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Unfortunately there is tremendous stigma associated with diapers. Most people view diapers as
babyish. This is the main reason most older children, adolescents, teenagers, and adults are
reluctant to wear them to bed. In fact most of them wouldn't be caught dead in a diaper. Older
children, adolescents, and teenagers are at a point in their lives where they want to become more
independent and in their minds diapers represent a stage in their lives when they were more
dependent on their parents. In their view wearing diapers to bed is regressing. Although I
sympathize with this view, to a large extent I think it misses the mark.
One of the hallmarks of independence is the ability to take care of one's self-this includes
managing health problems. I feel that by wearing diapers to bed the youngster is taking
responsibility for the situation which is a very mature thing to do and is what adults do. In fact it
could be argued that the youngster is acting more like a baby by not wearing diapers to bed. By
not wearing the appropriate protection to bed they are absolving themselves of responsibility and
they are in effect saying they are helpless to control the situation.
We all know what the function of wearing a diaper is, so it shouldn't make a difference whether
you're 2 or 102 the purpose is still the same. Unfortunately when you mention the word diaper to
most people the image that immediately comes to mind is that of a baby. Most people think that a
diaper and plastic pants are something to be outgrown like a high chair or a bib(of course they
make bibs for adults also so even this image is wrong).
Due to the stigma surrounding diaper use in older children, teenagers, adolescents, and adults
the diaper manufacturers seem to be placing a stronger emphasis in many cases on the
appearance of the garments rather than functionality or as artists might say they're emphasizing
form over functionality. Tying in with this concept is the emphasis on discretion. Some of the ways
the manufacturers seem to be doing this are by the introduction of underwear like products,
garments that are less bulky so they can't be noticed under clothes, and the design of diapers
with a cloth like(also known as a nonwoven) outer layer.
Since a significant number of people suffer from daytime incontinence I can certainly understand
this but there are a large number of people who suffer from bed-wetting as well, and in these
particular cases we should use whatever type of garments are necessary and not be concerned
with how a product looks or its image since it's only worn at night anyway. Granted there are
companies that manufacture diapers for both daytime and nighttime use but I think that the stigma
surrounding diapers has colored the diaper manufacturers in a negative way and this might
prevent them from manufacturing, marketing, and selling products that truly meet the customers
needs.
As far as the introduction of the underwear like products are concerned I think these serve more of

2. a psychological than a protective function for the bed wetter because for all intents and purposes
they're diapers. Because they pull on like underwear as opposed to taping on this seems to help a
person more psychologically. While this may be the case in many situations they don't work as
well as diapers.
The same with the introduction of diapers with a cloth like outer covering. Again this is an example
of a product that is more underwear like as opposed to diapers with a plastic outer covering. Of
course there is the possibility that these types of diapers could have been introduced because
they're more cost effective for the manufacturers to produce, they're more breathable and
therefore presumably more comfortable to wear, and they're theoretically healthier for the
individual's skin, or it could be for all these reasons. However considering that there are
companies that make both styles of diapers I suspect that the introduction of this style is due more
to aesthetic reasons and that the diaper manufacturers feel these will be less embarrassing to
wear. Furthermore some people have commented that the diapers with a cloth like outer layer are
actually more uncomfortable to wear and in fact provide less effective protection than the
disposable diapers with a plastic outer covering.
I've heard of cases where people have used the disposable diapers with a cloth like outer cover
for bed-wetting and leaked right through them. While this doesn't happen with everybody, people
should have the option of buying diapers with a plastic outer covering if that's what they prefer and
if that's what works best for them. A number of people seem to be disappointed with the fact that
most diaper manufacturers are moving away from making diapers with a plastic outer covering.
Perhaps customers should write or call the diaper companies and complain about this. In many
cases companies do respond to consumer criticism.
