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

Introduction: Why is wide diapering so important?

As parents, we want our children to lead healthy and happy lives. Therefore, it is important to take care of their development early on. A challenge in this regard is the healthy development of the hips. For the majority of our evolutionary history, humans lived as hunters and gatherers. During this time, children were almost always carried. Today, we have a different lifestyle. Children are carried less and are diapered with very thin disposable diapers. This can increase the risk of hip development issues.

An example of this is hip dysplasia. This condition can lead to serious consequences in adulthood and should therefore be avoided at all costs. To prevent this risk, parents can use wide diapering on their babies. Wide diapering is a special diapering technique that allows the hips to develop healthily.

My son was one week old when signs of an immature hip were detected. I was worried about his health, but fortunately, there was a way to address the problem. Wide diapering offered us a simple solution, and my baby’s hip continued to develop normally within a few weeks. Therefore, I am convinced that wide diapering is an effective means to positively influence hip development.

In this article, I want to share my experiences with wide diapering and help you apply this technique correctly to optimally support your child. I will explain in detail, what wide diapering is; its benefits; the materials you need; as well as tips for using 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 wide diapering?

Approximately 3% of children are born with hip dysplasia, making it the most common congenital malformation among babies. Other developmental issues can arise from our current lifestyle (Source: Familienhandbuch). Therefore, to determine if there is a hip malformation, a newborn screening is performed for every baby during the U3 preventive check-up (4th - 6th week of life).

If a hip malformation is detected, one of the therapeutic options is wide diapering. This works best with cloth diapers. To diaper a baby widely means to position the baby’s hip into the natural ideal position, with the hip joint bent at 90°, using the correct diapering technique. This encourages the growth of the acetabulum within a few weeks and thus corrects the hip position of the baby (see this study). More extreme cases may need to be corrected using a doctor-prescribed hip abduction brace, splint, or even surgery.

Photo by Yuri Shirota on Unsplash

How to recognize an immature hip or hip dysplasia

In newborns, the hip head initially consists of soft cartilage material, which matures and ossifies in the first months of life. If the hip hardens in the wrong position, this can lead to severe pain and complications in adulthood (Source: cleankids.de). To avoid permanent damage, the newborn screening (U3) assesses the extent of any malformation of the hip joint. In this screening, there are generally four different findings:

The child's hips are developing well

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

The baby's acetabulum is not yet fully matured

This means that the acetabulum matures to a healthy hip with delay. Colloquially, this is also referred to as an immature hip. In this case, the femoral head is centrally located in the joint but is not adequately covered by the acetabulum. 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 wide diapering (Source: Gelenk-Klinik).

The baby has hip dysplasia

In hip dysplasia, the acetabulum is either too short or too steep, and therefore the acetabular roof does not sufficiently cover the femoral head. Although the femoral head is still located within the hip joint, its position hinders the maturation of the acetabulum. If the hip ossifies in this malposition, there is a risk of premature wear of the bone and cartilage (Source: Gelenk-Klinik). Using a maturation orthosis (hip abduction brace or splint), the hip is positioned in the flexion-abduction position, where it can mature sufficiently through movement. In some cases, wide diapering of the baby may suffice as an alternative to the hip abduction brace (Source: Kinderhueftdysplasie.de).

The newborn has a subluxation or hip luxation

In the case of hip subluxation (incomplete dislocation of the hip), the femoral head is outside the acetabulum and is "decentering". Hip luxation (complete dislocation) is the most severe form of hip disorder (very rare, at 0.2 - 0.3%). Here, the femoral head is outside the acetabulum. In both conditions, the hip must first be repositioned (reduction) and immobilized (retention) in order to continue the therapy (maturation) (Source: Kinderhueftdysplasie.de).

Signs and symptoms of a hip disorder

Delayed hip maturation and hip dysplasia often occur without symptoms or pain, which is why the sonography during the U3 check-up is such an important examination. In cases of subluxation or luxation, the following changes are often noticeable to doctors and parents:

• The buttock creases are at different heights

• Different leg lengths

• The baby spreads one leg less

• From the walking age, possibly sinking on the affected side and groin pain (Source: Gelenk-Klinik)

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

Can you wrap too widely?

