In our last post, we discussed the history of disposable diapering in the United States, and how Dry Max represents a new spin on a trend Pampers has been pushing for a quarter of a decade. But the heart of this issue, for us, is in defining the problem and advising parents based on what we see. So it's time we got to the heart of the matter. What is it that Pampers Dry Max diapers appear to be doing to some of the infants and toddlers who wear them that goes so far beyond "everyday" diaper rashes that parents speak out, form groups to help spread the word, and demand a product recall? Is it even possible that a company would invest millions of dollars in pushing an idea so far that it can cause significant harm?

We had planned to cover both that topic and our diaper teardown and analysis in a single post, but we get into a LOT of detail in our teardown and analysis, and we've also seen a lot of push back from Pampers in the media regarding whether or not potential problems with Dry Max are even a legitimate issue for discussion. (They are "insulted.") Because of this, we've decided to dedicate a full post to what appears to be happening to kids, and how Pampers is spinning it, before we publish our analysis of why all of this might be happening. Defending the existence of a problem in the same blog post as the level of analysis we are bringing to bear just wasn't working. So what was conceived as a three-part series will now be four, although I promise we'll have the third installment - the teardown and diaper analysis - up sometime Wednesday. [Update: Part 3 is now online.]

Three ways Pampers' assessments minimize the problem

Pampers' defense against claims that diaper rashes have become a bigger problem with the introduction of Dry Max rely on internal documentation collected by the company and now shared, presumably in full, with the Consumer Product Safety Commission for the government's investigation. There are, however, some significant problems with their defense.

1. Diapers versus consumers

Until about a week ago, Pampers claimed they had received two complaints for every million diapers sold. This figure was presented as a "normal" level of complaints.

A million diapers is a lot of diapers. But let's not confuse diapers with consumers. We encouraged Casey, a reader we'll introduce you to later in this post, to estimate how many Dry Max diapers she used before discontinuing them; she tallied up an estimate of 360 diapers, including the period when she did hourly changes to try to address the problem. Based on the report of Alexis, whose story we'll also share, we'd assume she used one full package before switching brands. 100, 150 diapers.

Here comes a little guesswork - it could be off by a little or a lot, but is used to make a point independent of the actual figures.

If Pampers began introducing Dry Max diapers into the disposable diaper stream about a year ago, and admits to having done it since last August, we might assume that that date was the point when they were selling Dry Max diapers almost exclusively. Let's also estimate that the average child (averaging newborns to toddlers) uses somewhere around 150 diapers a month. That means a parent whose child was not suffering from a debilitating diaper rash - the level that would cause them to discontinue use of the diaper and switch to another brand - would have bought an average of 150 diapers a month for nine months, or 1350 diapers, while a parent whose child did have such a reaction, and discontinued use, did it after purchasing somewhere between 100 (a reasonable average number of diapers in a single package) and 400 diapers.

See what we're driving at? The implication of a figure like "two complaints for every million diapers sold" is that the ratio of satisfaction to dissatisfaction is 1:500,000. But if you consider that during this period satisfied customers are likely to have purchased far more diapers than those whose children suffered significant harm - in our example, anywhere from 3.5 times to nearly 14 times as many - you get a very different picture of the impact. That's because the reported number of incidents is the same, but the total pool had been wildly exaggerated.

If you go to a restaurant 14 times and I go once, and I complain about the service, the restaurant manager could conclude that everything is fine because only one out of every fifteen meals served resulted in a service complaint. If this occurrence were scaled up, however, he'd be a fool to think that this record makes him a shoe-in for the local "Best Restaurant" poll.

(And don't forget [thanks, Sarah!] that treating complaints as an indicator of the extent of any product safety problem disregards anyone (everyone) whose child experienced an unusually serious rash but did not call to complain. How many consumers a single complainant represents is an open question in product safety circles, and varies depending on the circumstances, but the answer is certainly not "one." Through research, surveying, and mathematical modeling, companies that wish to know such things are able to develop reasonable estimates.)

