How to clean a baby's bottom

Should we wipe or wash?

(Definitions: nappies = diapers. Prams or buggies = strollers)

It’s either the smoke from three blazing wood fires that’s stinging my eyes, or the particularly vicious onions I’m slicing. It’s hard to know which, and impossible to get away from either. I duck down away from the smoke as best I can and keep chopping, tens of onions, then hundreds. The pan of rice on one of the three fires is easily a metre across. Two men wrestle the body of a three-metre fish up onto the table to butcher it. The back-end of an arrow is sticking out of the top of its head. A boy sat on the floor is continually tearing open packets of spices. A cheer goes up - someone has just walked in bearing an entire chilli plant, roots and all, laden with tiny red fruits, each about the size of a baked bean. When Amerindians throw a village party, they really throw a village party!

While the men are chopping, and salting, and spicing, and tasting, the women are bringing firewood and making sure nothing burns that isn’t meant to. Smaller children play outside, and mothers with babies stay away from the smoke of the village kitchen. I’m watching a few of them, through streaming eyes, cutting grass away from the area where the village will come together to eat and celebrate later, using razor-sharp cutlasses (what, to me, appears to be a subspecies of machete), each with a baby slung onto their back. One of the babies is wiggling a little. Suddenly his mother straightens up, says something to the others, lodges her blade in the stump of a nearby ex-tree and steps into one of the newly-dug village toilets. About a minute later, she steps out holding her baby, who is looking much happier. She turns on the tap under a rainwater barrel, washes between the baby’s legs, pads him dry on a cloth, and seconds later, he’s back in the sling and dozing again listening to the wick-wick-wick of steel cutting through stems.

Cleaning a baby’s bottom takes longer in the West

Later, after I realised that I’d just witnessed in 60 seconds, without any fuss from either participant, the Amazonian equivalent of a worst-case nappy change, I thought about how much less efficient that mother’s interlude would have been in the West:

First, she couldn’t have just been there with a cutlass and a baby. She’d have needed that UK-favourite ‘key purchase’ or ‘useful gift’: the enormous nappy-changing bag with pockets to protect from every post-partum eventuality. Places for the nappy mat, for clean nappies, for dirty nappies, for nappy bags, for nappy wipes, for nappy creams, for spare clothes. Then, probably, she’d have needed a pram just to carry the bag. And then, because it’s daft to have a pram, but to carry your baby in a sling, she’d have put the baby in the pram too, which would have meant that, not being in contact with her, he’d not have been so quiet and content to let her get on with her job.

And then second, the result of a baby needing to poo in public would have been completely different too. At home, say at a baby group, there’d have been some sort of joke, eye-rolling, slightly embarrassed looks, sniffing at the nappy. Was its bulk just a gelatinous mixture of urine and absorbent polymers or was it something more disastrous? Then out would come the changing mat. Poppers would be undone. The baby’s lower half exposed. The edge of the nappy would be gingerly examined for leaks, maybe a change of clothes would be taken out of a bag somewhere. Then off comes the nappy, and there’d be a range of emotions including (but not limited to) disgust, resignation for the cleaning job to come, and pity for that poor red skin. Then there’d be wipes, and more wipes, and swearing under the breath, and crying, and more wipes, and not knowing when to stop, and then creams, struggling with new clothes, and bagging dirty clothes, and a huge bag of wipes and nappy to deal with. A quarter-hour operation, harrowing for all involved, and followed by a real, honest desire to never leave the house again.

Later that evening, I was struck by two realisations. One: that Amerindian mother had just shown me something very powerful. And two, off topic slightly: the smaller the chilli, the bigger the punch.

Bottom cleaning is very important, but very variable

A long time ago, doing some health and hygiene research work, I spent two months getting paid to investigate the process of how adults clean their, errr… posteriors. I looked at how the process differs between men and women, at different times of the month, and depending on how much hair we have. I saw how we form different groups within our culture (Are you a ‘sitter’ or a ‘stander’? Are you a ‘folder’ or a ‘scruncher’?), and how people in different cultures have very different approaches. Very importantly, I also learned how a person judges when they are clean enough to stop cleaning further.

All of it, especially this last part, involves a lot of thought and effort. And for good reason: leaving poo on the skin is a really bad mistake. Obviously, there’s the smell element and the staining of underwear, but those are just the tip of the iceberg. The turtle’s head, if you will.

