which you could use
104
whilst away. The nappy is ‘Tushies’ and is available
from internet suppliers. Other ‘compostable,
biodegradable’ alternative disposable nappies
unfortunately still have superabsorbent gels in the
core (Nature Boy & Girl, Moltex etc) albeit 50%
less and although they claim to be degradable, again
unfortunately in a landfill environment the gels and
plastics still take a very long time to break down.
See Fact File 13 Alternative Disposable Nappies for
more information.
Pocket Nappies and Mothercare’s Disposable Pads/
Weenee Pads:
One last alternative would be a mix of both real
and disposable, by using disposable booster pads
like Mothercare’s Disposable Pads or Weenees pad
(available from Lollipop suppliers). Mothercare’s
Disposable Pads are designed to be used with their
SMART nappies. However, the disposable pad could
be used with existing Pocket nappies if they fit
properly as the pads are quite slim. Weenees pad
are larger and shaped like an hour-glass both have
superabsorbent gels packed into them.
DO NOT TEAR WEENEE PADS UP
AFTER USE AND PUT THEM IN THE
TOILET (as directed on the wrapper).
These pads contain SAP Gel which
expand on contact with water. Anglian
Water has requested that they are not
disposed of down the toilet with your
child’s poo but are put in the bin. The
gels will cause blockages, clog filtration
systems and affect the natural bacteria
that they use to breakdown sewerage
waste..Line with a paper liner, remove
poo and pop down the loo, then put all
pads in the refuse bin.
Real Nappy Swim Pants and Suits
Pocket nappies like Happy Heiny’s, Fuzzy Bunz or
the Birth-to-Potty Pocket nappy, Bumgenius are
completely lined with fleece. At the back there is
an opening to allow a booster pad to be inserted
but in a holiday situation Mothercare SMART
Pads or a Weenees pad could be inserted instead.
Because it is all enclosed the disposable booster
stays wonderfully in place. The nappy becomes
just like a disposable nappy to put on and it can be
prepared in advance. Very quick to put on, fleece
is lovely against the skin and repels poo so they
can be flushed down the toilet efficiently. Then the
disposable pad can be taken out and disposed of
and the pocket nappy washed. Because the wrap is
so light, just like a Motherease wrap, it will wash and
dry (within 2 hours) very quickly - for holiday use
it could be hand washed if you bring some laundry
liquid/powder etc. They would take up no room at
all during travel.
One thing to also remember is your child’s swim
pants and suits. Try to opt for swim pants/suits that
are also ‘swimming pool’ friendly, i.e. they catch
all the poo’s and prevent them leaking out into
the pool! Your real nappy adviser should be able
to show you the latest designs that have integral
‘snug-fitting’ pants with a waterproof lining, which
will contain anything going. Internet suppliers also
sell some excellent cotton swim pants for example
Polyotters children’s swimwear. Deciding to use
these types of swimwear, will mean the disposal of
disposable swim-nappies at your holiday destination
will be kept to a minimum.
Hopefully this will give you some ideas! But
don’t worry about what you decide to do, enjoy
your holiday!
The downside is that pocket nappies are about £911 each and you would need enough to allow you
to rotate them during for your holiday. However,
if you do purchase them for holiday use, they
won’t be wasted as they are also good for nighttimes, when you are out and about and for use on
toddlers. The Bumgenius is a Birth-to-Potty pocket
nappy so can be sized to fit your child as they grow.
Real Nappy Library kits located around the county
have examples of pocket nappies if you would like
to try them out before you buy.
105
106
Fact File 12
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Contents:
1.Introduction
2. Legislation Governing Childcare Providers
3. Buckinghamshire Real Nappy Initiative and Childcare Providers
4. Real Nappy Systems suited to the childcare environment
5. What to supply in your Nappy Change Bag
6. Training and supporting your childcare provider
7. Associated Costs and Savings
8. Real Nappy Nurseries in Buckinghamshire
107
1.Introduction
Many real nappy parents experience difficulties of
finding a childminder or nursery who will continue
to use real nappies on their child. Many providers
currently insist that disposable nappies are used
whilst children are in their care. Real nappy parents
have also experienced a refusal from providers to
use real nappies following their request. This can
leave parents feeling like their personal preference of
real nappy usage has been taken out of their hands.
However, though this has been the experience over
the past few years, continued pressure by local
authorities to reduce and remove disposable nappy
waste from landfill have resulted in more parents
opting for real nappies. Coupled with requests
from real nappy parents and the government’s
Every Child Matters policies, mean that childcare
providers are going to have to adapt to real nappies
in the future.
