Category: 5. Diapers and clothing

​Step-by-Step

• When dressing your baby: While supporting your baby on your lap, stretch the garment neckline and pull it over your baby’s head. Use your fingers to keep it from catching on his or her face or ears. Don’t try to push your baby’s arm through the sleeve. Instead, put your hand into the sleeve from the outside, grasp your baby’s hand, and pull it through.
• When undressing your baby: Take off the sleeves one at a time while you support your baby’s back and head. Then stretch the neckline, lifting it free of your baby’s chin and face as you gently slip it off.

Clothing Tips

• In colder weather (under 75 degrees Fahrenheit [23.88 degrees Celsius]): Your baby will need several layers of clothing to keep warm. It’s generally best to dress your baby in an undershirt and diapers, covered by pajamas or a dressing gown, and then wrap him or her in a receiving blanket. For an extra layer, a wearable blanket sleeper or sleep sack is a safe alternative.
• In hot weather (over 75 degrees Fahrenheit [23.88 degrees Celsius]): You can reduce your baby’s clothing to a single layer. A good rule of thumb is to dress the baby in one more layer of clothing than you are wearing to be comfortable in the same environment.
• If your baby is premature: He or she may need still another layer of clothing until his or her weight reaches that of a full-term baby and his or her body is better able to adjust to changes in temperature.
• If you’ve never taken care of a newborn baby before: The first few times you change a baby’s clothes can be quite frustrating. Not only is it a struggle to get that tiny little arm through the sleeve, but your baby may shriek in protest through the whole process. Babies do not like the rush of air against their skin, nor do they enjoy being pushed and pulled through garments. It may make things easier for both of you if you hold your baby on your lap while changing the upper half of the body, then lay him or her on a bed or changing table while doing the lower half.
• When you’re dressing her in one-piece pajamas: Pull them over your baby’s legs before putting on the sleeves. Pull T-shirts over her head first, then put one arm at a time through the sleeves. Use this opportunity to ask “Where’s the baby’s hand?” As your baby gets older this will turn into a game, with him or her pushing his or her arm through just to hear you say, “There’s the baby’s hand!”

Certain clothing features can make dressing much easier. Look for garments that:

• Snap or zip all the way down the front, instead of the back
• Snap or zip down both legs to make diaper changes easier
• Have loose-fitting sleeves so your hand fits underneath to push the baby’s arm through
• Have no ribbons or strings to knot up, unravel, or wrap around the neck (which could cause choking)
• Are made of stretchy fabric (avoid tight bindings around arms, legs, or neck)

Swaddling

During the first few weeks, your baby will spend most of his or her time wrapped in a receiving blanket. Not only does this keep your baby warm, but the slight pressure around the body seems to give most newborns a sense of security.  

How to swaddle correctly:

1. To swaddle, spread the blanket out flat, with one corner folded down.
2. Lay your baby face-up on the blanket, with his or her head above the folded corner.
3. Straighten your baby’s left arm, and wrap the left corner of the blanket over your baby’s body and tuck it between his or her right arm and the right side of his or her body.
4. Then tuck the right arm down, and fold the right corner of the blanket over your baby’s body and under his or her left side.
5. Fold or twist the bottom of the blanket loosely and tuck it under one side of your baby.
6. Make sure your baby’s hips can move and that the blanket is not too tight. You want to be able to get at least two or three fingers between the baby’s chest and the swaddle.

New parents often learn how to swaddle their infant from the nurses in the hospital. A thin blanket wrapped snuggly around your baby’s body can resemble the womb and help soothe your newborn. When done correctly, swaddling can be an effective technique to help calm infants and promote sleep.

But if you plan to swaddle your infant at home, you need to follow a few guidelines to make sure you are doing it safely.

Back to sleep

To reduce the risk of Sudden Infant Death Syndrome, or SIDS, it’s important to place your baby to sleep on their back–every time you put them to sleep. This may be even more important if your baby is swaddled. Some studies have shown an increased risk of SIDS and unintentional suffocation when babies are swaddled if they are placed on their stomach to sleep, or if they roll onto their stomach. If babies are swaddled, they should be placed only on their back and monitored so they don’t roll over.

