Risks to Infant Health in Disposable Diapers
Posted on January 25 2023
Have you ever wondered if disposable diapers (also known as disposable nappies or single-use diapers) could pose risks to a baby? Have you experienced diaper dermatitis issues while using this type of diaper?
We begin with various random reports published by research agencies such as the United States Consumer Product Safety Commission, the Mexican Foundation for Dermatology, the National Cancer Institute in the United States, and the French Agency for Food, Environment, and Occupational Health and Safety (ANSES). The aim is to inform more moms and dads about the risks associated with using single-use diapers.
During 2002-2003, several studies were conducted in the United Kingdom involving more than 2000 households with at least one child aged 0 to 36 months who used disposable diapers. Throughout the research, it was found that in all cases, infants experienced diaper dermatitis at least once.
New studies conducted between 2017 and 2019 highlight for the first time the risks to infant health when using disposable diapers.
"several chemicals exceeded safety threshold values"
Based on testing performed with disposable diapers and their usage, assessments by organizations such as ANSES highlighted various chemicals for which safety threshold values were exceeded. ANSES became the first health and safety agency worldwide to comprehensively evaluate the safety risks of baby diapers.
CHEMICAL SUBSTANCES FOUND IN DISPOSABLE DIAPERS
In 2017 and 2018, the French National Consumer Institute (INC) conducted a study on 13 baby diaper brands with the intention of measuring chemical substances in a urine simulant, extracted respectively from shredded and intact diapers.
These tests consistently revealed the presence of dioxins and furans in both shredded and intact diapers, as well as in urine simulators. Additionally, the Joint Laboratory Service (SCL) detected several fragrances only in shredded intact diapers through solvent extraction.
Pesticide substances like glyphosate and AMPA were also found in shredded intact diapers through solvent extraction. Other pesticides found, such as quintozene and its metabolite pentachloroaniline, hexachlorobenzene, were quantified by the French National Consumer Institute in a diaper (shredded intact diaper, solvent extraction).
The consulted studies also identified the presence of Polycyclic Aromatic Hydrocarbons (PAHs) in disposable diapers. According to ANSES's evaluation, the formation of PAHs during the manufacturing of these diapers cannot be ruled out due to the use of high temperatures in certain manufacturing processes.
Although the cellulose used in these products is no longer bleached with elemental chlorine, processes involving chlorine agents like chlorine dioxide are used, which may contribute to the formation of dioxins and furans.
TRANSFER OF CHEMICAL MATERIAL TO THE SKIN
Chemicals in direct contact with the skin (top layer, lotion, leak guards, waist section) can be transferred directly to the skin or solubilized in sweat, urine, feces, or sebum. Only a fraction is transferred to the skin during use.
For substances in indirect contact with the skin (acquisition layer, Super Absorbent Polymer, core, surrounding nonwoven material, adhesive), transfer can occur through extraction or solubilization in bodily fluids, followed by migration to the top layer and release onto the skin under pressure (reflux).
"approximately 7% of the chemical material from a disposable diaper is actually transferred to the skin"
For this reason, skin diseases like contact dermatitis and diaper dermatitis can potentially increase dermal penetration of chemical substances based on the degree of skin damage. It is estimated that approximately 7% of the chemical material from a disposable diaper is actually transferred to the skin, and the prevalence of diseases like diaper dermatitis is estimated between 7% and 50%, depending on the country and hygiene practices.
A fully closed diaper that doesn't allow skin to breathe poses a high risk of infection. Conversely, highly breathable diapers significantly decrease the risk.
With improvements in the quality of single-use diapers, there has been a reduction in the incidence and severity of diaper dermatitis in recent years. However, the use of this type of diaper continues to lead to skin diseases in the diaper area that can affect dermal absorption.
For now, diaper dermatitis cannot be completely avoided with single-use diapers and can impact dermal absorption of chemical substances.
COMPOSITION OF A SINGLE-USE DIAPER
Top Layer: Polypropylene, polyethylene, polyester, or bioplastics derived from cornstarch and sugarcane.
Acquisition Layer: PET (polyethylene terephthalate) or cellulose and polyester fibers.
Core: Superabsorbent polymer (SAP) encapsulated in wood cellulose fibers.
Back Layer: Low-density polyethylene (LDPE) or a nonwoven mix with a film (LDPE).
Leak Guard: Hydrophobic nonwoven polypropylene.
Elastics: Thermoplastic polymers, Lycra (polyurethane)
Fasteners: Polyamide and polyethylene.
Adhesive: Hot melt adhesive or copolymer rubber and starch.
