Double Diapering – How to Make it Simple and Why it's Important

 

Introduction: Why is Double Diapering So Important?

As parents, we want our children to lead healthy and happy lives. That's why it's crucial that we pay attention to their development from an early age. One challenge we face is ensuring the healthy development of their hips. Humans have spent the majority of our evolutionary history as hunters and gatherers. During that time, children were almost always carried. Today, we live differently. Children are carried less and changed with very thin disposable diapers. This can increase the risk of improper hip development.

An example of this is hip dysplasia, a condition that can lead to serious consequences in adulthood and is definitely something to avoid. To prevent this, parents can practice wide diapering. Double diapering is a special changing technique that allows the hip to develop healthily.

My son was one week old when signs of immature hips were detected. I was concerned about his health, but fortunately, there was a way to treat the issue. Double diapering provided us with a simple solution, and my baby's hips developed normally within a few weeks. Therefore, I am convinced that wide diapering is an effective means of positively influencing hip development.

In this article, I want to share my experiences with double diapering and help you properly apply this technique to best support your child. I will explain in detail what double diapering is, the benefits it offers, the materials you will need, as well as tips for applying the technique in cases of immature hips or hip dysplasia – everything you need to give your child the best possible start in life!

What is Double Diapering?

About 3% of children are born with hip dysplasia, making it the most common congenital malformation in babies. Further developmental issues can arise from our modern lifestyle (Source: Family Manual). Therefore, to determine whether a baby has a hip malformation, a newborn screening is conducted during the U3 preventive examination (4th - 6th week of life).

If a malposition of the hip is detected, one of the possible treatments is double diapering. This works best with cloth diapers. Double diapering means that the baby's hips are positioned in the natural ideal position with a 90° flexed hip joint using the correct changing technique. This helps the acetabulum to mature within a few weeks and corrects the baby's hip position (see this study). More extreme forms may need to be addressed with medically prescribed hip abduction braces, splints, or even surgery.

 Photo by Yuri Shirota on Unsplash

How to Recognize Immature Hips or Hip Dysplasia

In newborns, the hip joint initially consists of soft cartilage material that matures and ossifies during the first months of life. If the hip hardens in the wrong position, it can lead to severe pain and complications in adulthood (Source: cleankids.de). To prevent permanent damage, newborn screening (U3) is conducted to determine the extent of any malformation of the hip joint. This screening generally reveals one of four different findings:

The Child's Hips Are Developing Well

Here, there are no remarkable findings, and treatment of the hips is not necessary, but wide diapering can still have a positive effect on hip development.

 

The Baby’s Hip Socket Is Not Yet Fully Mature

This means that the joint socket is maturing more slowly than the healthy hip. Commonly, this is also referred to as an immature hip. In this case, the head of the femur is centered in the joint but is not adequately covered by the hip socket. It is possible that the bone may mature on its own in the first weeks of life. However, the baby's hip development can and should be supported with double diapering (Source: Joint Clinic).

The Baby Has Hip Dysplasia

In hip dysplasia, the hip socket is too short or too steeply angled, and therefore the roof of the hip socket does not adequately cover the head of the femur. Although the femoral head is still within the hip joint, its displacement hinders the maturation of the joint socket. If the hip ossifies in this incorrect position, there is a risk of early wear and tear of the bone and cartilage (Source: Joint Clinic). With the help of an orthosis (abduction brace or splint), the hip is put into the flexion-abduction position and can sufficiently mature through movement in this position. In some cases, double diapering of the baby can also be an alternative to the abduction brace (Source: Kinderhueftdysplasie.de).

The Newborn Has a Subluxation or Hip Dislocation

In a hip subluxation (incomplete hip dislocation), the head of the femur is partially out of the hip socket and is in the process of "decentering." Hip dislocation (complete dislocation), the most severe form of hip ailment (very rare at 0.2 - 0.3%), occurs when the head of the femur is completely out of the hip socket. In both conditions, the hip must first be realigned (reposition) and immobilized (retention) before therapy (maturing) can continue (Source: Kinderhueftdysplasie.de).

Signs and Symptoms of Hip Disorders

Delays in hip maturity and hip dysplasia often occur without symptoms or pain, which is why the ultrasound at the U3 examination is so important. In the case of subluxation or dislocation, doctors and parents may often notice the following changes:

• The gluteal folds are at different heights

• Unequal leg lengths

• The baby spreads one leg less outward

• After starting to walk, there might be a collapse on the affected side and groin pain (Source: Joint Clinic)

If you notice any of these irregularities in your child, be sure to consult your pediatrician.

Can You Double Diaper Too Much?

As already mentioned, babies generally come into the world with hips that are not fully ossified. This is why it is so important that the natural posture, the flexed abduction posture or frog position, is sufficiently supported. Wide diapering promotes this flexed abduction posture and is therefore often recommended preventively by doctors and midwives. However, it's best to always consult with your midwife and/or doctor to ensure you are doing it correctly.