When to stop swaddling

Stop swaddling as soon as your baby shows any signs of trying to roll over. Some babies start working on rolling as early as 2 months of age, but every baby is different. There is no evidence with regard to SIDS risk related to the arms swaddled in or out.

What about wearable blankets or sleep sacks?

Infant sleep clothing, such as layers of clothing or a wearable blanket or sleep sack, is preferred over blankets and other coverings to keep a baby warm. A safe sleep space for infants should stay free of any loose bedding or soft objects. However, as with regular blanket swaddling, the use of wearable blankets or sleep sacks that compress the arms, chest and body should stop once a baby shows signs of starting to roll over. Sleep sacks that do not swaddle and allow the baby to move freely can be used as long as you want.

Know the risks

Parents should know that there are some risks to swaddling. Swaddling may decrease a baby’s arousal, so that it’s harder for them to wake up. That is why swaddling can seem so attractive to new, sleep-deprived parents—the baby sleeps longer and doesn’t wake up as easily. But we know that decreased arousal can be a problem and may be one of the main reasons that babies die of SIDS.

AAP safe sleep recommendations

The AAP recommends parents follow the safe sleep recommendations every time they place their baby to sleep for naps or at nighttime:

• Place your baby on their back to sleep on a firm, flat surface and monitor them to be sure they don’t roll over while swaddled.
• Do not have any loose blankets in your baby’s crib. A loose blanket, including a swaddling blanket that comes unwrapped, could cover your baby’s face and increase the risk of suffocation.
• Do not use weighted swaddles or weighted blankets, which can place too much pressure on a baby’s chest and lungs.
• Use caution when buying products that claim to reduce the risk of SIDS. Wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS.
• Your baby is safest in their own crib or bassinet, not in your bed.
• Swaddling can increase the chance your baby will overheat, so avoid letting your baby get too hot. The baby could be too hot if you notice sweating, damp hair, flushed cheeks, heat rash and rapid breathing.
• Consider using a pacifier for naps and bedtime.
• Place the crib in an area that is always smoke-free.

Keep hips loose

Babies who are swaddled too tightly may develop a problem with their hips. Studies have found that straightening and tightly wrapping a baby’s legs can lead to hip dislocation or hip dysplasia. This is an abnormal formation of the hip joint where the top of the thigh bone is not held firmly in the socket of the hip.

The Pediatric Orthopaedic Society of North America, with the AAP Section on Orthopaedics, promotes “hip-healthy swaddling” that allows the baby’s legs to bend up and out.

How to swaddle correctly

• Use only a thin blanket for swaddling.
• To swaddle, spread the blanket out flat, with one corner folded down.
• Lay the baby face-up on the blanket, with their head above the folded corner.
• Straighten their left arm and wrap the left corner of the blanket over your baby’s body, tucking it between their right arm and the right side of their body.
• Then tuck the right arm down, and fold the right corner of the blanket over her body and under their left side.
• Fold or twist the bottom of the blanket loosely and tuck it under one side of the baby.
• Make sure their hips can move and that the blanket is not too tight. You want to be able to get at least two or three fingers between the baby’s chest and the swaddle

Swaddling in child care

Some child care centers may have a policy against swaddling infants in their care. This is because of the increased risks of SIDS or suffocation if the baby rolls over while swaddled, in addition to the other risks of overheating and hip dysplasia.

Compared to a private home, where one or two people are caring for an infant, a child care center usually has a number of caregivers who may have variations in their swaddling technique. This raises a concern because studies show babies who are not usually swaddled react differently when swaddled for the first time at this older age. They may have a harder time waking up, which increases their risk of SIDS.

The difference in the advice for swaddling at home or the hospital nursery, versus in a child care center, really comes down to the age of the child and the setting. A newborn can be swaddled correctly and placed on their back in his crib at home, and it can help comfort and soothe them to sleep. When the child is older, in a new environment, with a different caregiver, if they are learning to roll or perhaps haven’t been swaddled before, swaddling becomes more challenging and risky.

