Cloth or disposable diapers: what actually matters for baby’s skin

Cloth or disposable? It’s one of the first decisions new parents make, and the debate can get heated, with each side claiming fewer rashes. If your main concern is your baby’s skin, the honest answer is less dramatic: the type of diaper matters less than how dry it keeps the skin, and how often it gets changed.

What causes diaper rash in the first place

Most diaper rash is irritant dermatitis, meaning skin inflammation from something that irritates it rather than an allergy. Inside a diaper, skin sits wet and warm, rubs against fabric, and is exposed to urine and stool. Skin that stays wet softens and breaks down more easily, and urine and stool together make things worse.

The Canadian Paediatric Society says the best way to prevent diaper rash is to change your baby’s diaper often, especially during diarrhea. It also lists snug, airtight pants or plastic-covered diapers that keep wetness from drying, or that rub the skin, among the causes. Keep that in mind as you read the research, because it explains most of it: whatever keeps the skin drier tends to win.

What the studies found

The research on cloth versus disposable is thinner and older than you’d expect, and it doesn’t all point the same way.

• An older study favoured disposables. In 1986, American researchers examined 1,089 babies aged 1 to 20 months. Babies diapered only in disposables had less rash than those who wore cloth all or some of the time. Rash was most common around 9 to 12 months of age.
• A review of newer studies favoured absorbency. A 2019 review of 110 studies on newborn skin care concluded that super-absorbent diapers, which pull urine into a gel core away from the skin, reduce moisture at skin level and reduce diaper rash. It also found barrier creams help but are no substitute for frequent changes.
• A recent survey found no difference. In 2025, Brazilian paediatric dermatologists surveyed families of 1,389 babies who weren’t yet toilet trained. Mild diaper rash a few times a year was reported by about 47% of families in both groups. Severe rash a few times a year was reported by 13% of disposable users and about 11% of cloth users, a difference too small to be meaningful. The authors concluded that cloth diapers did not increase diaper rash.

Why the mixed picture? The studies are very different. The 1986 study compared cloth to the disposables of its time, and diapers of both kinds have changed a lot since. The 2025 survey relied on parents’ memories, and only about one in 11 families used cloth. And families who choose cloth may also change more often, or clean differently: in the survey, cloth users mostly cleaned with cotton or cloth and water, while disposable users mostly used wet wipes.

Why absorbency and change frequency matter most

Disposables and cloth handle wetness differently. The American Academy of Pediatrics notes that disposables are very absorbent, while cloth diapers are less absorbent and need to be changed more often. They also usually need a waterproof cover over them.

Neither of those is a problem in itself. A cloth diaper changed promptly can keep skin just as healthy. The trouble comes when a cloth diaper stays on too long, or when an airtight cover holds moisture in. With disposables, the risk is the opposite: because they feel dry, it’s easy to leave them on longer than you should. The AAP points out that very absorbent disposables can even make it hard to tell how much a newborn is peeing.

Whatever you choose:

• Change wet or soiled diapers promptly, day and night as much as is practical.
• Change more often during diarrhea.
• Make sure the fit is snug enough to prevent leaks but not tight enough to rub.
• Let the skin air out between changes when you can. Research on diaper-free time is still limited, but drier skin is the goal.
• Use a plain, fragrance-free barrier ointment when the skin looks irritated.

If you want to compare gentle options, our baby care list includes barrier ointments.

Making cloth diapers work for sensitive skin

If you use cloth, a few habits help protect your baby’s skin.

• Change often. Cloth doesn’t pull wetness away from the skin as well as a gel core, so plan on more frequent changes.
• Choose breathable covers that fit well. Avoid tight, airtight pants over the diaper.
• Rinse thoroughly when washing. Leftover detergent in fabric that sits against wet skin for hours is an avoidable irritant.
• Skip fragranced detergents, fabric softeners and dryer sheets for diapers. Fragrance is a common cause of skin reactions.
• Follow the manufacturer’s washing instructions for the fabric.

There’s one more thing worth knowing. In 2017, doctors at a US children’s hospital described four older babies and toddlers who developed blistering, raw diaper rashes while using cloth diapers. In all four, the rash cleared completely after switching to disposables. That’s a small case report, not a trend, but it’s a good reminder not to stick with a system that isn’t working for your child.

What about “free from” disposables?

Disposable diapers now come with long lists of claims: chlorine-free, fragrance-free, plant-based, lotion-free. Some of these matter more than others for skin. Fragrance-free is the one worth looking for if your baby reacts easily, since added scent adds nothing for the skin. Beyond that, a good fit and a core that keeps the surface dry are what count.

When to see a doctor

Most diaper rash improves within a few days of more frequent changes and a barrier ointment. The Canadian Paediatric Society says to see a doctor if:

• the rash is severe or keeps getting worse despite treatment
• there are blisters, boils, pus or discharge
• the rash comes with a fever

If you’re not sure what you’re looking at, your doctor, nurse practitioner or pharmacist can help sort it out.

Cloth and disposable diapers can both be kind to your baby’s skin. The deciding factors are dryness, fit and how often you change, not the label on the package. Pick the system that suits your family, watch your baby’s skin, and be willing to switch if a rash just won’t settle.