What Materials Are Suitable for Double Diapering?/What Diapers Can I Use for Double Diapering?

Double Diapering Cloth Diapers

Cloth diapers are very suitable for double diapering because they are inherently a bit wider in the crotch compared to disposable diapers. For wide diapering, you can use our Judes cloth diapers, for example. They are perfect for beginners in the world of cloth diapers because they are particularly easy to use. Judes consists of an absorbent inner diaper and a waterproof, yet breathable outer cover. We have already received multiple positive feedback from pediatricians.

For optimal hip positioning, however, you should still supplement the cloth diaper with additional wrapping material. The following materials are particularly well-suited for double diapering:

Muslin cloths/Flannelette cloths

These cotton cloths can be easily folded to the right size and are the most commonly used for wide diapering.

Folded Towel

You can also simply fold a small towel and place it between the diaper and the outer cover.

Maternity Pads

You can also use the large maternity pads for double diapering, which are usually still lying around the house after childbirth. However, this does create extra waste that our environment can well do without.

Larger Outer Cover

During the time you are wide diapering your baby, you can also buy a Judes outer cover in size 2* and place the cloth between the inner diaper and the outer cover. This way you even enhance the absorbency and the cloth does not shift and stays in the right place.

Our Judes cloth diapers also have many other advantages compared to other cloth diaper brands and are a great sustainable alternative to disposable diapers.

*usually, children are wide diapered in the first weeks/months of life, during which time your baby normally still wears size 1

Double Diapering with Disposable Diapers

You can also double diaper your child with disposable diapers. To do this, you can use the materials mentioned above and place them between the diaper and the bodysuit. For better support, either put an outer cover or underwear on your baby, so everything stays in place even with a lot of movement.

Often you read the recommendation to simply diaper with two diapers and turn the second diaper inside out. But disposable diapers are not resilient enough, and the effect of wide diapering is lost. Besides, this creates even more avoidable waste.

How to Properly Double Diaper Your Child – A Step-by-Step Guide

Fortunately, double diapering is very easy. Nevertheless, I will offer you a brief guide and explain what to watch for when double diapering.

1. Before diapering, prepare all the materials you'll need.

2. Fold the preferred cloth into a 15 cm wide strip. The length of the cloth should be about the length of the unfolded diaper.

3. Place your baby on their back and put on a fresh (cloth) diaper.

4. Now place the cloth so that it is evenly long in front and back - make sure that not too much fabric accumulates at the back and your baby can still lie comfortably on their back.

5. Now pull the outer cover or underwear over it and make sure nothing shifts.

6. Now you can dress your baby in a bodysuit and all other clothes as usual.

When Is the Hip Mature? How Long Should You Double Diaper?

If there were any concerns during the U3 preventive check-up, a decision will be made, based on the degree of hip dysplasia, on which treatment option is best suited. Progress is regularly monitored during the treatment. Your baby should be wide diapered continuously, meaning also overnight. Stretching breaks are of course okay, but your perseverance will pay off in the end. After all, the hip usually matures within a few weeks.

In our baby’s case, the malposition was detected in the hospital during the U2 examination (3rd to 10th day of life), and by wide diapering, no abnormalities were observed anymore by the time of the U3 check-up. And don't worry, your baby will quickly get used to double diapering and probably won't even notice it anymore.

Photo by @isabelplett

Double Diapering and Baby Carriers

Many parents wonder if slings could negatively affect their child's posture and whether they can continue to carry their baby despite double diapering. Carrying in a carrier or sling is not a problem when wide diapering and can even be beneficial for the hips.

However, this is only true if the carrier fits properly and supports the baby's natural flexed abduction posture. Therefore, before purchasing a carrier, you should definitely book a carrying consultation (a voucher can be a great gift for a birth) to find the right carrier for you and your baby.

Caution: You should never carry your baby facing forward, as this works against the natural curvature of your child's back and causes the legs to hang down. This can prevent the hips from developing properly (Source: Kinderdok.blog).

If you want to swaddle your baby, make sure that you do it in a hip-friendly manner, as tight swaddling of the legs can hinder proper hip development. Here is a guide to hip-friendly swaddling.

Why Should You Double Diaper Your Child?

As you can see, double diapering can be used not only for hip dysplasia but can generally be beneficial for your baby's hip health. The most important thing is that you use the correct technique and consistently wide diaper your baby day and night. The easiest way to do this is to use cloth diapers for your baby instead of disposable diapers. If you have any questions or doubts, contact your doctor or midwife.

Did you find the article helpful? I appreciate your feedback! If you would like to share your experiences with me and the Judes Family, please feel free to leave a comment.