New parents often worry that their babies are not pooping enough. A baby eating formula usually has a bowel movement at least once most days, but may go 1 to 2 days between bowel movements. For breastfed infants it depends on age. During the first month of life, stooling less than once a day might mean your newborn isn’t eating enough. However, breastfed infants may go several days or even a week between bowel movements, using every drop they eat to make more baby, not poop.

Infants normally work really hard to have a bowel movement, so straining at the stool isn’t necessarily alarming, even when the infant cries or gets red in the face. For an infant to have a bowel movement can be a major effort, and it shows. Just imagine trying to poop lying on your back and you’ll get the picture.

If you’re concerned your baby may be constipated, ask yourself the following questions:

• Is my baby excessively fussy?
• Is my baby spitting up more than usual?
• Is my baby having dramatically more or fewer bowel movements than before?
• Are my baby’s stools unusually hard, or do they contain blood related to hard stools?
• Does my baby strain for more than 10 minutes without success?

These signs can all suggest actual constipation.

Is there anything I can give my baby for constipation?

Once your baby is at least a month old, if you think they are constipated, you can try giving them a little apple or pear juice. The sugars in these fruit juices aren’t digested very well, so they draw fluid into the intestines and help loosen stool. Although fruit juice is not recommended for babies under a year of age, as a rule of thumb, you can give 1 ounce a day for every month of life up to about 4 months (a 3-month-old baby would get 3 ounces). Once your infant is taking solid foods you can try vegetables and fruits, especially that old standby, prunes. If these dietary changes don’t help, it’s time to call your child’s pediatrician.

Diarrhea isn’t just a loose stool; it’s a watery stool that occurs up to 12 times a day.

• If you’re breastfeeding: A breastfed baby’s stools are light yellow, soft, or even runny, and they often contain small pieces that look like seeds. Breastfed babies may pass stools with every breastfeeding.
• If your baby is formula-fed: Babies who are formula-fed pass stools that are yellow to tan and about as firm as peanut butter.

Whether you breastfeed or formula-feed your baby, as he grows it’s normal for you to see stools less frequently.

A greenish tinge to the stools is normal. As long as your baby is feeding and growing normally, you should not be concerned unless her stools are whitish and clay-like, watery and filled with mucus, or hard and dry. They should also not be black or bloody. If they are, call your pediatrician.

Call Your Pediatrician Right Away If Your Baby has Diarrhea and

• Is 3 months or younger
• Has a rectal temperature of 100.4°F (38°C) or higher
• Is vomiting
• Lacks energy or is irritable and doesn’t want to feed
• Has signs of dehydration, such as dry mouth, or has not passed urine for 3 or more hours

WARNING!

A baby can become dehydrated quickly. If your baby is younger than 3 months and has a fever as well as  diarrhea, call your pediatrician at once. If your baby is older than 3 months and has had mild diarrhea with a slight fever for more than a day, check whether he’s passing a normal amount of urine. Also check his temperature with a thermometer. Then call your pediatrician.

Coping with Diarrhea in Babies

A viral infection that causes vomiting and diarrhea may make your baby irritable for 1 or 2 days. If your baby is otherwise healthy, symptoms should clear up on their own. Your pediatrician will advise giving fluids to your baby to make up for the fluids and electrolytes (eg, sodium, potassium) lost with the diarrhea.

• If you’re breastfeeding: Your pediatrician will probably recommend that you keep breastfeeding as usual.
• If your baby is formula-fed: Your pediatrician may instruct you to give your baby a special drink that contains electrolytes and sugar.

Pharmacies carry premixed drinks with the right balance of electrolytes for newborns and young infants; homemade solutions may not have the correct electrolyte balance and therefore should not be used.

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As a new parent, you may not have heard of the ongoing cloth versus disposable diaper debate. Use of disposable diapers has become so accepted as a modern-day convenience that many parents wouldn’t dream of using a substitute. In contrast to 1955, when essentially all American babies wore cloth diapers, an estimated 90% (or even 95%) of 21st century American babies are sporting the latest in disposable fashions.

While a simple internet search on the subject quickly makes it clear how strongly some people feel about the cloth versus disposable debate, we have no intention of taking sides. Instead, we figure we’d offer you some facts and practical advice related to the use of each type, with the rest of our information weighted toward disposable use only because it is applicable to a majority of parents these days.