In Buckinghamshire, only 2 nurseries currently
operate a real nappy policy on their premises and
a few childminders hold their own real nappy kits.
A growing number of childminders will happily
accommodate real nappies at a parent’s request.
However, approx 1000 childminders operate in
Bucks alone and whilst some do not provide care
to the under 5’s a vast number do, making nappy
provision an essential part of the childcare package.
2. L egislation Governing Childcare
Providers
Legislation already exists under the Childcare
Act 2006 which set the standards for learning,
development and care of children from birth to
five. All childcare providers have a statutory duty
to adhere to the Statutory Framework for the
Early Years Foundation Stage, and the Day Care
+ Childminding (National Standards)(England)
Regulations 2003 No. 1996 in addition to Part XA of
the Childrens Act 1989.
Early Years Childcare Inspectors, employed by
Ofsted have a duty to inspect all childminding and
early years’ provision and environments.
Whilst nappy provision is not specifically mentioned
within the legislation, neither is the insistence that
disposable nappy provision has to be provided.
Equally, real nappy provision is not excluded.
However, 14 National Standards each with set
criteria have to be met by providers, so a real
nappy preference by parents could be challenged
under some of these specific standards. These are
as follows:
Day Care + Childminding (National Standards)
(England) Regulations 2003
National Standards for Under 8’s daycare +
childminding (note: these standards will be replaced
by the Early Years Foundation Stage Framework
from September 2008)
Written by: DfES: Dept. for Education + Skills
ISBN 1 844 78 0600 Quote ref: DfES/0649/2003
For a copy of the complete publication,
Tel: 0845 602 2260
108
There are 14 National Standards in total; however the following standards could be applied to a real nappy
or a Natural Infant Hygiene (NIH) request:
Care, Learning + Play
‘Requires a regulated person to meet children’s individual needs and promote their
welfare.’
National Standard 3
Applied real nappy/NIH request: A parent who uses real nappies on their
child at home could request that their child’s individual real nappy needs are
met in the childcare provision, with a continuation of real nappy usage during
their childcare. Equally a parent who adopts Natural Infant Hygiene could also
request a continuation of this practice in the childcare environment.
Health
‘Promotes the good health of children.’
Applied real nappy/NIH request: A child who uses real nappies for health
reasons could apply a real nappy request on this standard. For example:
National Standard 7
National Standard 9
•because a parent wants their child to avoid the chemicals and SAPs
(Superabsorbent Polymer Gels) contained in disposable nappies or because a
child is allergic to these substances
•a child has eczema which is aggravated by disposable nappy use.
•NIH is adopted to encourage gentle toileting from birth to toddler-hood
without the reliance on disposable nappies.
•NIH is adopted to prevent a child sitting in body waste for long periods
of time.
Equal Opportunities
‘Actively promotes equality of opportunity and anti-discriminatory practice for all
children. Diversity and difference within all children includes making sure that all
children and families feel included, safe and valued; that all children and adults are
treated as individuals and are not discriminated against.’
Applied real nappy/NIH request: Where a childcare provider insists that
parents/children switch to using disposable nappies during their care; or if a
childcare provider refuses to use real nappies/or to continue NIH on a child
despite a parental preference/request to adopt these practices; a challenge by
the parents could insist that their right to equal opportunity is not being met
under this standard.
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Working in Partnership with Parents + Carers
‘Childcare providers have to work in partnership with parents to support the child
in their care. Equally, providers should work together with professionals from other
agencies.’
Applied real nappy/NIH request: A parent’s request for continued real
nappy usage or adoption of NIH practice during their child’s care should be
acknowledged and responded to.
National Standard 12
Parents can work in partnership with carers to ensure that continued real
nappy usage/NIH is made possible by providing equipment, showing how the
real nappies are fitted and how NIH is managed if the provider is unfamiliar
with the nappy design or NIH principles/practice.
Providers should ensure that their staff receive real nappy training and that
provision is made for storage of real nappies during the day, Equally, providing
information and training on NIH practices for staff should be made available
and that all parents are made aware that real nappies and NIH can be
catered for.
Buckinghamshire Real Nappy Initiative can help provide professional advice and
training to childcare providers in Bucks to help ensure that real nappy provision
for children and parents is sufficiently met.
Babies and Children Under 2 years of age
Point A.4 Food + Drink
‘Feeding and nappy changes take place in accordance with the child’s individual needs
and not as part of the childminder’s routine.’
