A community member is asking -
Does the lack of access to diapers to keep babies clean, dry, and healthy an adverse childhood experience? Babies that do not have regular diaper changes are not having their their
 basic needs met, and often suffer a painful excoriated bottom, and more for the first three years of their lives - sometimes longer.  While the baby may not be able to tell you, their brain and body will remember. See  THIS ARTICLE and BIPARTISAN RESOLUTION SUPPORTING DIAPER BANKS for more information. Question - Is the lack of access to diapers an ACE? Thoughts? 
“Many families simply do not earn enough to purchase the diapers their child needs to stay clean, dry and healthy. In fact, diapers alone can consume up to 14 percent of a low-income parent’s post-tax earnings. source 

Original Post

I would say yes, as it is a form of neglect. The infant is aware that his/her needs are not being met. We have family centers in my area that are funded by private contributions and are a source of diapers for families with financial struggles. I was made aware that government run social programs do not provide diapers, so the family who cannot afford them will be inadvertently negligent in changing the baby on a regular basis. It is a sad situation.

I am a retired maternity nurse.  In 2012, while volunteering at a food bank,  I noticed mothers looking for diapers. Thru research I found the  National Diaper Bank Network, founded in 2011.   The NDBN was founded after a story appeared in TIME magazine about a social worker ,Joanne Goldblum, whose "diaper bank" was making news.  In 2010, Huggies hired a global research team and together with two universities, and a few diaper bank founders, the Every Little Bottom Study was conducted. The results showed that in the United States, one in three mothers struggled to provide enough diapers for a child. This was named  "diaper need". In a  follow up study by the Huggies and the NDBN in 2017  (Diaper Need and It's Impact on U.S. Families) ,two in five families said they stretch the diapers by keeping a child in their diaper longer. This practice  increases a child's risk for skin rashes and urinary tract infections, among other serious side affects. The study found  fifty-four percent of respondents took a child to a doctor to treat rash, with one-in- four, three or more times in the past year. In 2016, I became a certified member-diaper bank of the NDBN. There are now more than 200 such diaper banks across the country. Our annual conference is coming up soon.  I look forward to hearing more. 

I think it's an ACE not only for the reasons already mentioned (health and neglect of the baby/child), but also because it is both an indicator and cause of parental stress. If they can't afford diapers, there's clearly some financial stress in the household. And no parent wants their child to sit in a soiled diaper any longer than they have to, so being in that situation and hearing your baby crying to be clean and comfortable would add to a parent's stress.

I think we need to be careful about the ACE phrase.  For me, I think it is important the term is used for adversity that is at a more macro level e.g. neglect as Teresa said.  Each contributor to neglect is most definitely affecting the child adversely but I am not keen on calling each component an ACE itself.   

You made an excellent point. The diaper issue, however, is a component of poverty which is in itself an ACE. When working at the family center I was told by struggling moms who came in for diapers that their daycare facilities changed the babies on a regular and frequent schedule, whether the child needed changing or not. The moms said they were going through many diapers a week and needed help. I'm thinking that somewhere in arriving at that decision a professional assessed the importance of addressing the child's needs on a timely basis so as not to take the chance of ignoring an infant or non-verbal child.

Absolutely hear ya!  I am wondering what the context is around the question being posed.  If nappy poverty and the undoubted consequent adverse effect on the wee baby is called an 'ACE' - in and of itself - what does the person want to do with that descriptor?  What impact will it have on the work with the family or client?  Will they be linking it as an ACE score ? 

I am a bit of a purist when it comes to using the ACE term.  

So nice to have someone to chat with.  Per Pediatrics (originally published online July 29, 2013) Diaper Need and It's Impact on Child Health, authors Smith MV et al, showed a significant association between maternal mental health and diaper need (diapers even more strongly associated than with depression than  food need).  Impact on Children: Parent less likely to engage in positive parenting & preventative child health practices. Parental depression and substance use linked to school readiness and early school success; impairments in cognitive and motor function; and increased risk for mental illness.  Conclusion: Diapers have the potential to affect positive change across generations and government systems.  

Also see article in Contemporary Pediatrics July 1, 2014:   Diaper Need is a malady of early childhood poverty by Joanne Goldblum MSW.  Goldblum says doctors are in position to raise awareness of diaper need, ask parents if they struggle to obtain diapers; help quantify scope and impact of diaper need; and direct families to resources. 

A fairly recent peer-reviewed study of diaper need, found all families members felt both happier and healthier when their family was receiving help with diapers.

Looking forward to more thoughts. 

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Carey S. Sipp (ACEs Connection Staff)
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