• Disposable. Disposable diapers are very absorbent, a feature that can be good and bad. Using them may mean your baby’s skin has less contact with pee and poop and may offer the added convenience of less frequent changing. However, it may also be more difficult to monitor exactly how much your baby is peeing—a task that is especially important during the newborn period, as well as when you’re faced with watching for signs of dehydration.

Do you see what I pee?

Disposable diapers these days are so effective at absorbing whatever pee may come their way, they can actually pose a challenge to parents who are trying to keep close tabs on just how much their newborns are peeing . Fortunately, some diaper brands now come with a colorfully effective solution: a strip on the diaper that changes color when wet, allowing you to more clearly see when your baby pees.

Some cloth diaper advocates argue that babies in disposable diapers have a much higher incidence of diaper rash (presumably due to longer contact with diaper contents resulting from less frequent changing). Interestingly, however, one of the commonly recommended approaches to treating Diaper rashes is for cloth diaper users to switch to disposable. Also garnishing a lot of attention is the fact that “disposable” diapers are not biodegradable, and billions (with estimates around 20 billion diapers, or 3.5 million tons) make their way into landfills each year.

We have been happy to learn that some communities have begun recycling or responsibly composting used disposable diapers, while some of the country’s leading diaper makers seem to be making an effort to be more eco-friendly, improving everything from the materials they use to the amount, transport, and packaging of diapers. We certainly hope that this sustainability-minded approach continues across the entire disposable diaper industry.

• Cloth. Cloth diapers are supposedly more comfortable than disposable diapers (we say supposedly because neither of us has any personal recollection, and we aren’t exactly sure how one would otherwise prove such a claim). Proponents also claim that babies who wear cloth diapers are five times less likely to develop diaper rashes than their disposable diaper-clad counterparts. But unlike disposable diapers, cloth diapers are not as absorbent, need to be changed more frequently, and usually need to be worn with an overlying stay-dry cover. These covers typically come in the form of plastic, cotton, or terry cloth.

An environmentally superior diaper?

One of the most significant concerns parents have when it comes to the use of diapers these days is the effect they have on the environment—a concern that is well worth paying attention to. What may come as a surprise, however, is that it’s in no way clear that disposable diapers have any greater effect than their cloth counterparts. Both disposable and cloth diapers have an effect on the environment that is determined by taking into account the full “life cycle” of the diaper, from start to final use. This includes how much energy, water, and raw materials are used, as well as how much atmospheric emissions and waterborne and solid wastes are created.

While studies suggest that disposable diapers use more raw materials and produce more solid wastes, cloth diaper use potentially consumes significantly more water and produces more waterborne wastes. The conclusion: we wish we had a definitive one for you. When it comes to declaring environmental superiority of cloth versus disposable diapers, it still seems to be a wash.

As for the materials used to make them, cloth diapers have long been made of cotton—a material that is notorious for requiring a lot of water to produce. Those focused on reducing the environmental impact of diapering point to bamboo-based cloth diapers as more eco-friendly, as well as a more readily available alternative to cotton.

And because cloth diapers (and their covers) require a lot of washing by either the parents or a diaper service and therefore use a great deal of water and detergent, people in the disposable diaper camp point out that cloth diapers also have a negative effect on the environment—especially when they are washed in small, half-full loads of laundry, put into a dryer instead of line dried, or both washed and dried.

At least half of all babies get a diaper rash at some point. In fact, reddened, inflamed skin in the diaper area is one of the most common reasons parents seek medical care from their child’s doctor. You’re not alone!

Because there are many different types of diaper rashes―and they can look surprisingly similar―check out this list from the American Academy of Pediatrics (AAP) to help identify, soothe, and prevent several different types of diaper rashes.

1. Irritant diaper rash

The most common type of diaper rash is “irritant dermatitis.” The diaper area spends much of the day in contact with two very irritating substances: urine and stool. If your child has diarrhea or is teething―meaning extra saliva is being swallowed and passes through the gut―the chance of developing a diaper rash is even greater.

Irritant diaper rash looks like pink or red patches on the skin covered by the diaper. The groin folds are more protected from urine and stool, so this skin usually looks normal.