Annex A
Applied real nappy request: A child who regularly uses real nappies at home
and has more frequent nappy changes that real nappies require/encourage
(compared with disposable nappies), is an identifiable individual need. Under
this annex point, childminder’s are required to respect real nappy usage and
real nappy change routines.
3. Buckinghamshire Real Nappy Initiative and Childcare Providers
Throughout the coming years, Buckinghamshire
Real Nappy Initiative will be working with childcare
providers to ensure that parents and children can
continue their real nappy usage within a childcare
environment. If your family experiences difficulties
when requesting real nappy usage during your child’s
care, please contact Buckinghamshire Real Nappy
Initiative or your local Early Years and Childcare
Service to feedback these difficulties.
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The Early Years and Childcare Service, can be
contacted in writing, by phone or email to:
The Early Years and Childcare Service,
Buckinghamshre County Council, The Friary,
Rickfords Hill, Aylesbury, Bucks, HP20 2RT 01296
383705 Email: [email protected]
4. Real Nappies suited to the childcare environment
Regardless of whether your real nappy child/ren
are being cared for by a grandparent, childminder
or nursery or they have started at pre-school,
the following real nappies are particularly suited
to these environments. They have been selected
because of their versatility and ease of use. Also
included in this section is a list of equipment to
have in your carer’s nappy change bag, to help equip
them with everything they need to make the switch
to real nappies as easy as possible.
Fiddly nappies to avoid in a childcare environment:
whilst you may be happy to use nappy systems that
have to be folded, or that come in 2-parts, spare
a thought for your carer who might be new to
condition such as arthritis which make these nappy
systems more difficult to use during your child’s stay.
For example, nappies to avoid unless your childcare
provider is confident and happy to use are:
• Terry nappies
• Prefolds
•2-Part nappies (which have detached absorbent
and wrap parts)
•Nappies with poppers (for carers who
experience arthritis in the hands)
•Nappies which rely on Nappi Nippas to secure
absorbent core
real nappies; may have a number of nappy children
to care for at one time, or might have a health
The following nappy systems are particularly suited to the childcare environment:
POCKET Nappy Systems
•Pocket nappies/training pants can be prepared in advance, prior to
‘dropping’ off your child/ren.
Fleece lined wrap which has
absorbent material stuffed into a
‘pocket’ in the lining.
•These can be put on and taken off just like a disposable nappy.
Can be secured by either poppers or Velcro to suit your carer’s
preference.
Sized: e.g. Fuzzi Bunz, Nature
Babies Stuffables
•Birth-to-Potty options can be supplied so that they adapt as your
child grows, allowing continued familiarity by the carer. Suitable if
children of different ages are going to be cared for together, as they
can be adapted to the different sizes. E.g. siblings
Birth-to-Potty: e.g. BumGenius
•Training Nappies/Pants can be pulled up and down for ease during
toilet training.
Pocket Training Nappies:
e.g. Happy Heinys Training
Pants (can be pulled up and
down)
•All are fleece-lined so no need for extra paper liner to be placed on
top. NOTE: Only use fleece-lined nappies if your child is not allergic
to fleece.
•Nappy can be sluiced in the toilet flush to remove poo, but it is
preferable to remove wet, absorbent pad prior to sluicing to reduce
the amount of water contained during storage. NOTE: Remember to
advise carer of this requirement, to avoid heavy water-logged nappies
during storage.
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All-In-One Nappy Systems
Absorbent ‘sized’ nappy with
integral waterproof wrap.
•This can be put on and taken off just like a disposable nappy. Velcro
or poppers are available, but check which is provided with your
selected design.
e.g. Popolini Easy-Fix
•Come in set sizes so make sure of correct fitting to prevent
any leaks.
•Some have higher percentages of man-made fibres so ensure that
your child will be comfortable in them throughout the day.
•Can be lined with a paper liner or booster insert can be sluiced to
remove poo prior to storage.
Birth-to-Potty Nappy Systems
•Whilst these are 2-part nappies, these systems can be suitable where
children of different ages are going to be cared for together, for
example: siblings
Absorbent, birth-to-potty nappy
core with pop-in booster and
separate, ‘sized’ wrap over the top. •Avoid if carer has arthritis as these systems use poppers although the
wraps do come in Velcro options.
e.g. Motherease, Lollipop
Onelife, Popolini One Size,
Bumbles
•Make sure the proper ‘sized’ wrap is supplied to prevent leaks and
inconvenience.