As I said before people should have a wide variety of products to choose from due the fact that
people have different needs and preferences in this area and I'm not against people using pull-
ups, disposable diapers with a cloth like outer covering, or other products of a similar nature if
that's what they prefer and if they offer adequate protection for the user however as mentioned
previously this isn't always the case. What I am against is this emphasis on discretion and image
at all costs as opposed to manufacturing, marketing, and selling products that will most effectively
manage a person's bed-wetting.
The trade-off between image and protection is made by large amount of people unfortunately and I
believe that many of these people will suffer as a result. To me I would think it would be much
more satisfying to use a product that might be considered "babyish" by most people but offers
better protection than to use a product that is considered more "dignified" but that leaves the
wearer and bedding drenched. In a situation such as this a person has to ask him or herself how
much is it worth to them to wear a product that has a better image versus a product that will offer
more effective protection and therefore provide more comfort.
People who are reluctant to wear diapers to bed because most people feel they are strictly for
babies need to keep in mind the old saw "what is popular is not always right, what is right is not
always popular." There was a time when most people thought the earth was flat, slavery was an
acceptable practice, and the sun revolved around the earth but we now know these views are
incorrect. I believe that in time we'll become more informed(and as a result more enlightened)
about this issue also. Furthermore there are plenty of companies that manufacture and sell plastic
pants, pin-on cloth diapers, and disposable tape-on diapers for older children, adolescents,

3. teenagers, and adults that wet the bed so this is a very common problem. This is another thing
that people need to consider.
Most pediatricians, child psychologists, and other medical professionals advise against using
diapers in older bed wetters because they feel it might hurt the youngster's self-esteem and self-
image. In fact one book I read said the following- "I've known parents that have kept their children
in diapers at night as late as 7, 8, 9, and even 12 years of age but wearing diapers makes a child
feel like a baby" and "diapers are a symbol of babyishness." Maybe there are some children and
teenagers who actually want to wear diapers to bed but they feel that their parents will look down
on them for requesting this because the youngster realizes that most people feel diapers are for
babies only. And since many books and other sources suggest that only babies wear diapers
that's probably why there is such reluctance to use them for bed-wetting. In other words it's
possible that many people feel ashamed about wearing diapers to bed not because they actually
feel that way but because the professionals do and they believe that they should feel this way
also.
This wouldn't be the first time we are cowed by what the experts say as Stanley Milgram's
experiment and other psychology experiments so vividly demonstrate. Parents could feel the same
way also-they might want to use diapers for their bed wetter or want to grant the child's request to
wear diapers to bed but they too might be influenced by what the authorities say.
This raises an interesting question-is the fact that diapers have such a negative image by most of
society the result of assimilating the opinions of most medical professionals, or is the negative
opinion of diapers by most medical professionals influenced by how the public feels-the proverbial
chicken or egg debate. How much of our attitudes regarding diaper use by older bed wetters is
influenced by cultural attitudes, parents and other relatives, medical professionals, and other
factors?How and to what degree do these factors interact with each other?I think it would be
interesting to study this issue in depth.
By gaining better insight into how these ideas developed we might have a deeper understanding
of why we have such negative attitudes regarding this issue which in turn might significantly
reduce the stigma associated with using diapers to manage bed-wetting in older children,
adolescents, teenagers, and adults.
To get back to self-image older children and teenagers are particularly sensitive and concerned
with self-image and the image that diapers conjure up in most peoples minds are babies.
Commercials also stress this. For example the ad for Huggies pull-ups has the following motto-"I'm
a big kid now!" the implication being that only babies wear diapers. I have heard urologists,
pediatricians, and other medical professionals(who in my opinion should be more sensitive and
also should know better regarding this issue) claim that putting an older child, teen, or adult in
diapers at night makes them feel undignified but to me it's more undignified waking up in pee
soaked sheets and clothing!
It would be interesting to see how developmental psychologists feel about this issue. We tend to
have certain preconceived ideas about our child's growth process and if they deviate from that in
the slightest we become alarmed. For example children should talk by a certain age, they should
read by a certain age, they should walk by a certain age, etc. And while it is true that we should
have reasonable parameters established for theses situations in order to rule out the possibility of

4. cognitive and/or physical problems, the same reasoning shouldn't be applied in my opinion to the
use of diapers and plastic pants for the management of bed-wetting in older children, adolescents,
teenagers, and adults.