Image caption: Examples of irritant diaper rash. The far right photo shows a more severe case with open sores.

What parents can do to prevent diaper rash:In general, try to limit contact of urine and stool with the skin:Change diapers frequently. Moisture from leaving a wet or soiled diaper on too long can cause skin to chafe. Urine in the diaper also can break down over time to produce irritating chemicals. In addition, the digestive enzymes that stool contains can start to wear away at skin.Clean the skin gently during changes. For wipes, choose a product that is free of alcohol and fragrance. You can also cleanse the skin with water and a non-soap/gentle cleanser, which may be less painful than wiping if the skin is irritated or has open sores. Use a squirt or spray bottle of water for severe rashes, if possible, to rinse without rubbing. Pat gently and allow skin to air-dry.Coat the skin with a thick layer of barrier paste. The brand is less important than the ingredients. Zinc oxide and petrolatum are both good choices, and fragrance-free products are best. Think of diaper paste as a shield that sits between the skin and the contents of the diaper. If the paste isn’t soiled, no need to rub it off during changes; simply add more paste on top. In general, there is no such thing as too much diaper paste. Apply a thick layer, like icing on a cupcake.Choose a highly absorbent diaper. The more absorbent the diaper, the better job it does of keeping the skin dry. Although there is no current evidence showing which type of diaper does the best job of preventing diaper rash, cloth diapers typically are less absorbent than most disposable brands. If you use cloth diapers, you may want to consider using disposable diapers until the rash heals.Leave some breathing room. Make sure the diaper isn’t too tight, especially overnight. A diaper that is loose will be less likely to rub against the skin.Keep the area clean. If the diaper area is irritated, a daily bath will help remove debris, irritants and possible bacteria. Don’t forget to apply a thick layer of barrier paste in the diaper area after bathing.

2. Yeast infection

Another fairly common cause of diaper rash is yeast infection, caused by overgrowth of a type of fungus found naturally in the digestive tract. Clues that the rash might be due to a yeast infection include shiny, bright red or pink patches with sharp edges. This rash may also have little pink bumps or pimples. In severe cases, there may be sores or cracking skin that oozes or bleeds. Unlike with irritant diaper rash, a yeast diaper rash is usually worse in the groin folds.

A yeast diaper rash may develop after your baby has taken antibiotics. If your baby has this type of diaper rash, be sure to wash your hands thoroughly before and after diaper changes. Your pediatrician may recommend or prescribe a topical antifungal cream for the rash. 

Image caption: Scaling skin spreading to the thighs and abdomen is typical with a yeast (candida) diaper rash.

3. Bacteria

Rarely, diaper rash can be caused by a bacterial infection. This is also called impetigo. Certain types of bacteria (like staph and strep) can cause diaper rash or make an existing one worse. Bright red skin around the anus can be a clue to a strep infection. Yellow crusting, weeping, or pimples can be a clue to a staphylococcus or “staph” infection. Any infection in the diaper area needs to be confirmed and treated by your child’s doctor.

Image caption: Left, strep infection diaper rash; Right: staph diaper infection

Do not use over-the-counter antibiotic ointment for diaper rashes; sometimes ingredients in these products can worsen skin irritation.

4. Allergy

Occasionally, babies with sensitive skin may have an allergic reaction to a specific ingredient in diapers, wipes, and/or creams. Common allergens include dyes or elastics in the diaper, and fragrances or preservatives in diaper wipes or creams. Clues that might suggest an allergy include a rash that happens after every exposure to that product and a rash that shows up everywhere that product is applied. Switching brands or types of products for a 2-week period can sometimes help sort this out. 

Image caption: allergic reaction to diaper wipes.

5. Other rare types of diaper rashes

There are rare conditions that can start as or mimic diaper rash. Examples include seborrheic dermatitis, which may involve overproduction of oil in the skin, and pediatric psoriasis. Genetic conditions such as acrodermatitis enteropathica, an inherited form of zinc deficiency, may also cause rashes in the diaper area. 