Lotion (not always): Pharmaceutical-grade purified vaseline (= vaseline), stearyl alcohol, liquid paraffin.
Although manufacturers claim to use safe pigments in diapers, in practice, brands seek to limit baby skin exposure.
NUMBER OF CHEMICALS THAT COULD BE FOUND IN A SINGLE-USE DIAPER
Following the evaluation of results obtained by INC and SCL, various chemical products were found. While they may not represent all baby diapers available on the market, they provide a general idea of the large number of substances used:
Polycyclic Aromatic Hydrocarbons (PAHs)
Benzo [g, h, i] perylene
Benzo [b] fluoranthene
Benzo [a] anthracene
Indeno [1,2,3-c, d] pyrene
Cyclopenta [c, d] pyrene
Chrysene
5-methylchrysene
Benzo [k] fluoranthene
Benzo [j] fluoranthene
Benzo [e] pyrene
Benzo [a] pyrene
Dibenzo [a, h] anthracene
Volatile Organic Compounds (VOCs)
Naphthalene
Styrene
Toluene
1,4-dichlorobenzene
1,3-dichlorobenzene
o-xylene + styrene
m-xylene + p-xylene
Chlorobenzene
p-isopropyltoluene
n-propylbenzene
1,2,3-trichlorobenzene
1,2,4-trichlorobenzene
1,3,5-trimethylbenzene
Pesticides
Hexachlorobenzene
Quintozene
Pentachloroaniline + quintozene
Glyphosate
AMPA + glyphosate
Fragrances
Benzyl alcohol
Coumarin
Limonene
Linalool
Benzyl salicylate
Hydroxyisohexyl 3-cyclohexene carboxaldehyde
Butylphenyl methylpropional
Alpha-isomethyl ionone
Formaldehyde
Dioxins and furans
1,2,3,6,7,8-HxCDD
1,3,6,7,8-HxCDD
1,2,3,4,6,7,8-HpCDD
OCDD
2,3,7,8-TCDF
2,3,4,7,8-PeCDF
1,2,3,4,7,8-HxCDF
1,2,3,6,7,8-HxCDF
2,3,4,6,7,8-HxCDF
1,2,3,4,7,8,9-HpCDF
1,2,3,4,6,7,8-HpCDF
OCDF
PCB-81
PCB-126
PCB-77
PCB-123
PCB-118
PCB-114
PCB-105
PCB-167
PCB-156
PCB-157
PCB-169
PCB-189
Out of the listed substances above, SCL only identified toxicity in the following chemical substances: p-isopropyltoluene, benzyl salicylate, butylphenyl methylpropional, hydroxyisohexyl 3-cyclohexene carboxaldehyde, and alpha-isomethyl ionone.
However, Lyral or hydroxyisohexyl 3-cyclohexene carboxaldehyde is a fragrance considered an allergen, so it's best to avoid diapers with perfumed substances and choose only those labeled as free from perfumes ("fragrance-free").
HEALTH RISKS
Given the proximity of these chemical substances to genital organs, the health risk is present in single-use diapers.
For HAPs, the toxicity of only a limited number is known. Some other HAPs, primarily those with high molecular weight, are associated with carcinogenic and genotoxic problems, as reported by the United States National Cancer Institute. In various studies, concentrations of HAPs detected in shredded baby diapers have been higher than those found in food. Moreover, concentrations of HAPs and fragrances in single-use baby diapers are higher than those found in feminine hygiene products.
Another concerning factor is the consequences of HAPs related to reproduction. Mice tests consuming high levels of a HAP during pregnancy had reproductive problems and their offspring faced similar issues. Additionally, animal studies have shown that HAPs can produce harmful effects on skin, bodily fluids, and the ability to fight infections after both short and long-term exposure.
Formaldehydes can cause skin irritation, and while the short-term effects of this chemical on health are well known, not much is known about potential long-term effects. The United States National Cancer Institute has been analyzing human studies indicating that formaldehyde exposure is associated with certain types of cancer.
Another notable point by INC is that maximum concentration levels for DL-PCBs and glyphosate in diapers were always higher than those found in food.
One conclusion highlighted by an ANSES study is that the following chemicals are considered higher risk than others found: dioxins, furans, DL-PCB, HAPs (benzo [g, h, i] perylene, chrysene, 5-methylchrysene, benzo [e] pyrene), some VOCs (1,2,4-trichlorobenzene and 1,2,3-trichlorobenzene), hexachlorobenzene, Fragrances (coumarin, limonene, hydroxyisohexyl 3-cyclohexene carboxaldehyde, butylphenyl methylpropional, benzyl salicylate), formaldehyde.