•Paper liner or fleece liner has to be added to aid removal of poo
prior to storage.
5. What to supply in your Nappy Change Bag
Prepare your Nappy Change Bag with:
1. 1 real nappy per 3 hours – 3 nappies will give you approx 9 hours for 1 child. Monitor and consider
adjusting if your child regularly runs out.
2. Waterproof ‘used’ nappy bag, to store wet nappies – these can hold up to 4 nappies at a time. Larger
nappy bags are available. Approx. £5 (Using a properly designed wet nappy bag prevents plastic bags
being taken into a childcare setting, removing any health + safety risks).
3. Washable wipes and ‘pump-action’ water spray bottle* ( *although nurseries have dedicated nappy
change areas so should have close access to running water)
4. Waterproof nappy change mat if required – for extra comfort and to catch spillages, line with a cotton
prefold/muslin/terry or towel.
5. Nappy change creams if required.
6. Paper or fleece liners if required.
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6.Training and supporting your
childcare provider
7. Associated Costs and Savings
Your child/ren will be dropped off in a real nappy
When selecting a childcare provider, take along your and picked up in a real nappy; all nappies are
supplied so your childcare provider doesn’t have the
selected real nappies and nappy change bag so that
providers can see the type of nappies and equipment responsibility of supplying disposables for your child/
that you would like them to use. Providers can then ren. This will also mean you have potentially saved
your provider associated costs of a clinical waste
discuss whether they are familiar with the nappy
collection as your child doesn’t use disposables,
system and if it suits their environment.
so greatly reduces this business cost. Negotiate
If your chosen provider is happy to use real
whether a reduction in your childcare cost would
nappies but are not sure how to use your nappy
apply if you supply all the nappies, as you have saved
system, offer to show them how the nappies work.
their business the cost of purchasing and disposing
Remember to advise them of the requirement to
of disposables. Some childminders and nurseries
‘Put the Poo in the Loo’ before storing the nappy
provide real nappies which is included in the
in the wet bag. By removing excrement and putting
childcare cost as they will also be responsible for
it in the toilet, ensures that it is treated in the
laundering them.
sewerage system where it should be and removes
odours from the nappy during storage, it also
prepares the nappy ready for washing at home.
8.Real Nappy Nurseries in
For comfort, real nappies generally require changing
on average every 3 hours which may be more
frequent than disposable nappies. Advise your
childcare provider of this, otherwise your child may
experience discomfort if a ‘disposable nappy change’
approach is used which might result in nappy rash
or leaking. If this is the case the provider may loose
confidence in using real nappies. Information fact
files on real nappy change routines can be provided
to your provider for free and can be downloaded
from the initiative’s website.
Buckinghamshire Real Nappy Initiative can also
provide free training and advice to childcare
providers on how to use real nappies. Childminder
Real Nappy Library kits are also available for
childminders to borrow for free if they would like to
try them out before purchasing their own kit.
Buckinghamshire
The following nurseries provide and launder real
nappies at their nursery (at the time of going to
print). They have been using real nappies for over
10 years and can accommodate real nappy parents
who provide their own nappies:
Cressex Day Nursery.
Holmer lane, High Wycombe, Bucks, HP12 4QA
Tel: 01494 474844
Sandcastle Day Nursery.
Sands First School Building, Lane End Road, High
Wycombe, Bucks, HP12 4JF Tel: 01494 474848
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114
Fact File 13
Alternative Disposable Nappies….
Compostable nappies
should not be put in here
If you use any type of disposable nappy, always remember to:
‘Put the Poo in the Loo before Disposing of your Disposable!’
Contents:
1.Introduction
2. What is a disposable nappy made of?
3. Superabsorbent Gels / SAPs
4. Children with eczema, skin or chemical sensitivities
5. Do Alternative Disposables contain SAPs?
6. Do Alternative Disposables have any benefits?
7. Do Alternative Disposables help in the landfill environment?
8. Cautionary Guidance on disposing of Alternative Disposables
- Fortnightly Green/Kitchen waste collections in Buckinghamshire
- Home Compost Bins
- Wormeries
- Home Incineration
9. Are disposable nappy ingredients listed on wrappers to help you choose?
10.Your council’s Point of View on Alternative Disposables
11.Where to purchase Alternative Disposables
115
We receive many enquiries about ‘COMPOSTABLE’ nappies. Common questions asked are:
‘Can I put my ‘compostable/bio-degradable’ disposable nappy in to my ‘GREEN/ KITCHEN’ waste collection
to be collected fortnightly?