When to call the doctor:If your child’s rash does not clear using the simple tips discussed, contact your child’s doctor to see if a prescription medication is needed. Be sure to follow the instructions carefully; some prescription medications for diaper rash are only safe to use for short periods of time.
Other signs that it is time to call the doctor:The rash is not going away, or it is getting worse after two to three days of treatment.The rash includes pimples, peeling skin, blisters, pus-filled or oozing or crusty sores.Your baby is taking an antibiotic medicine and develops a bright pink or red rash with red spots at the edges. The rash is especially painful, which could be a sign of cellulitis.Your baby has a fever in addition to the rash.

Bottom Line:

Talk with your pediatrician if you have any questions about diaper rashes, and how to treat and prevent them.

Washability is definitely something to consider. Be sure to look at the labels not only for size, flame-resistance, or snug-fitting information but also for washing instructions. Unless you relish the thought of hand-washing a lot of baby clothes and frequently replacing those that don’t hold up well, we suggest you give some serious thought to the durability and washability of the baby clothes you buy—especially your baby’s everyday outfits, Onesies, and sleepers.

• Washing. Because newborns tend to have sensitive skin (and because you don’t know who has handled the clothing and with what before it made its way into your possession), it’s generally a good idea to wash all clothes prior to using them. An exception might be outerwear such as coats and jackets that don’t have much contact with the skin (and tend not to wash and dry easily). As a helpful hint, consider putting small items such as socks in a mesh bag for washing and drying and remember to fasten any Velcro tabs (such as on bibs) before tossing them into the fray to avoid snagging other clothes.
• Detergents. It is a common recommendation that baby clothes should be washed separately, using special “baby” detergents that supposedly leave fewer residues and are therefore less likely to cause skin irritation. In reality, we’ve found that many if not most parents simply toss their baby’s clothes in with the rest of the family’s laundry without causing any problems. That said, it is worth paying attention to the fact that detergents in general don’t strip away the flame-retardant properties of sleepwear, but soap flakes can. Given that information, you can choose your detergent as we do—buy one that smells good and gets the dirt out, and only feel compelled to invest in a milder “baby” detergent (or hypoallergenic/fragrance-free “adult” detergent) if your baby develops any signs of skin irritation.
• Stain removal. The best approach to managing stains made by breast milk, formula, spit-up, or poop is to try wiping or rinsing off the offending substance as much as you can while it’s still relatively fresh. We realize that this may be easier said than done—especially if you find yourself in the middle of a diaper change or feeding with a clothing stain that is settling itself in for the long haul—but if you can remove even some of it with a baby wipe or soak the clothes in some water and detergent, you’ll be glad you did. We also suggest stocking your laundry room with a good stain remover and designating a place for soaking stained or soiled clothing.

Becoming a parent usually involves changing a lot of diapers—as many as 8 to 12 a day once you get into the swing of things. Most U.S. parents will go through nearly 3,000 diapers during their baby’s first year alone and average six diaper changes a day for an estimated total of 8,000 over the course of a baby’s diaper-wearing career.

From choosing a good spot to change your baby’s diaper to perfecting your technique, there are ways to make it easier.

Location, location, location

Wherever you choose to change your baby’s diaper—whether it’s on your brand-new changing table or next to you on your bed—you’ll want to prepare the area so everything you need is accessible. At a minimum, this means a diaper and something to wipe with. Changing tables are clearly the norm when it comes to location.

Some people, one of us included, even opt to have more than one around the house. As convenient as they may be, you should be aware, if you aren’t already, that changing tables aren’t really necessary. If you decide you don’t want your diaper changing to be limited geographically by where your changing table happens to be, or you want to save yourself the expense, simply consider keeping diapers accessible in convenient locations around the house (and in the car, once you start to venture out). That way, you can limit how far you have to go to take care of business.

Changing pads

Some people opt to use a simple diaper-changing pad in lieu of the table, and the floor, bed, or couch or even the back seat of your car can easily serve the same purpose once you are comfortable with the routine. That said, some particularly messy episodes might require not only a new diaper but also an extra pair of hands, a new outfit, and even a trip to the tub. On such occasions, you’ll be much better off if you choose your changing station close to all your supplies.