2. Inconsistent numbers

Two weeks ago, Pampers was stating they had had "no increase" in complaints of rashes than with their previous designs, and cited a rate of two complaints for every million diapers sold as proof. Here is one of several references made to that figure:

The Consumer Product Safety Commission said last week it is probing reports about babies and toddlers suffering severe diaper rashes and blisters from the new, thinner diapers. P&G responded that the claims were "completely false" and that it has received fewer than two complaints about rashes for every million Pampers sold. [Link]

Jodi Allen, president of Pampers' North American division, who has been making the rounds and engaging consumers directly on the question of Dry Max rashes, repeated this figure in an interview with Advertising Age:

At any given time, 250,000 U.S. babies have diaper rash, Ms. Allen said. But P&G has gotten only two reports for every million among the 2 billion Dry Max diapers it’s sold so far. While it’s not dispatching teams to every home that reports a rash, P&G is doing extensive follow-up calls when it gets complaints and inviting some parents to visit a pediatrician on the company’s dime to explore the problems. [Link]

A few days ago, however, spokesperson Bryan McCleary began using a different figure. We noticed it first in an article published by the French wire service AFP:

"Two billion Drymax have been sold," said McCleary. "America has voted with their purchases.

"We saw a big increase in sales, a big increase in consumer acceptance... they will be appearing in other Pampers markets soon."

He said complaints about the diapers were not above normal levels of one per five million sold. [Link]

McCleary repeats it again in an interview with Business Week:

P&G spokesman Bryan McCleary said in an interview that the company has found no evidence that the diapers cause rashes or burns and that P&G has received one rash complaint for every 5 million Dry Max diapers sold -- about 400 complaints so far. [Link]

Those figures differ by a factor of ten, folks. In other words, for every ten complaints Pampers admitted to in articles published on May 10 and May 13, they are now admitting to one. Meanwhile, the estimate of Dry Max diapers sold (two billion) has not been altered.

So... what happened between May 13 and May 15 that could possibly cause a company to scale back its own internal estimates of harm by a factor of ten, never publicly correcting or referring to the discrepancy and pushing forward with their new numbers as though nothing had changed?

Oh yeah.

3. Numbers versus severity

Inconsistent statistics and misleading expressions of them are certainly frustrating, but even they are not the biggest problem with Pampers' public analysis of what is happening in homes that use Pampers Dry Max. The elephant in the room is the reason why the parents who are angry with Pampers are as angry as they are, and it is probably a contributing factor in why, if a product engineering problem existed, it might not be fixed in the product testing phase. It is also something so blindingly obvious it is very strange to us that no major news organization has yet made mention of it.

Pampers has publicly relied exclusively on the number of diaper rashes that are occurring, without considering their severity. They have stated that they have not received complaints or calls at a more frequent rate than with the old diapers. Even if we are willing to suspend our disbelief and accept these numbers (see #2, above), it does not follow that a similar number of diaper rashes, of much greater severity, would not represent a product defect, a problem that needs to be addressed, or a significant hardship for infants and their families.

We suspect that Pampers does not even collect information regarding the severity of diaper rashes, as doing so would be a complex undertaking and create potential product liability issues. If this is true, it means that Pampers has no data regarding how severe diaper rashes from Dry Max diapers are compared with their old diapers or with competing brands, and they have given no indication that they believe such knowledge would be beneficial or would affect their belief in their product's quality. Which is ridiculous.

Two tales of Dry Max rashes

As in the case with Carter's tagless clothing, it looks to us like we're dealing here with an irritant that causes contact dermatitis in some but not others; that the non-universality of effect causes some reasonable people with good intentions to question its reality; and that the "diaper rash" it produces is likely to be so severe that it is the worst the child has ever experienced and, in many cases, the worst the parent has ever seen.

To illustrate what appears to be happening, we'd like to share two stories with you. Like so many consumer accounts of unusual diaper rashes experienced with Pampers Dry Max, in both of these cases parents were using reformulated products that were not labeled as having been changed - and, in fact, were sold in packaging still advertising product features (such as a mesh liner) that were no longer present.