‘Can I put my ‘compostable’ disposable nappy into my home composter?’
So before reading this fact file, which outlines the reasons why this can’t be done, please read the following:
For parents who have ‘green’ and ‘kitchen’ waste collected fortnightly in Bucks, which is taken to our High
Heavens Compost facility or those who would like to home compost these nappies, please note that:
Disposable nappies that claim to be ‘compostable’ are not accepted in your ‘green’ and ‘kitchen’ waste
collections. We also do not recommend these nappies to be composted at home in your home composter.
This is because they will contaminate these sites rendering the compost useless. So please remove baby’s
excrement from the disposable nappy - pop this down the toilet to be treated in the sewerage system
properly. Put the disposable nappy in your ‘refuse’ household bin. The disposable nappies will be taken to a
Bucks landfill site to be buried.
1.Introduction
In Bucks today, 87,000 disposable nappies will be
disposed of in household bins that ultimately end
up in Buckinghamshire landfill. That amounts to
31 million disposables per year at a cost of ¼
million pounds to Buckinghamshire Council Tax
payers. Disposable nappies are impacting on local
finances as well as our local landfill environment
and cannot be sustained in the future. So what is
the alternative….?
Buckinghamshire Real Nappy Initiative is actively
encouraging parents to use Real, washable nappies
instead of disposable nappies on their children.
Using modern Real nappies are a viable option
especially with the fabulous range of real nappies
currently available and modern laundering facilities.
However, it is claimed that nationally 95% of parents
are using disposable nappies so a major shift in
nappy behaviour would need to happen to solve this
problem. Parents, who generally use real nappies,
also use disposables on occasions such as at night
or when away from home. Many try to choose
disposables which they hope will have a reduced
impact on the environment.
So are eco-disposable, biodegradable or even
‘compostable’ disposable nappies preferable to
the high street brands? Enquiries to the initiative
have included questions about these new breed of
disposables. Until further research is carried out to
confirm that these nappies are compostable, fully
biodegradable or ecologically sustainable, we prefer
to call them ‘Alternative Disposable Nappies’.
Are Alternative Disposables really eco-friendly? Can they be composted to such an extent that they
bio-degrade? Are the materials they use from sustainable sources? And when they are manufactured,
are ecological and ethical processes incorporated?
116
2.What Is A Disposable Nappy
Made Of?
3.Superabsorbent Gels (Commonly
Known As SAPS)
First we need to know what disposable nappies are
made of. If you have the chance, take a look at a
disposable nappy. You will see paper, wood pulp,
plastic coatings, colour dyes and abit of Velcro to
hold it together. But what actually makes the nappy
absorb all of your child’s urine (pee)?
When you hear that disposable nappies don’t
degrade very well, bearing in mind that they have
a high content of paper products, we are referring
to these gels and the plastic coatings, dyes and
bleaches. These are the reasons why they don’t
degrade! Guessimates suggest each nappy will take
200-500 years to break down but no-one really
knows – yet. The other problems with SAPS are
that they continue to absorb any type of moisture
around them once in the refuse bin, truck and in
landfill. But as there is nothing to draw the excess
moisture off (such as the horticulturists gel), the
nappies grow in considerable size and weight, adding
to the tonnage weight and bulk in the
landfill environment.
What you won’t see, hidden in the core of the
nappy liner amongst the wood pulp, is a crystal gel
that you may have seen on the skin of your child – a
super-absorbent polymer gel (sodium polyacrylate
or SAPS as they are commonly known). The tiny
individual grains, can absorb 100 times their own
weight in moisture.
Experiment! An interesting experiment is to fill a
disposable nappy with a couple of litres of water,
allow it to absorb then cut the core of the nappy
open to expose the swollen gel. You may have
noticed these tiny balls of gel on your child during
nappy changes – these have escaped from the core,
although manufacturer’s say this shouldn’t happen,
many parents experience this common problem.
The horticulturists amongst you may have come
across similar crystals that are sprinkled around the
base of plants, which swell and absorb water so that
plants can draw from over a long period of time
(generally whilst your away on holiday!). The crystal
gel eventually shrink down to almost the original
size, after the plant has removed all the moisture via
the osmosis process.
These are a very similar to the gels used in
disposables except extra chemicals have been added
to the disposable gel to deal with the hygiene of
urine, human faeces and associated smells.