From microscopic viruses and bacteria to tapeworms the length of buses, we humans suffer from hundreds of diseases that spread faecally, and poor wiping followed by later itching and scratching is the major way that happens. And why is itching and scratching so prevalent, especially amongst children?

Because, poo on skin rapidly damages the skin and makes it uncomfortable. The bile acids, digestive enzymes, and microbes in our guts are very effective at breaking down things like skin. Once they emerge in poo, these active ingredients will keep doing their jobs. (NB. this self-digestion effect is especially powerful in babies or other people that have their skin wetted by urine, because this raises the pH, reactivating some of the other enzymes). The skin damage makes it weaker, more sensitive, and more prone to infection.

In adults, this damage is uncommon and may just lead to an uncomfortable shifting in seats and slightly more ginger (and probably thorough) wiping next time. In babies however, it is rife: we call it ‘nappy rash’ or ‘diaper dermatitis’ and in some samples it is affecting one in four babies at any one time . It’s not just more common, it’s much more severe because nappies make the skin wetter and softer, which increases the friction and makes them rub more, and leaving them even more unprotected from the digestive damage of poo.

(NB. I’m not anti-nappy, to be clear. There are times, such as on long car journeys, when they are absolutely essential. But, let’s face it, there are also times when we all use them when they’re not necessary. If your baby is crawling about outside, who cares if she wees on the flowers? The more that baby bottoms are out of nappies, the happier and healthier their skin is).

We are all taught to blame nappy rash on ourselves: we made the wrong choice of weaning food, or we made the wrong choice of creams and lotions. It’s not true. It’s not us. It’s the culture of nappies. The evidence is unignorable: It doesn’t matter whether you use wipes or water, creams or no creams - if a baby is always in nappies, they get nappy rash (Bartels et al. 2014). And, worse, if a baby poos in a nappy, it will get covered in poo. Which is both disgusting and more difficult than you’d initially imagine to clean off properly.

Wiping is not a suitable cleaning method

Thinking about the challenge of cleaning bottoms is easier (and less gross) if we abstract it slightly. Luckily there’s a topical issue that provides a useful analogy: Imagine, if you can, that there’s a pipe releasing industrial waste into one of Britain’s rivers. The pipe is above the water level, but somewhat hidden nettles and brambles, and other things that will stand in for folds of skin during our mental re-enactment. Two or three times each day, the pipe discharges some noxious, brightly-coloured, sticky, sludge.

The local press, alerted by some meddling kids and their dog, are on their way to photograph the sticky sludge and the company will have to pay a fine, so they’ve hired you as an operative to clean up the mess quickly! What do you do?

Suddenly, the difference in effect between the WEIRD paper-wiping approach and the more traditional water-washing approach becomes intuitively obvious. There is no way. No chance at all. That you could fool people if you tried to wipe the sludge away with the equivalent of paper. There’s be loads left stuck to the plants, in cracks in the ground, everywhere. And the damage you’d do to the plants would be immediately obvious. Our imaginary clean-up operative is in an unwinnable situation. The company would have to pay its (probably ludicrously small) fine. Luckily, there is another way.

A washed bottom is much cleaner than a wiped one

The most effective way to clean a bottom (and, if you ever have to, a toxic-waste pipe near a river) is with a flow of water. Much of the world knows this - this is why bidets and sprayers are so popular. It’s also why, while living in many countries in Africa, we worked hard to eat, work, and greet with our right hands. The left hand is culturally held to be a vital tool for using water to clean poo off yourself (and, as a parent, off others).

I’ll get into a little bit of detail here, because this isn’t knowledge that’s common in the UK or US and should be: Adults who wash their bottoms after defecating first put water on their hands (this prevents the poo sticking to the hand), then they pour water in a stream over their bottom while cleaning the folds (usually with just one finger) until they can feel that the skin is completely clean. That finger and hand can then be washed properly with soap afterwards. Done. Clean.

We can see that this method has various advantages over paper or wipes.

1. The poo isn’t smeared over or rubbed into the folds, but is washed off them

2. It’s much easier to clean hair with water than it is to wipe it with paper

3. The fingers are far more sensitive so it’s easier to judge when cleaning is complete

4. It’s easy to know where on the hands to wash afterwards (unlike when toilet paper tears, when the poo might be anywhere)

5. The skin isn’t abraded anywhere near as much as it is by dry paper.

So how should we clean a baby’s bottom?