Disposable changing pads, available in most drugstores and sometimes referred to as bed liners, underpads, or “chux,” can be helpful in protecting your changing table, crib, bed, floor, or wherever else you may choose to set up shop. These are especially good when you’re away from home because they can be used first as a changing pad and then to wrap the dirty diaper for a quick and easy disposal. If you’re at home and don’t mind a bit of extra laundry, a towel can easily serve the same purpose.

The technique

Before starting to change your baby’s diaper, keep in mind that some babies have a tendency to pee as soon as they are exposed to open air. By keeping them relatively covered as much as you can during the course of a diaper change, you can help keep yourself, your changing surface, and your baby’s clothes from getting unnecessarily wet.

If your baby is cooperative, which most babies are at least until they learn how to roll (somewhere around four months of age), you can first lift their legs with one hand. Using your other hand, place an opened clean diaper under their still-diapered bottom Make sure you have the picture side of the new diaper in front, face down on the changing surface, and the side with the tabs underneath your baby.

Once you have your clean diaper appropriately positioned, go ahead and unfasten the old diaper. Wipe your baby’s bottom with the front (inner side) of it as you remove it. While you clearly don’t have to wipe with the old diaper before taking it off, doing so often removes a significant amount of poop before you reach for your first baby wipe.

If the old diaper isn’t overwhelmingly messy, leaving it folded over on itself but still under your baby’s bottom can help prevent their still-dirty bottom from getting the new diaper soiled before you’ve had the chance to clean them up. It can also serve to absorb any new pee that may present itself during the uncovered stage of the diaper change. Next, wipe your baby’s bottom and surrounding dirty areas with a baby wipe, moist tissue, or washcloth.

Then remove the old diaper, along with the wipes, from underneath your baby and find a “safe” place to set them so you don’t end up with your baby’s foot in poop or find yourself with a new mess to clean up after accidentally knocking the diaper and its contents onto the floor.

Securing the new diaper simply involves making sure that the front of the diaper is centered between the legs and pulled up to at least the same level in the back that it is in the front—usually around the level of the belly button. Check to see that the tabs are evenly secured in the front so there aren’t any gaps around the hips.

Also, to help prevent leakage, make sure the fringe around the legs isn’t tucked into the diaper’s elastic edges.

​A word on changing a boy’s diaper

Baby boys are notorious for indiscriminately spraying their parents, grandparents, and pediatricians. Simply being aware of this inherent hazard can help limit the amount of time you leave yourself vulnerable during a diaper change. So can holding your hand, a diaper, or a tissue over your baby’s penis during the process.

If you find yourself caught in the line of fire, take comfort in knowing it happens to the best of us. While it may not help you much, those of us in the medical profession who have been peed on more than once find some comfort in reminding ourselves that urine is, after all, a sterile bodily fluid. If you can get the diaper on without being doused but nevertheless find yourself faced with urine sneaking out of your baby boy’s diapers, you can also try aiming his penis downward before covering it with the diaper.

At an average of nearly 30 cents a diaper for brand-name disposables and about 3,000 diapers, you can expect to spend around $1,000 during your first year of diapering—and that’s not even factoring in wipes, diaper creams, and all the other diapering paraphernalia. With those figures in mind, we thought it would be useful to point out several potential ways you can save yourselfsome money in the diapering department.

• Start small. Start out by buying diapers in smaller quantities. You’ll want to make sure you’ve found a good match, but also, keep in mind that your newborn will be growing very quickly in the months to come. If at first you happen to settle on a more expensive brand, remember that as your baby gets older (ie, potentially has less sensitive skin, less leaky poop, and pees less frequently), you may want to experiment with less expensive brands.
• Divide and conquer. Calculate your cost per diaper. This may sound obvious, but by simply dividing the cost of a pack of diapers by the number of diapers in the pack, you can figure out whether what you’re getting is really a good deal or is just being advertised as one. Quite often, the retail (and virtual) stores list this price-per-diaper cost for you, if you just remember to look for it. If and when you do, you’ll find that mega-jumbo packs aren’t always the best bargain, and one store’s sale price doesn’t always beat the everyday price at another.