4.Children With Eczema, Skin Or
Chemical Sensitivities
Parents and carers who have children with these
health conditions need to consider which nappies
will not aggravate these conditions. Special
consideration should be given to disposable nappies
containing these gels. The reason for this is that
gels can migrate from the core of the nappy and can
come into direct contact with the skin; this can lead
to direct irritation of skin as the gels are abrasive
especially when children move. In addition to this,
the gels are not only excellent at absorbing urine
but any type of moisture it comes into contact
with. This includes skin moisture. So for a child
that experiences dry skin because of eczema or skin
sensitivities, skin moisture loss can be increased by
exposure to these gels, causing greater aggravation
to broken, dry/cracked or sore skin.
117
5.Do Alternative Disposable Nappies
Contain SAPS?
So one would expect that in an Alternative
Disposable nappy which claims to be bio-degradable
or compostable that no SAPS would be used? Is the
expectation that they should have less chemicals,
bleaches and dyes so – in theory – they could be
very degradable once the ‘poo’ has been removed?
Perhaps another expectation would be that they are
made from sustainable materials such as recycled
paper/wood pulp or the manufacturing processes
are ecologically sustainable?
Are SAPS used? YES Unfortunately all disposable
nappies that currently suggest they are either:
‘eco-friendly’, ‘degradable’, or ‘compostable’, contain
super-absorbent gel (SAPS). All that is, accept one
American brand called Tushies, which doesn’t claim
to be degradable or ecologically sustainable at all.
Sustainable Materials? NO Most of these nappies
do not use any recycled materials, however even if
recycled wood pulp or paper were used, research
would have to consider the impact (if any) it
could have on a child’s health? Virgin wood pulp
is used instead although the Nature Boy & Girl
manufacturers ‘Naty’ state that:
•‘…The back sheet of the Nature diaper is a
lamination of renewable/biodegradable maize Bio
film and of natural tree-pulp
TCF-pulp (totally chlorine free) tissue.’
•The printing colour on the diapers is, Nr S-i2: OK
Compost; PMS 3425 Green. Certificate attesting
to the fact that the printing ink is free of heavy
metals injurious to health.
118
•Naty AB has developed the renewable/
biodegradable maize Bio film, which is used in
the lamination. The film is based on cornstarch
and biodegradable polyester. The compostability
of this product is certified by the ”Ok Compost”
label, based on the guidelines of the European
normalisation committee Cent/TC261/SC4/
WG2N97, 05REV3 and issued by AIB Vincotte.
•Naty is exclusive holder of the renewable/
biodegradable maize Bio film
•The renewable/biodegradable maize Bio film is
100 % GM free.
•The renewable/biodegradable maize Bio film is
not only watertight but also “breathes” resulting
in an airier, drier and more comfortable nappy.
However Naty also confirm that:
‘…The products also reduce the need for nonbiodegradable super absorbents in the nappy with
50 % compared with the market leaders.
’
6.Do Alternative Disposables Have
Any Benefits?
However, there is one benefit of these nappies as
highlighted by Naty. They use 50% SAPS, reducing
the amount of plastics and chemicals by half,
compared with leading brands. In theory then, this
could equate to the nappy weighing 50% less
on absorption.
Could this be a benefit to waste authorities bearing
in mind that waste is charged per tonnage weight?
Perhaps, but no studies have been conducted to see
if this is the case. So the decision is yours!
7.Do Alternative Disposables Help
In The Landfill Environment?
One might assume that ‘compostable’ disposable
nappies mean that they degrade down more
quickly in the landfill environment. Unfortunately
this is not the case. The landfill environment is
compacted down to make way for more refuse.
Such compaction means that everything is squashed
tightly together so oxygen (which is essential for
the decomposition/break down of materials) levels
drop and decomposition is slowed down. In Bucks,
we regularly pull out newspapers from our landfill
sites that are dated over 50 years old and can still
be read. Newspaper is generally considered highly
degradable yet in a landfill environment they take
decades to finally degrade. So what hope has 7,500
tonnes (per year) of Bucks disposable nappy waste,
whether ‘alternative’ or not?
8.Cautionary Guidance on Disposing
of Alternative Disposables
Fortnightly green/kitchen waste collections in Bucks
For residents who have ‘green’ and ‘kitchen’ waste
collected fortnightly from their homes, which is
taken to High Heavens Compost facility or to an
external Compost Facility, please note the following:
Disposable nappies that claim to be ‘compostable’
ARE NOT ACCEPTED IN YOUR GREEN/KITCHEN
WASTE COLLECTIONS.