Frequently we feel pressured to use socially accepted methods to resolve various medical issues
but in some cases it's a good idea to consider alternative approaches and this may entail using
methods that a large majority consider unorthodox or not accepted by the mainstream. A case in
point is the following. In May-June 2007 there was an article on Naomi Judd. The article talked
about how the traditional treatments that were used by her doctors to treat he hepatitis were not
working so she tried various non traditional methods which are not fully accepted by western
medicine such as biofeedback, aromatherapy, and meditation. It turns out that these methods
worked.
I think that the use of diapers to manage bed-wetting in older children, adolescents, teenagers,
and adults is another example of a management technique that is not fully accepted by most
medical professionals and the public. Just like Naomi Judd had the courage to try alternative
approaches to manage her disease people must have the courage to use alternative methods to
manage bed-wetting.
I think we need to reevaluate our attitudes on diaper use for older bed wetters for two reasons. As
mentioned previously in some cases the pull-ups and "Goodnites" aren't as effective at protecting
both the youngster and the bed. The second reason is that it makes the person who has no other
option but to wear diapers to bed feel they are somehow inadequate. This in turn can lead to
feelings of low self-esteem, low self-worth, and subsequent depression.
In going over the literature and opinions of many professionals regarding diaper use in older bed
wetters one thing sticks out in my mind-the status quo has a negative opinion of diaper use. The
literature and opinions are very consistent regarding this issue-most people believe you shouldn't
keep a bed wetter in diapers past the age of 4 or 5.After that the majority of people feel you should
use pull-ups or "Goodnites" only.
It's my firm opinion that we have a double standard regarding this particular form of incontinence.
For instance we seem to have no problem with the use of diapers for developmentally disabled
children, the elderly with incontinence, and people suffering from disorders such as cerebral palsy,
multiple sclerosis, Alzheimer's disease, Parkinson's disease, or other ailments, but if you suggest
putting an older child, adolescent, teen, or adult with a bed-wetting problem in a diaper people
think you're barbaric and should be driven out of town on a rail.
There is a saying that goes something like this- "Nothing is good or bad but thinking makes it so."
While this is not the case for everything-torture, murder, rape, and stealing are inherently bad-
there is nothing intrinsically shameful about wearing diapers to bed. Wearing diapers to bed after
the age of 4 or 5 is considered shameful because we have been conditioned to think this way for
years. It would be interesting to see how other cultures feel about this issue but unfortunately I
suspect they feel the same way we do. From what I understand the Japanese, British, and most
Europeans are even more uptight about this issue.
There are many different reasons I feel most parents don't use diapers to manage bed-wetting
with both teenagers and older children. The next few sections discuss this. I believe that one of the

5. reasons for our negative reactions toward older children being in diapers at night stems from
attitudes left over from potty training. Many parents try to motivate their child during this stage with
praise such as "we're so proud of you, you're becoming a big kid now!" While these parents might
have good intentions(of course we all know the road to hell is paved with good intentions),
unfortunately they use the same approach with an older child or teenager who still needs diapers
at night .Children and teens still in diapers at night see the commercials for Huggies pull-ups and
might remember what their parents told them about diapers during their potty training years and
then feel ashamed about using diapers for their bed-wetting. In addition many parents try to
motivate their child to achieve night dryness by claiming that only babies wear diapers. I think this
puts a lot of pressure on a child and most likely will exacerbate the situation.
Children grow at different rates-just as some children walk sooner than others, talk sooner than
others, and learn to read sooner than others, some need diapers at night later than others. In my
opinion a different approach is warranted. The parents need to encourage their children by letting
them know that peoples bodies develop at different rates and there is no shame in using diapers
to manage the bed-wetting. I would remind the child that people of all ages have problems with
wetting the bed and many of them also wear diapers during the night.
Colin Ellison
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