FINAL THOUGHTS
Currently, there are no epidemiological data demonstrating health effects related to diaper use. However, various studies warn that dangerous chemical products have been found in diapers. Based on the results of tests conducted by INC and SCL with realistic scenarios evaluating health risks of single-use baby diapers, cases of surpassing sanitary thresholds for several substances were shown.
In conclusion, it's not currently possible to rule out a health risk associated with the use of single-use diapers.
Glossary
ANSES. French Agency for Food, Environment, and Occupational Health and Safety.
AMPA. Aminomethylphosphonic acid.
DIOXINS AND FURANS. Highly toxic substances at very low levels, composed of complex chemicals containing chlorine.
FORMALDEHYDE. A highly volatile and flammable chemical compound with aldehyde.
FRAGRANCES. Chemicals derived from petroleum or natural raw materials.
HAP. Polycyclic Aromatic Hydrocarbons, a group of over 100 chemicals formed during incomplete combustion of coal, oil, gas, wood, waste, and other organic substances like tobacco and charcoal-grilled meat.
INC. French National Consumer Institute.
LDPE. Low-density polyethylene.
LYRAL. Hydroxyisohexyl 3-cyclohexene carboxaldehyde, a fragrance known for its floral lily and cyclamen scent.
PESTICIDE. Any substance intended for controlling, killing, repelling, or attracting pests.
PET. Polyethylene terephthalate.
SAP. Super Absorbent Polymers insoluble in water, cross-linked acrylic acid copolymers known for their superabsorbent properties.
SCL. Joint Laboratory Service.
VOCs. Volatile Organic Compounds containing carbon, found in all living things.
References
French Agency for Food, Environment, and Occupational Health and Safety (January 2019). Safety of Baby Diapers. https://www.anses.fr/en/content/anses-recommends-improving-baby-diaper-safety
Mexican Foundation for Dermatology (November 2017). Diaper Dermatitis. https://fmd.org.mx/dermatitis-del-panal/
National Cancer Institute (June 2011). Formaldehyde and Cancer Risk. https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/formaldehyde/formaldehyde-fact-sheet
Profeco. Quality Study (April 2015). Disposable Diapers. https://www.gob.mx/cms/uploads/attachment/file/100350/RC458_Estudios_Calidad_de_Pa_ales_Desechables.pdf
We begin with various random reports published by research agencies such as the United States Consumer Product Safety Commission, the Mexican Foundation for Dermatology, the National Cancer Institute in the United States, and the French Agency for Food, Environment, and Occupational Health and Safety (ANSES). The aim is to inform more moms and dads about the risks associated with using single-use diapers.
During 2002-2003, several studies were conducted in the United Kingdom involving more than 2000 households with at least one child aged 0 to 36 months who used disposable diapers. Throughout the research, it was found that in all cases, infants experienced diaper dermatitis at least once.
New studies conducted between 2017 and 2019 highlight for the first time the risks to infant health when using disposable diapers.
"several chemicals exceeded safety threshold values"
Based on testing performed with disposable diapers and their usage, assessments by organizations such as ANSES highlighted various chemicals for which safety threshold values were exceeded. ANSES became the first health and safety agency worldwide to comprehensively evaluate the safety risks of baby diapers.
CHEMICAL SUBSTANCES FOUND IN DISPOSABLE DIAPERS
In 2017 and 2018, the French National Consumer Institute (INC) conducted a study on 13 baby diaper brands with the intention of measuring chemical substances in a urine simulant, extracted respectively from shredded and intact diapers.
These tests consistently revealed the presence of dioxins and furans in both shredded and intact diapers, as well as in urine simulators. Additionally, the Joint Laboratory Service (SCL) detected several fragrances only in shredded intact diapers through solvent extraction.
Pesticide substances like glyphosate and AMPA were also found in shredded intact diapers through solvent extraction. Other pesticides found, such as quintozene and its metabolite pentachloroaniline, hexachlorobenzene, were quantified by the French National Consumer Institute in a diaper (shredded intact diaper, solvent extraction).
The consulted studies also identified the presence of Polycyclic Aromatic Hydrocarbons (PAHs) in disposable diapers. According to ANSES's evaluation, the formation of PAHs during the manufacturing of these diapers cannot be ruled out due to the use of high temperatures in certain manufacturing processes.
Although the cellulose used in these products is no longer bleached with elemental chlorine, processes involving chlorine agents like chlorine dioxide are used, which may contribute to the formation of dioxins and furans.
