Despite caring for infants for years as a family physician, when I had my daughter Madi, I had no idea how to change her diaper. The first time I put on her diaper, I put it on backwards and I really didn’t know what to look for when it came to features. Fortunately, with the help of our amazing nurses and after reviewing medical resources, I learned how to put on a diaper properly. I was also able to figure out diaper sizing, learn how to protect and treat diaper rash, and how to prevent diaper leaks. 

I have partnered with Pampers, our family’s preferred diaper brand, to share tips on diapering.

Tip 1: How to put on a diaper properly

Step 1: Be prepared – have diapers and wipes (alternatively you can use a clean single use cloth and water) readily available along with a safe surface for diaper change. *Do not leave your infant unattended during a diaper change.

Step 2: Remove the diaper, fold it closed and put it out of the infant’s reach.

Step 3: Clean the child’s diaper area (making sure you clean between the folds of the skin) with a baby wipe or single use cloth and water. If your infants bum is wet, make sure to pat (and not rub) the area dry. If the infant has a diaper rash or redness, apply diaper cream. *Make sure to check in with your health provider if the rash persists of if you have concerns

Step 4: Raise your baby’s legs and lower body by the ankles and slide a clean diaper underneath. The colourful markings should be at the front facing you, while the two wings of the diaper on the back.  *Make sure you always have one hand on the baby during the diaper change.

Step 5: Lift the two wings of the diaper on the left and right side and stick the stretchy fastening tape found on each wing to the front of the diaper. The diaper should look straight and the waist snug just under the belly button. The diaper should not be fastened too tight and you should be able to run two fingers between the diaper and the baby’s stomach. Pull out the leg cuffs (the ruffly part of the diaper that goes around the legs) to prevent diaper leaks.

Step 6: Move the baby to a safe place, such as the crib while you dispose of the dirty diaper and wash your hands.

Tip 2: Figuring out diaper sizing

Babies come in different shapes and sizes. For my son, I find that he fits better in a size up! 

To figure out the best size diaper for my kids, I start first with checking the online sizing guide by Pampers – it’s a great recourse and a great starting point. From there I double check the waist and bum coverage. Diapers should fit snugly around the waist and you should be able to fit one to two fingers between the baby’s waist and the diaper. In addition, diapers should provide your baby’s bum full coverage when fastened and the tabs should not overlap or cause redness around the waist.

If I notice that the diaper isn’t covering the bum completely, there are red marks around the waist or thighs, or if the diaper is soaking through (bigger diapers hold more waste as they have more absorbent material), I would try a size up.

On the other hand, if you are noticing that there are gaps around the waist and thighs, the diaper may be too large for your little one and there can be leakage through the gaps. You can check for gaps by running your fingers around the edges. If you are noticing gaps, I would try a size down. 

Tip 3: How to prevent and treat diaper rash?

Diaper rash is often caused by irritants in pee and poo, changes in pH levels, wet skin and friction.

Diaper rash is red skin on the area in direct contact with the diaper.  Areas like the buttocks, genitals, lower stomach, and upper thighs are most common.   

Treating diaper rash at home is as simple as ABCD!

A – Air

One of the easiest things to do at home is to maximize exposure of the affected skin to air.  Removing the diaper removes the cause of the rash – there is no longer a warm, wet diaper rubbing against the affected skin.  

If diaper free time is not practical for your family, then frequent diaper changes at least every 3 hours is recommended.

B – Barrier

Topical barriers are one of the most important strategies for managing diaper rash at home.  Pastes are the preferredproduct over ointments and creams.  

Find a barrier paste that contains at least 20% zinc oxide and apply it thickly (like icing on a cake!).  It can even be covered with petroleum jelly to avoid the paste sticking to the diaper.  

C – Cleansing

The diaper area should be cleaned daily with lukewarm water using irritant-free soap or cleanser.  Aggressive wiping of the diaper area should be avoided.  Residual barrier paste does not need to be removed at each diaper change.  

Look for baby wipes that are fragrance free and with minimum preservatives, like Pampers Sensitive or Aqua Pure wipes. Another alternative is to use a damp cloth with water for cleaning the affected area.

D – Diapers

Disposable diapers may be better at wicking moisture away from the skin, versus cloth diapers. It’s important to use a diaper that is very absorbent, to help keep baby’s skin drier and healthier. Even better, a diaper with little holes in its liner, or a similar technology, to pull away wetness and mess into the diaper’s core and way from your baby’s skin, like Pampers Swaddlers.  

Change diapers frequently, every 3 hours or more.

Following the above steps, diaper rash should improve in 2 to 3 days.  If there is no improvement after 7 days of following ABCD or if you are concerned, then the baby’s rash should be assessed by a health care professional for other causes.

Tip 4: How to prevent diaper leaks

Diaper leaks are frustrating! 

My daughter Madi had many leaks early on. One error that we realized was that we had her diaper too high in the front (above her belly button) and too low in the back. Ideally, the diaper should look straight and the waist snug just under the belly button. I also didn’t know the importance of the positioning of the leg cuffs (the ruffly part of the diaper that goes around the legs). After putting on the diaper, pull out the leg cuffs. This will help prevent the leakage from the sides. Once we made the positioning changes and pulled out the leg cuffs, the frequency of leaks decreased dramatically!

If your baby continues to have leaks I would check to see if the diaper is the correct size. Diapers should fit snugly around the waist (you should be able to fit one finger between the baby’s waist and the diaper), give your baby’s bum full coverage when fastened and the tabs should not overlap or cause redness around the waist. If your diaper is too large, it will leak as there may be gaps around the legs. On the other hand, if the diaper is too small, there isn’t enough absorbent material for the volume of urine or it may not cover the buttocks completely. Pampers has a great sizing guide recourse on their website to help identity if your baby is wearing the right diaper – check it out!

This post was written by  Stephanie Liu, MD, MSc, CCFP, BHSc.