All of these advantages apply equally if not more to babies. We've already said that, if kept in nappies, the skin is very easy to damage with wiping, so wipes are best kept for when they are completely unavoidable.

Baby wipes are completely unavoidable when: Baby is covered with poo AND baby is not near suitable washing equipment.

If either of these things is not true, then we don’t have to use a microplastic-shedding, irritant-laden, sewer-blocking, baby-skin-abrading baby wipe! And we can make sure those things aren’t true by:

• Not letting them get poo on them:

  • I am not exaggerating when I state that working out how to help babies poo outside of nappies, directly into the toilet or potty, is life changing. Both for the parent and the baby. They are saved from the agony of nappy rash and the risk of infections, allergies, and antibiotics that will worsen their health throughout their entire lives. We are saved from one of the most disgusting elements of normal human existence.

  • See the link below on how to do it (so named “elimination communication”) but, in a nutshell: take the baby’s nappy off when you think they need to poo (signals for this include all the play-group favourites: farting, grunting, going red in the face, pulling a ‘poo face’, or their eyelids going red) and hold them over a receptacle. Then wait. Each time they poo or fart, count to 50. If you get to 50 without another interruption, then they are done. Wash their bottom, replace their nappy, and off you go. Simple. Easy. Clean.

  • Keep babies out of nappies as much as you can for better skin health. Summer time is your friend - put them outside without a nappy and their skin will thank you!

Baby skin doesn’t cope well with nappies. Wherever possible, take them off. This is easier if the baby has just weed or pooed, because you know they won’t do it again for a while. And elimination communication teaches babies to fully empty bladder and bowel, so surprises are less likely!

• Making use of the washing equipment you have:

  • Say you didn’t notice in time, and now Junior is in the swamp. Fortunately, though, you’re near the bathroom sink. Take off the lower clothes, turn on the tap. The water sluices off most of the poo, you run a finger between the folds of the thighs and the buttocks, and in much (much) less time than it takes with wipes, you have a much (much) cleaner baby.

(NB. It is useful to clean the sink after this, but luckily sinks can take harsh cleaning products better than baby’s bottoms can. Antibac spray is suitable, but so is alcohol hand-gel. Flushing the u-bend is hygienic and easy to achieve by part-filling the sink and then pulling the plug out. Obviously, never use the kitchen sink).

Humans have an evolutionary aversion towards human poo, for very good reason. But our WEIRD obsession with cleanliness and the strength of our cultural taboo around dealing with, touching, or even looking at poo has, paradoxically, ended up with us leaving it on our skin and that of our babies, and getting our health damaged as a result.

Wondering about what you might do in the privacy of your own bathroom? There’s a link at the bottom to a Medium article on butt-washing.

Curious about where to start? For your baby? Try a washing-up bowl next to your changing station. For you? A small watering can next to your toilet is a good first step!

Happy washing!

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Want to hear my partner and I discuss our experiences of managing pain in children? We have a podcast where we use the topic from the previous post and give context and examples to help bring it to life. There’s also a weekly news section where we dive into interesting research into child development from the previous week.

This is the sound of Sunday evenings in our house!

Toileting babies

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Notes

Want to know more about how to clean your bottom with a scoop of water? https://arkitrek.com/how-to-wipe-your-arse-with-your-left-hand/

No difference in diaper dermatitis with water-only washing, wipes, or creams: https://onlinelibrary.wiley.com/doi/abs/10.1111/pde.12370

Wipes contain potential allergens contributing to perineal dermatitis: https://www.liebertpub.com/doi/abs/10.1097/DER.0000000000000177

Wipes with fewer ingredients are less irritating: https://www.sciencedirect.com/science/article/pii/S1875957220301686

Wet wipes have significant environmental impact: https://wypeuk.com/blogs/the-suppository/why-wet-wipes-are-bad-for-the-environment-what-to-do-about-it

Elimination communication: https://godiaperfree.com/elimination-communication/

Butt-washing: https://iwangulenko.medium.com/toilet-paper-shortage-learn-how-to-hygienically-clean-your-butt-without-it-a875cbb06cbe