DIAPER(LESS) TRIVIA

Did you know that in certain Asian and African cultures, babies are not put into diapers? When a baby awakens or the parent notices certain cues, the parent places the baby over a bush or another designated area to pee or poop. Although you may want to adapt this technique when it comes time to potty train, based on social norms in America, we don’t recommend you try this with your newborn at home!

• Cut coupons. If you’re the coupon type, it won’t take much convincing for you to find a quick search for diaper coupons well worth your while. If you’re not the coupon type, you might want to give it a try anyway. At the rate you’ll be using diapers, there’s really not a good reason to pass up $1, $2, or even $5 off a pack. While you’re at it, consider using your coupons at stores that double manufacturers’ coupons.
• Think big. When you find a sale or have coupons, buy extra diapers in advance to spare yourself a middle of the night run to the grocery store because you’ve used your last one. If you’re going to take advantage and really stock up, you might just want to consider having your reserve supply be a size up from the one your baby’s currently wearing. That way, you don’t wind up having a stockpile of leftover, too-small diapers that don’t fit as your baby outgrows them faster than you can use them.
• Join the club. Take note of frequent buyers’ clubs. You know you’re going to be in the market for diapers for a long time to come, and by simply collecting proofs of purchase (or “diaper points”), many companies reward you with baby clothes, toys, music, and other products. Similarly, some grocery and drugstore chains now tally up dollars spent on baby items and offer rebates or coupons each time you reach a certain total (for example, a $10 store coupon every time you spend $100 on baby items at that store).
• Consider your options. Consider using cloth diapers and washing them yourself. By some estimates, using a diaper service instead of paying for disposable diapers only lets you break even. By others, washing cloth diapers yourself has the potential to cut your diapering costs by as much as half.

We are big believers that there’s really no need for parents to pay a high price in exchange for less gas. That said, if you find yourself going head to head with your baby’s gas, there are several things you can reasonably do to try and remedy the situation—only some of which have anything to do with eating. We simply suggest that you do so with only modest expectations, since breaking up gas is definitely hard to do.

Find Foods at Fault

Although there are definitely some foods that are more suspect than others, identifying which ones they are in a breastfeeding mother’s diet is often easier said than done. While it is certainly worth paying attention to whether or not a certain food or drink clearly causes your baby distress, just remember that food is not the only cause for gas. Be sure not to randomly remove so many foods that you leave yourself with very little on your plate.

Formula for Success

Especially in a baby’s early formula-drinking days, either consider holding off on mixing up powdered formula for the time being and use concentrated or ready-to-feed formula instead, or let your freshly mixed powdered formula settle before serving. The more mixing and shaking involved, the more air bubbles get into the mix—resulting in more swallowed air and potentially more gas. Be sure to discuss any formula changes with your pediatrician. When an abundance of gas is involved, trying a different formula may well be just what your doctor orders.

Slow the Flow

Help your baby swallow less air by slowing the flow of liquids from his bottle into his mouth. Trial and error with different bottles and nipples tends to be the best approach.

Clear the Air

If your baby’s gas issues leave you wanting to better clear the air while bottle-feeding, also look for bottles (such as those that are vented, angled, or collapsible) meant specifically to keep babies from swallowing extra air while drinking.

Keep Things on the Up and Up

Try stepping up your burping efforts by burping during, as well as after, each feeding. Just be forewarned—some babies don’t take at all kindly to this sort of rude interruption.

Pump Your Own Gas

You can help get rid of unwanted gas by simply laying your baby flat on his back and moving his legs in a bicycling motion. Better yet—give him some tummy time. This not only can help keep his head from becoming flat while strengthening his upper body, but can put a lot of pressure on any gas that’s thinking about settling in to be on its way out instead.

Burst Their Bubbles

While there currently seems to be no inherent harm in reaching for a bottle of gas drops to break up your baby’s gas, the best tip we have for you is that we’ve been told you can get your money back from either the manufacturer or the pharmacy if you find they don’t work! Simethicone gas drops (such as Mylicon, Little Tummys gas relief drops, and Phazyme) are thought to be safe to give—as often as 12 times a day, if necessary—and many parents do just that. But at approximately $12 per 1-ounce (30 mL) bottle, they’re not exactly cheap. And studies suggest that they’re not that effective either.