TRANSFER OF CHEMICAL MATERIAL TO THE SKIN
Chemicals in direct contact with the skin (top layer, lotion, leak guards, waist section) can be transferred directly to the skin or solubilized in sweat, urine, feces, or sebum. Only a fraction is transferred to the skin during use.
For substances in indirect contact with the skin (acquisition layer, Super Absorbent Polymer, core, surrounding nonwoven material, adhesive), transfer can occur through extraction or solubilization in bodily fluids, followed by migration to the top layer and release onto the skin under pressure (reflux).
"approximately 7% of the chemical material from a disposable diaper is actually transferred to the skin"
For this reason, skin diseases like contact dermatitis and diaper dermatitis can potentially increase dermal penetration of chemical substances based on the degree of skin damage. It is estimated that approximately 7% of the chemical material from a disposable diaper is actually transferred to the skin, and the prevalence of diseases like diaper dermatitis is estimated between 7% and 50%, depending on the country and hygiene practices.
A fully closed diaper that doesn't allow skin to breathe poses a high risk of infection. Conversely, highly breathable diapers significantly decrease the risk.
With improvements in the quality of single-use diapers, there has been a reduction in the incidence and severity of diaper dermatitis in recent years. However, the use of this type of diaper continues to lead to skin diseases in the diaper area that can affect dermal absorption.
For now, diaper dermatitis cannot be completely avoided with single-use diapers and can impact dermal absorption of chemical substances.
COMPOSITION OF A SINGLE-USE DIAPER
Top Layer: Polypropylene, polyethylene, polyester, or bioplastics derived from cornstarch and sugarcane.
Acquisition Layer: PET (polyethylene terephthalate) or cellulose and polyester fibers.
Core: Superabsorbent polymer (SAP) encapsulated in wood cellulose fibers.
Back Layer: Low-density polyethylene (LDPE) or a nonwoven mix with a film (LDPE).
Leak Guard: Hydrophobic nonwoven polypropylene.
Elastics: Thermoplastic polymers, Lycra (polyurethane)
Fasteners: Polyamide and polyethylene.
Adhesive: Hot melt adhesive or copolymer rubber and starch.
Lotion (not always): Pharmaceutical-grade purified vaseline (= vaseline), stearyl alcohol, liquid paraffin.
Although manufacturers claim to use safe pigments in diapers, in practice, brands seek to limit baby skin exposure.
NUMBER OF CHEMICALS THAT COULD BE FOUND IN A SINGLE-USE DIAPER
Following the evaluation of results obtained by INC and SCL, various chemical products were found. While they may not represent all baby diapers available on the market, they provide a general idea of the large number of substances used:
Polycyclic Aromatic Hydrocarbons (PAHs)
Benzo [g, h, i] perylene
Benzo [b] fluoranthene
Benzo [a] anthracene
Indeno [1,2,3-c, d] pyrene
Cyclopenta [c, d] pyrene
Chrysene
5-methylchrysene
Benzo [k] fluoranthene
Benzo [j] fluoranthene
Benzo [e] pyrene
Benzo [a] pyrene
Dibenzo [a, h] anthracene
Volatile Organic Compounds (VOCs)
Naphthalene
Styrene
Toluene
1,4-dichlorobenzene
1,3-dichlorobenzene
o-xylene + styrene
m-xylene + p-xylene
Chlorobenzene
p-isopropyltoluene
n-propylbenzene
1,2,3-trichlorobenzene
1,2,4-trichlorobenzene
1,3,5-trimethylbenzene
Pesticides
Hexachlorobenzene
Quintozene
Pentachloroaniline + quintozene
Glyphosate
AMPA + glyphosate
Fragrances
Benzyl alcohol
Coumarin
Limonene
Linalool
Benzyl salicylate
Hydroxyisohexyl 3-cyclohexene carboxaldehyde
Butylphenyl methylpropional
Alpha-isomethyl ionone
Formaldehyde
Dioxins and furans
1,2,3,6,7,8-HxCDD
1,3,6,7,8-HxCDD
1,2,3,4,6,7,8-HpCDD
OCDD
2,3,7,8-TCDF
2,3,4,7,8-PeCDF
1,2,3,4,7,8-HxCDF
1,2,3,6,7,8-HxCDF
2,3,4,6,7,8-HxCDF
1,2,3,4,7,8,9-HpCDF
1,2,3,4,6,7,8-HpCDF
OCDF
PCB-81
PCB-126
PCB-77
PCB-123
PCB-118
PCB-114
PCB-105
PCB-167
PCB-156
PCB-157
PCB-169
PCB-189
Out of the listed substances above, SCL only identified toxicity in the following chemical substances: p-isopropyltoluene, benzyl salicylate, butylphenyl methylpropional, hydroxyisohexyl 3-cyclohexene carboxaldehyde, and alpha-isomethyl ionone.