This is because they will contaminate these sites
and put waste operators at risk. So please remove
poo (line the nappy with a paper liner and pop
this down the toilet as you normally do when
using real nappies) and put the disposable nappy
in your normal household refuse bin. Removing
the poo will reduce any odours and discourage
flies during storage. They will then be taken to a
Buckinghamshire landfill site to be buried.
Home Compost Bins
•If you see claims on disposable nappy wrappers
stating that the nappies are ‘compostable’, treat
these nappies with caution.
•No thoroughly conducted research has been
undertaken in this area, and those that have, have
been carried out on a very small scale.
•A single compost bin would be overwhelmed
with the large volume of disposable nappies
generated over just 1 week (40+ nappies). Even if
only 1 nappy per night is used for example, that’s
still 7 per week, 30 per month, 364 per year!
•Household compost bins do not reach high
enough temperatures to breakdown excrement
(poo) or SAP gels.
•Human excrement should not be put into your
household compost bin as it could result in
local contamination of your home and garden
environment. Poo belongs in the Loo not in
your garden.
•If you do manage to produce compost from
disposable nappies, the advice is to only put
the compost on flower borders not on fruit
+ vegetable plots, unless future research
conclusions suggest otherwise.
•If you do decide to use disposables in conjunction
with real nappies, remember to line them with a
paper liner to make excrement disposal into your
toilet system easier – just as you normally do
when using real nappies.
•Poo should be put in the toilet so it enters the
sewerage system where it will be treated.
•The nappy should then be put in the
‘household’ bin!
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Horse and cow manure heaps
Should be treated with the same caution as home
compost bins, especially where SAPs and excrement
are concerned and even though the temperatures
generated are generally higher. Horses and cows
are vegetarian so manure produced doesn’t need to
be treated like human sewerage.
Womeries
Putting them in a wormery, is another suggestion
that you may hear. Experienced Compost Officers
in Buckinghamshire who are very knowledgeable
about wormeries advise against putting ‘alternative’
disposable nappies into wormeries – even if there is
a claim on the wrapper that this can be done.
A small home wormery would be unable to manage
the sheer quantity of nappies that 1 child would
produce (up to 5,500 disposables - 1½ tonnes over
a 2½ year period), or even if you only used 1 each
night = 7 per week. The worms would be affected
by the chemicals they consume. No thoroughly
conducted research has been undertaken in this
area, and those that have, have been carried out
on a very small scale. Worms are essential to our
environment and ‘wormery’ worms need looking
after too with a healthy diet & TLC!
Home Incineration
Parents have also advised, that instead of putting
their disposable nappies in the refuse bin (because
of concerns about landfill or they do not have
storage space prior to collection) that they have put
them on the open fire in their living room or in the
garden incinerator/bonfire instead. Some parents
also advise, that when they run out of disposables
they sometimes dry out a ‘used, urine-soaked’
disposable nappy on a radiator, they genuinely didn’t
realise that they contained chemicals.
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Home Incineration: Please do not do this as the
chemicals that are contained within the nappies could
affect your home environment and potentially your
health. No studies exist looking at the potential effects
of heating up the gels in these ways. Incinerating them
on open fires, indoors or out, speeds up the release of
CO2 (Carbon Dioxide), dioxins and chemicals directly
into your immediate atmosphere and ultimately into the
global atmosphere. CO2 is a gas that can be harmful to
the environment and is the gas that is said to be linked
to global warming.
9. A
re Disposable nappy ingredients
listed on the wrapper to help
you choose?
Many parents are genuinely unaware of the
chemical gels disposable nappies contain, as nappy
manufacturers are not obliged to list the ingredients
on the wrapper. This is because disposable nappies
are not considered a ‘cosmetic’ product. Legislation
changed approx. 25 years ago whereby cosmetic
companies had to list the ingredients used in
their product. This doesn’t apply to disposable or
sanitary products as they are not considered to be
a ‘cosmetic’ product. Interestingly, real nappies are
clothing and as such have to list their ingredients on
their labels.
If disposables aren’t classed as ‘cosmetics’ then surely
they should be classed as ‘clothing’? DISCUSS!
10. Your Council’s Viewpoint on
Alternative Disposables
Disposable nappies, when wet, weigh a considerable
weight. Your council is charged per tonnage weight
of waste that is disposed of at local landfill sites.