As mentioned earlier, babies are generally born with an incompletely ossified hip. That is why it is so important to adequately support the natural posture, the squat-spread position or frog position. Wide diapering promotes this squat-spread position and is therefore often recommended preventatively by doctors and midwives. It's best to always consult with your midwife and/or doctor, so you can't go wrong.

What materials are suitable for wide diapering?/Which diapers can I use for wide diapering?

Wide Diapering with Cloth Diapers

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

For optimal hip positioning, you should still supplement the cloth diaper with additional diapering materials. The following materials are particularly suitable for wide diapering:

Muslin/Flannel Cloths

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

Folded Towel

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

Maternity Pads

You can also use the large maternity pads for wide diapering, which you usually still have lying around at home after giving birth. However, this creates extra waste, which our environment can do well without.

Larger Diaper Cover

You can also buy a Judes diaper cover in size 2* for the time you are wide diapering your baby and place the cloth between the inner diaper and the cover. This even increases the absorbency, and the cloth does not slip 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 this time your baby typically still wears size 1.

Wide Diapering with Disposable Diapers

You can also wide diaper your child with disposable diapers. For this, you can use the materials mentioned above and place them between the diaper and the bodysuit. For better support, you can dress your baby in either a diaper cover or underpants, so that everything stays in place even with a lot of movement.

You often read recommendations to simply use two diapers and turn the second one upside down. However, disposable diapers are not sturdy enough and the effect of wide diapering is lost. Moreover, this creates even more avoidable waste.

How to properly wide diaper your child – a step-by-step guide

Fortunately, wide diapering is very easy to apply. I will provide you with a short guide and explain what to pay attention to when wide diapering.

1. Gather all the necessary materials before diapering.

2. Fold the preferred cloth into a strip 15 cm wide. The length of the cloth should approximately match 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 equally long in the front and back - ensure that not too much fabric gathers at the back, allowing your baby to lie comfortably on their back.

5. Now pull the diaper cover or underpants over it and make sure nothing slips.

6. Now you can dress your baby as usual with a bodysuit and any other clothing items.

When is the hip fully matured? How long should you use wide diapering?

If any abnormalities were detected during the U3 check-up, the best therapeutic option is chosen based on the degree of hip dysplasia. Progress is regularly monitored during treatment. Your baby should be wide diapered as consistently as possible, which means also overnight. Breaks for kicking are, of course, okay, but your perseverance will pay off in the end. This is because the hip usually matures within a few weeks.

In our baby's case, the malposition was detected while still in the hospital during the U2 (3rd to 10th day of life), and through wide diapering, no abnormalities were noted by the U3. And don't worry, your baby will quickly get used to wide diapering and likely won't even notice it.

Photo by @isabelplett

Wide Diapering and Baby Carriers

Many parents wonder whether a baby sling can negatively affect their child's posture and whether they can still carry their baby despite wide diapering. Carrying in a carrier or sling is not a problem with wide diapering and can even be beneficial for the hips.

This is true only if the carrier is properly fitted and supports the natural squat-spread position of the baby. Therefore, you should definitely book a babywearing consultation before purchasing a carrier (a voucher can be a great gift for a birth) to find the right carrier for you and your baby.

Attention: You should never carry your baby facing forward, as this counteracts your child's natural spine curvature and causes the legs to hang downward. This can prevent the hip from developing properly (Source: Kinderdok.blog).

If you want to swaddle your baby, you should also ensure that you swaddle them in a hip-friendly way because tight swaddling of the legs can hinder the proper development of the hip. Here you will find a guide to hip-friendly swaddling.

Why should you wide diaper your child?

As you can see, wide diapering can be applied not only in cases of hip dysplasia but can also be beneficial for your baby's overall 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 is to use cloth diapers for your baby instead of disposable ones. If you have any questions or doubts, consult your doctor or midwife.

Did you find this article helpful? I look forward to your feedback! If you want to share your experiences with me and the Judes Family, feel free to leave a comment.