However, Lyral or hydroxyisohexyl 3-cyclohexene carboxaldehyde is a fragrance considered an allergen, so it's best to avoid diapers with perfumed substances and choose only those labeled as free from perfumes ("fragrance-free").
HEALTH RISKS
Given the proximity of these chemical substances to genital organs, the health risk is present in single-use diapers.
For HAPs, the toxicity of only a limited number is known. Some other HAPs, primarily those with high molecular weight, are associated with carcinogenic and genotoxic problems, as reported by the United States National Cancer Institute. In various studies, concentrations of HAPs detected in shredded baby diapers have been higher than those found in food. Moreover, concentrations of HAPs and fragrances in single-use baby diapers are higher than those found in feminine hygiene products.
Another concerning factor is the consequences of HAPs related to reproduction. Mice tests consuming high levels of a HAP during pregnancy had reproductive problems and their offspring faced similar issues. Additionally, animal studies have shown that HAPs can produce harmful effects on skin, bodily fluids, and the ability to fight infections after both short and long-term exposure.
Formaldehydes can cause skin irritation, and while the short-term effects of this chemical on health are well known, not much is known about potential long-term effects. The United States National Cancer Institute has been analyzing human studies indicating that formaldehyde exposure is associated with certain types of cancer.
Another notable point by INC is that maximum concentration levels for DL-PCBs and glyphosate in diapers were always higher than those found in food.
One conclusion highlighted by an ANSES study is that the following chemicals are considered higher risk than others found: dioxins, furans, DL-PCB, HAPs (benzo [g, h, i] perylene, chrysene, 5-methylchrysene, benzo [e] pyrene), some VOCs (1,2,4-trichlorobenzene and 1,2,3-trichlorobenzene), hexachlorobenzene, Fragrances (coumarin, limonene, hydroxyisohexyl 3-cyclohexene carboxaldehyde, butylphenyl methylpropional, benzyl salicylate), formaldehyde.
FINAL THOUGHTS
Currently, there are no epidemiological data demonstrating health effects related to diaper use. However, various studies warn that dangerous chemical products have been found in diapers. Based on the results of tests conducted by INC and SCL with realistic scenarios evaluating health risks of single-use baby diapers, cases of surpassing sanitary thresholds for several substances were shown.
In conclusion, it's not currently possible to rule out a health risk associated with the use of single-use diapers.
Glossary
ANSES. French Agency for Food, Environment, and Occupational Health and Safety.
AMPA. Aminomethylphosphonic acid.
DIOXINS AND FURANS. Highly toxic substances at very low levels, composed of complex chemicals containing chlorine.
FORMALDEHYDE. A highly volatile and flammable chemical compound with aldehyde.
FRAGRANCES. Chemicals derived from petroleum or natural raw materials.
HAP. Polycyclic Aromatic Hydrocarbons, a group of over 100 chemicals formed during incomplete combustion of coal, oil, gas, wood, waste, and other organic substances like tobacco and charcoal-grilled meat.
INC. French National Consumer Institute.
LDPE. Low-density polyethylene.
LYRAL. Hydroxyisohexyl 3-cyclohexene carboxaldehyde, a fragrance known for its floral lily and cyclamen scent.
PESTICIDE. Any substance intended for controlling, killing, repelling, or attracting pests.
PET. Polyethylene terephthalate.
SAP. Super Absorbent Polymers insoluble in water, cross-linked acrylic acid copolymers known for their superabsorbent properties.
SCL. Joint Laboratory Service.
VOCs. Volatile Organic Compounds containing carbon, found in all living things.
References
French Agency for Food, Environment, and Occupational Health and Safety (January 2019). Safety of Baby Diapers. https://www.anses.fr/en/content/anses-recommends-improving-baby-diaper-safety
Mexican Foundation for Dermatology (November 2017). Diaper Dermatitis. https://fmd.org.mx/dermatitis-del-panal/
National Cancer Institute (June 2011). Formaldehyde and Cancer Risk. https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/formaldehyde/formaldehyde-fact-sheet
Profeco. Quality Study (April 2015). Disposable Diapers. https://www.gob.mx/cms/uploads/attachment/file/100350/RC458_Estudios_Calidad_de_Pa_ales_Desechables.pdf