Although ‘alternative’ disposable nappies claim
to be compostable and more environmentally
friendly, indications are that they still consume a
lot of natural resources in their production and
transportation and do not do what they say on the
tin! i.e. they are not compostable or degrade any
more quickly than a conventional disposable nappy
in the landfill environment.
In Bucks, your waste management teams would
prefer you to put ALL types of disposable nappy
in your household bin rather than try to manage
the disposal of this waste at home – even if your
intentions are for the sake of the planet! The only
alternative to reducing the amount of disposable
nappy waste going into local landfill are by using real
nappies or by adopting Natural Infant Hygiene.
On a more positive note, alternative disposable
nappies, along with ‘own-brand’ disposable nappies,
tend to have 50% less SAP gels in them, which mean
they will ultimately weigh 50% less after swelling to
full capacity. So in considering all the known facts
to-date and by disposing of your disposable nappy in
the correct way, the choice about which ‘alternative’
nappy to use - is yours!
11. Where To Purchase ‘Alternative’
Disposable Nappies ?
Nearly all the local real nappy advisers and online
real nappy suppliers can offer an ‘alternative’
disposable nappy brand of one type or another.
Tushies are available locally from Little Green
Earthlets or from online suppliers. Nature Boy &
Girl are sold via some local Mothercare, Waitrose
and Sainsbury stores.
If you would like an updated list of local and national
real nappy suppliers, this can be found on the
website or by contacting the initiative direct.
Alternative disposable nappies that you may hear about
are listed below. Please note: new ‘ALTERNATIVE’ brands
are emerging all the time so this list is only for starters! Apply the same consideration to any you find….
Tushies
Only 1 nappy called ‘Tushies’ (an American brand) which actively doesn’t claim that it is bio-degradable
or otherwise, is totally gel-free (SAP free), dye and chlorine/bleach/perfume free and contains only wood
pulp, paper and abit of sticky tape. It’s a very effective disposable nappy but again shouldn’t be composted,
as baby’s faeces would need to be completely removed before shredding up. In theory, if this nappy
only contains urine and has the plastic securing tape and external coating plastic removed, it could be
composted, as it would only contain wood pulp, paper and urine. Urine is an excellent ‘activator’ within the
composting process.
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Tender Care
Is made by the same manufacturer of Tushies, but contains gel (SAPS), albeit 50% less than leading
manufacturers. It is chlorine, latex and perfume free.Visit: www.tendercarenappies.co.uk for more
information.
Nature Boy & Girl
Made in Sweden with revolutionary environmentally conscious manufacturing techniques, however this still
contains gel albeit 50% less than the leading brands. Claims that it is made of 70% degradable materials.
Available from Motercare, Waitrose and Sainsburys. Visit: www.naty.se for more information.
Moltex
Made in Germany. Claims to have minimal impact on the environment during manufacture. Virgin paper
and wood pulp, no dyes, bleaches/chlorine but still has super-absorbent gels (SAPs). Again contains 50% less
gels than leading brands. Claims that it can be composted or put in a wormery, however this is not possible
in a home compost system (due to the excrement and sheer volume produced) or in Buckinghamshire
High Heavens compost facility. Visit: www.moltex.de for more information.
SMART Disposable Pads by Mothercare
New pad designed to be used with Mothercare’s SMART nappy system. This pad also has superabsorbent
gels in them so do not home compost or put down the toilet.
Weenee Pads
Another disposable pad option is the Weenee pad that can also be inserted into a real nappy for extra
absorbency. Again, this pad has the superabsorbent gels but claims it can be composted, put in a wormery
or even torn up and put down the toilet.
Studies that are available via the internet are on a small scale and do not consider the short or long-term
impact of the SAP gels if compost is put onto soil used for growing fruit or vegetables, which will ultimately
be consumed.
Shredding these pads and putting them in the toilet is also a cause for concern as they are entering the
sewerage system. The gel swells to 100 times its original weight and size so could block pipes and have an
impact within septic tanks e.g. on the essential bacteria that is present. No studies have been conducted
to consider this impact. Anglian Water request that these pads are not disposed of in the toilet as they
will affect their natural bacteria filtration systems and cause blockages. If you would like to dispose of this
product in this way, contact your water supplier to see if this product is acceptable in their systems. For
more information visit: www.teamlollipop.co.uk
© Written by Janice O’Flynn-Mundin, Buckinghamshire Real Nappy Initiative Updated February 2008
For a free Nappy Information Pack or additional Fact Files call: 0845 3708090 or email:
[email protected] or visit www.recycleforbuckinghamshire.co.uk to download.
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