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How do I wash cloth diapers?
Q: I'm planning to use cloth diapers when my child arrives. Are there risks involved with using them or are they just a safe as disposables? Also, how do you wash them? Can you throw them in the washing machine or should you first rinse them to get the poop out? If they put my baby in disposable diapers in the hospital can I still use cloth diapers when I take her home? Or do I need to insist that they use only cloth?
A: Margaret, both cloth and disposable diapers are safe and healthy. Each has slightly different advantages and disadvantages. You may choose to use only cloth diapers, only disposable diapers or a combination of cloth and disposable. Although the hospital nursery is likely to use disposable diapers, you can change to cloth diapers when you bring baby home.

If you are thinking of using cloth diapers, there are no major health risks, but there are a couple of health considerations. Cloth diapers are slightly less absorbent than disposable diapers, so you need to change them more frequently to keep your baby dry and prevent diaper rash. Also, cloth diapers tend to fit less snugly around the baby's waist and legs than disposable diapers, which have elasticized waist and leg bands. This can sometimes lead to leakage of urine or stool, and you may have to clean up your baby and change his clothes a little more often. You can minimize leaks in cloth diapers by pinning the diaper on tightly and using waterproof diaper covers that fit snugly around the baby's waist and legs.

To wash cloth diapers, you can either use a diaper service or wash the diapers at home. A diaper service is a professional laundry that rents you a supply of diapers and gives you a diaper pail that you line with a plastic bag. When you change your baby's diaper, you simply drop the dirty diaper into the diaper pail. Once or twice a week, the diaper service picks up your bag of soiled diapers and delivers freshly laundered ones. Diaper services are very convenient, and the cost is comparable with that of disposable diapers.

If you wash your cloth diapers at home, you will need to buy a covered diaper pail. A diaper pail with a foot pedal is best so you don't have to handle the cover, which can get soiled. Consider adding baking soda or a deodorizer to cut down on diaper odor. Follow these steps for diaper changing and laundering:
  • Throw urine-soaked diapers directly into the pail.
  • If the diaper has stool, flush it down the toilet before putting the diaper in the pail. If the stool is soft and clinging to the diaper, you can swish the diaper in the toilet before putting it in the diaper pail. Be sure to wash your hands well afterward.
  • Launder the diapers separately from other clothes, and launder no more than two dozen diapers in a single load.
  • Use a laundry soap that is unscented and recommended for babies, since perfumes can be irritating for babies' skin.
  • Use a cold presoak cycle to prevent staining and rinse out the solids. After the cold cycle, run the washing machine on a hot or warm wash and a cold rinse at the highest water level.
  • If your baby develops diaper rash, consider using a double-rinse cycle and/or adding ¼ cup of vinegar into the fabric softener dispenser. Do not use fabric softener, since it can coat the diapers and make them less absorbent.
  • Dry the diapers on normal heat for about 60 minutes.

No matter what kind of diaper you use or how you choose to clean them, remember that diapering is a great time to be face-to-face and enjoy playing, smiling, cooing, talking, singing to and tickling your baby.

Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician