Updated: Nov 29, 2022
Contributed by Hannah Wagie --
When we decided to have our first baby, I was in graduate school with a teaching assistant’s compensation, the value of which was not found in the monthly paycheck but rather in the education I was getting. The cost of daycare was daunting, to say the least. I immediately began looking into ways to cut our expenses, from hunting down the best garage sales with brand-name baby clothes to making my own diaper cream from coconut oil, shea butter, and arrowroot powder. Cloth diapers seemed like an obvious strategy.
The sheer number of options for cloth diapering was impressive: prefolds, pocket diapers, all-in-ones, and many more that have been designed and produced in the seven years since I started looking into them! There are many different routes to cloth diapering that range from simple, economical models to more luxury styles with convenience features. Many fantastic posts* have been written explaining the differences in cloth diaper types, so I won’t detail that here. However, my goal is to assist you in making decisions about how to diaper your baby.
The cost was my initial concern when planning on how to diaper my baby, as my nesting instinct tallied up all of the things (I thought) I needed to take care of her. However, three other considerations became apparent in making that decision as well: convenience, health, and environmental impact.
Ease of use is something that immediately concerns many parents about diapering. Cloth diapers are now available in fitted styles with Velcro or snap fasteners, which are as easy to put on a squirmy baby as disposables. For simpler cloth diapers, like pre-folds and flats, there are handy plastic/silicone fasteners like Snappi or Boingo, so there is no need to fumble around with a sharp object like a safety pin while wrestling a tiny but bafflingly strong child.
A misconception still exists that reusable diapers just aren’t as good as disposables in preventing leaks. The image of rubber pants bulging on a baby’s bottom may come to mind. Modern reusable diapers are now available in different materials that allow you to mix and match layers to achieve the absorbance your baby needs: cotton, bamboo, hemp, microfiber, and fleece. Waterproof covers also boost the containment power of reusables with polyurethane-coated types and even lanolin-treated wool. (If you decide to go with disposables, you may find that adding a reusable cover can stop leaks overnight.)
Another convenience concern, though, is the ability to launder the diapers. If you have access to your own washer and dryer at home, this isn’t a big concern. Relying on a laundromat, however, may not be a consistent solution, nor is sharing laundry facilities, because diapers do need to be washed fairly frequently (every 1-2 days in my experience). Diaper laundry services, which typically include rental, pick up from your home, vigorous washing routine, and drop off, may be available.
The “one-size” pocket diapers we purchased for our children were able to expand by using a set of snaps on the front and side of the diaper from “small” to “medium” to “large.” However, for the first six weeks or so, the “small” size was still too big for our 8-pound babies, so we used disposables for the newborn period. Newborn-sized cloth diapers do exist, but the limited time that they are used makes them obsolete quickly. Renting cloth diapers is an option for this stage (and larger), either from a laundry service, or rental-only with washing at home.
Whether washing at home or using a commercial laundry service, you will need to personally dispose of poop before placing a used cloth diaper in a diaper pail (we just used a 5-gallon bucket) or wet/dry bag (available in stylish patterns and colors). Aversion to personal poop disposal can vary from parent to parent. Simply shaking or scraping it into the toilet works fine for some. Our babies’ solid waste always seemed to be on the sticky side, so we opted to use liners in the diaper. There are products that are labeled specifically as cloth diaper liners, usually made of biodegradable rayon, that are advertised as flushable (OsoCozy). I found the price tag too high on even the least expensive option of official cloth diaper liners (more than $0.05 per liner), and “flushable” is never a guarantee. Instead, we used Viva paper towels, which are stronger than a typical paper towel but still break down over time, cut to fit a diaper. Admittedly, we flushed these and luckily had no issues with our plumbing. Another option is a kind of diaper bidet: attach a hose and sprayer to a toilet to wash off poop into the bowl. There are a number engineered for this very purpose (and also several online tutorials to make one yourself).
Traveling and daycare also became a concern. Our daycare did not allow cloth diapers unless a physician recommended them for health reasons. Dealing with a cloth diaper on our commute or on a vacation was more than I was willing to deal with. There is no strict dichotomy here: doing a combination of cloth and disposable, it turned out, was still more economical and still reduced the amount of waste we produced!
Interestingly, disposable diapers were developed in part as a response to severe diaper rash and subsequent bacterial, yeast, or fungal infections that were seen frequently in pediatricians’ offices.  Certainly, part of the problem was not changing old-style cloth-and-rubber-pants diapers often enough as were inadequate cleaning procedures. However, modern cloth diapers are typically made with highly absorbent materials inside and waterproof but breathable outside covers. There are resources on how to properly wash cloth diapers as well as more personalized advice available based on your particular diapers, washing machine, and water hardness where you live.
Some babies are simply not able to tolerate disposable diapers due to allergies or sensitive skin.  While allergens were not always considered a cause of diaper rash, the increasing number of ingredients found in modern, engineered diapers have made this possibility come to light. Leading dermatitis-causing substances in disposables are found in disperse dyes that decorate the exterior, synthetic-rubber elastic around the cuffs of fitted styles, fragrances, and glues. Studies supported by diaper-industry leaders claim that known allergens and sensitizers are left out of their diaper formulas. However, because diapers are not regulated like apparel in the US, the material and “ingredients” added to diapers are not required to be disclosed. (It seems that diapers and hats are the only things worn consistently that are not regulated in this way.) [Diapers are actually regulated by the United States Consumer Safety Commission and not the FDA (Federal Drug Administration), like wipes, lotions, tampons, pads, and adult diapers are.) In a positive development, this awareness has led some diaper manufacturers to remove fragrances, and it seems that all use pigments (which do not cause allergies) to replace dyes. Latex is a well-known allergen, so the stretchy parts of diaper cuffs are usually elastic that don’t use latex (this applies to cloth diapers, too).
Aside from contact allergens, there are some chemicals classified as endocrine disrupters that are relevant to diapers (as well as lotions, creams, and wipes). Dioxins, parabens, and phthalates are the chemical families most often mentioned as concerns. Each arises in a different area of diaper manufacturing.
Dioxins arise in the manufacture of any product containing wood pulp, such as diapers that use it as a core, absorbent material. The presence of dioxins is a result of the breakdown of chlorine bleach used to whiten the wood pulp. While dioxin molecules themselves can cross the skin barrier into the bloodstream, much of it remains bound to the pulp inside the diaper. Now, many diapers appear to be elemental chlorine-bleach frees or totally chlorine bleach-free as manufacturers switch to improved whitening processes. Many cloth diapers likely contain some level of dioxin as well from cotton bleaching. Keep in mind, however, that dioxins are prevalent in the environment from a variety of sources (including natural processes as well as manufacturing and incineration from waste disposal) that find their way into the food supply. Overall, diapers (cloth or disposable) are likely to be small contributors to the amount of dioxin exposure your baby faces.  
Parabens are used to increase the shelf life of products like lotions and moisturizers, which is how they enter disposable diapers with their anti-microbial properties. The concern is that this family of molecules can mimic estrogen; when the concentration of this hormone is too high, it may lead to breast cancer. It isn’t clear whether this molecule can enter the human body transdermally. Again, diaper ingredients are not required to be disclosed, so the presence of parabens is unclear unless explicitly labeled free of them. Many lotions and moisturizers and especially diaper creams now advertise “paraben-free.” 
Phthalates are a class of chemicals that can be hidden in ingredients listed vaguely as “fragrance/parfum” and are also used to make some plastics more flexible, both of which are relevant to disposable diapers. In addition to hormone disruption as the main concern for phthalate exposure, there appears to be some evidence for an increase in ADHD and asthma in children as well as a cause of topical allergies. Fetal exposure via mother is shown to lead to male reproductive underdevelopment, possibly by blocking the production of testosterone and androgen. However, not all phthalates pose the same risk, nor do they all enter the human body in the same way. For diapers, the major route would likely be transdermal, i.e., crossing the skin into blood circulation. Three phthalates that are shown to enter the human body transdermally and accumulate in the skin are 1) DEHP (plasticizer, mobile as dust/aerosol at room temperature), 2) DEP (solvent for fragrances and lotions, gas phase at room temperature), and 3) DBP (plasticizer). Both DEHP and DBP have been banned in the use of “child care articles”per the Consumer Product Safety Improvement Act of 2008. The third phthalate, DEP, is allowed. The concerns for this phthalate seem to apply mainly to pregnant women as it is known to cross the placenta and affect developing reproductive organs. Concerns about this chemical is certainly valid, but given that phthalates are ever-present around us due to their use in plastics, it can be argued that the topical exposure to phthalates in diapers seems to be a small contribution compared to the amount that is eaten and breathed in. Since this is a current topic of debate, here is an easier-to-read version .)    
For cloth diapers, sensitivity to detergents and synthetic fabrics (polyester, etc.) may arise. Detergent sensitivity is usually a problem all over the body since clothing is likely washed in the same brand, so that issue can probably be solved by switching brands. Natural materials for cloth diapers, such as hemp or bamboo inserts and wool or fleece covers, are now widely available. Since diaper rash due to wetness is a concern for both types of diapers, it is helpful to realize that cloth diapers have some ability to fine-tune how wet your baby’s bottom stays by increasing the number of layers in the diaper or switching the type of material used.
Because the waterproof lining and fasteners of reusable diapers utilize plastics, they can share some of the same health concerns as disposable diapers. These products also require regulation. Many cloth diaper companies state that they are CPSIA compliant as part of their advertising.
In making the decision about diapering with your baby’s health in mind, you have lots of choices! Reusable diapers can give you more control over the composition of the diaper itself, from materials to design. However, many disposable diaper companies seem to be increasing transparency about the materials they use to meet consumer demands (even though they are not required to do so). Choosing a brand that is voluntarily forthcoming with information can be reassuring.
Eco-friendly disposable diapers have been on the market in the United States starting in the mid-2000s as the next logical step for a few well-established “natural” companies, like Seventh Generation and Earth’s Best. “Natural” options for diapers are often promoted with some combination of attributes related to biodegradability, environmental sustainability, and the absence of certain chemicals and/or allergens (discussed in the Health section).
Reducing the impact of disposable diapers in landfills is a common environmental reason to use cloth diapers. Disposables became widely available around 1960, and their use skyrocketed in place of reusable diapers for the next few decades. By the early 1990s, concerns about the sheer volume of diapers in landfills appeared in media. Since then, the number of diapers put in a landfill has increased by about 1 million tons of diapers themselves (a number which doesn’t even include the waste inside of them), accounting for about 1.5% of total solid waste landfilled in the US. (The EPA has a graph of the increased disposable diapers in landfills here.) The waste inside is also a point of contention: throwing away poop can introduce pathogens into groundwater as it sits through all weather conditions in a landfill.
Discussing the biodegradability of an absorbent item is a bit of a paradox: for something to degrade in a landfill, water and oxygen break down the material. However, the job of a diaper is to not break down when it gets wet but rather to hold more and more water as it expands. In addition, for something to biodegrade, sunlight and oxygen must be able to contact that item, something which is difficult for anything, biodegradable or not, buried under a mountain of waste. It appears to be possible to compost the wood pulp interior of a diaper at home effectively, but to do so properly means making sure no feces are included and ripping open the cover to dump out the fluff on the inside. Recently, however, a maker of bamboo disposables called Dyper has begun a composting program where used diapers are sent to a commercial composting facility.
Reusable diapers can be used for more than one child, significantly delaying the point at which they would enter a landfill. I was impressed with how well our pocket diapers held up with two children (just a few broken elastics here and there) and was comfortable enough to pass them on to my sister for her new baby. In addition, you can even donate used cloth diapers!
In 2005, the United Kingdom’s Environment Agency conducted a life cycle analysis of disposable and reusable diapers that has oft been cited. This type of assessment attempts to quantify the environmental impact of a particular product considering everything from sourcing raw materials to manufacturing to transportation of the finished product to retail outlets. The study concluded that neither diaper type was superior environmentally, arguing that each type had a significant impact. Disposables, it reports, had the biggest impact on raw material production (fluff from wood pulp and super-absorbent polymers from petroleum sources*). Reusable diapers were assessed according to laundering method (home or commercial, i.e., diaper service) since the water and electricity were the largest contributors to the environmental impact of this type of diaper. Interestingly, waste generation (although it acknowledged that disposables clearly produced more) was not deemed to be a major factor in comparison to the impact of emissions during the production and care of both types.
Possibly less-read is the “Updated Life-Cycle Assessment Study” issued by the same agency three years later. Some factors that the original study included in the life-cycle model were refined in this update. For disposables, newer manufacturing data revealed that the average weight of a diaper had gone down, which was reflected in lower energy consumption. For reusables, more types were assessed. Originally, only cotton prefolds were considered (cotton being a crop that uses a lot of fertilizer and pesticides) but the update included modern reusable designs that are fitted and made of a greater variety of materials like microfiber, bamboo, and hemp. Also, updates to how reusable diapers are laundered at home made a significant difference, now considering energy-efficient washers and dryers, use of cold water, and line-drying as part of the mix. (The previous assessment had also assumed some of the prefolds were being ironed, which was mercifully removed in the update. That’s a mom standard no one needs to strive for.) A similar 2009 Australian study underscored that efforts like the ones listed to reduce energy consumption by consumers laundering at home could make a noticeable dent in the environmental impact of reusable diapers.
So how does all of this confusing information help you decide between disposable and reusable diapers? Life-cycle analyses are designed as a birds’-eye view of environmental impact, not instructions for an individual consumer. For example, the washing requirements of reusables are far more burdensome if you live in a drought-prone area or suffer regular energy shortages. Or if you live in a crowded urban area, maybe crowded landfills are a bigger problem. One thing was clear, however, that for either diapering system, in the last 10-15 years, the industry has seemed to respond to consumer demand for more responsible manufacturing. Certainly, keep the pressure on to improve environmental standards, but remember that you are already responsible for at least one small human, and saving the entire world is not a mom standard that society needs to place on you.
Planning for my first baby, I did a careful comparison between reusable and disposable diapers using an inexpensive disposable option, and an economical pocket diaper with extra inserts. Using only the reusable diapers I chose would cost us approximately the same as using only disposables in the first year due to purchasing the cloth diapers up-front. In subsequent years, however, the cost of using reusables was 63% of the cost of disposables. Once I learned our daycare would not allow us to send her with cloth diapers, I included a scenario where we used a mixture of cloth and disposable diapers. Even this scenario was only slightly more expensive in the first year, with a cost of 77% in the subsequent years. Planning for washing every two days with seven diapers used a day, I padded the number to be safe and decided to use 20 as the number of reusables we would purchase. Yet reusable diapers require more than the diaper itself. My initial analysis considered the cost of utilities (water and electric) for a washer and dryer, detergent, and liners (to catch solids in the diaper). I should have also included the water used in flushing the liner and poop down the toilet. There are now good resources to assist you with this, especially if you go with the rental option.
Items to include on your balance sheet if you choose to pursue reusables:
Inserts or prefolds – buy enough to double up!
Fasteners, if needed
Determine how often you’ll realistically wash to figure out how many to buy or rent
Initial poop disposal options
Receptacle: wet bag or dry, sealed bucket (people have opinions about this!)
Detergent that won’t leave residue
> Consider carefully which cycles you’ll use and its temperature! Here is an online calculator that lets you compare the costs of different cycles and machines.
The case can be made that either reusable or disposable diapers can be utilized responsibly. Consider which factors – convenience, health, environment, and/or cost – are priorities for you. Remember, this aspect is based on your own personal values and is a choice that belongs only to you! Hopefully, this guide will help you gather the information you need to make a decision that you are satisfied with.
Reflecting on the way we chose to diaper our babies, I think I would have essentially come to the same conclusion. A mixture of disposable and reusable diapers allowed us to cut costs in a way that wasn’t too overwhelming or time-consuming with the bonus of reducing our waste.
Hannah Wagie has a background in chemistry and loves to talk about science. She is a mom of two high-energy kids who have taught her more than all of her formal education ever could.