ZRecs reader Alexis and her then sixteen-month-old daughter had their first encounter with Pampers Dry Max over a year ago, in March 2009. Here is Alexis' story:

[My daughter's daycare] called my husband on a Friday saying that she had broken out in a horrible diaper rash and that we should come and get her from school. She had an awful red, bumpy, rough diaper area and swollen redness from her belly button to the small of her back. Part of the rash was a really bad yeast rash but the other part looked how your skin looks after you skin your knee. It was very painful and she screamed every time I used a wipe or even a cloth diaper rinsed with warm water on her bottom.

The pediatrician's office was closed but we called the on-call doctor who said it sounded like an allergic reaction. I was confused because she had not eaten anything different, no new lotions or creams, nothing. And she had no rash in the morning when I changed her.

We had just opened a new box of diapers and brought them to the daycare that morning. They were the same brand of diapers we'd been using since day 1 - Pampers. Upon closer inspection I found that the mesh liner that we had come to love with Pampers (and is why we paid so much money for the darn things) had been removed. Also, the new diapers were as stiff as a board and she leaked out of every single one out of the box, before we had realized this is what caused the reaction.

Alexis' daughter recovered fairly quickly; they went to their pediatrician, who prescribed multiple oatmeal baths, Benadryl, and three different topical creams. But it seemed clear to Alexis, and seems reasonably clear to us, that her daughter had a sensitivity to the new diaper that she did not have to the old version. In our view, even parents whose kids haven't reacted to Pampers Dry Max should be able to accept that.

But compared with many consumer stories about these diapers, Alexis and her daughter were pretty lucky. After reading our initial warning about Pampers Dry Max, reader Casey wrote in. We have read and received many accounts which share many of the characteristics of Casey's, but hers offers a couple of insights you won't see in some: A frank admission of how difficult it can be to identify a problem when you are using a product you have learned to trust; and how guilty a parent can feel after realizing that their child's suffering could have been avoided "if only" they had put the pieces together sooner.

We have been Pampers users since Kael, my 4.5 year old, was born. Even when we used cloth during the day, we used Pampers at night. I say this, because when we were doing what we thought was "trying everything" to get rid of the rash, we did not switch diapers for a very long time. I assumed Pampers were the diapers, and because of our previous experiences with them, I never once assumed it could be the diapers that were causing the problems.

Somewhere around November 2009, Asa, my younger son (now almost 3), started developing a diaper rash. It's not unusual for him to get an occasional rash. He has sensitive skin, and so we were prepared. We tried all our usual tricks. We used Butt Paste, Aquaphor, Vasaline, Desitin, A&D. We started changing him hourly all day long. For a 2.5 year old, this is a big waste of diapers, but it was worth it to get rid of the rash that no paste could cure.

After using the different types of diaper creams for weeks, I decided it wasn't working. Because he had been sensitive to dairy when he was younger, I decided to work on dietary issues. I limited his fruit intake thinking that maybe his poop was too acidic or sugary. (I know it makes almost no sense now.) I eliminated milk, cheese, and yogurt from his diet. I did this in early December. I remember because it was the holiday season and crazy to try to control what he was eating with all our get-togethers.

In December, we went to my parents' house for Christmas and spent 10 days with them. At some point in early December, the rash started moving down the backs of his legs. During the time we were there, my mom was really appalled by Asa's rash. This was when I decided to start doing very frequent changes.

Also, looking back on Facebook, I found the post from my friend that first caused me to suspect the diapers would be the issue. It was posted January 31.

On January 31, I was reading my Facebook updates and a friend of mine made an offhand comment about how Pampers had a new diaper that was causing rashes.

Apparently pampers has reformulated their diapers to be 20% less material and still as absorbent, but they put them in the old boxes without notice and these new materials can cause serious diaper rashes to babies. hmm, glad I use huggies ;-)

We were really surprised, because none of the boxes of diapers had indicated anything new or different with the diapers. We switched immediately. We noticed a small improvement in the rash. Instead of red, raised, and cracking, it was no longer cracking open.

At this point, I made our first doctor's appointment. We went in, explained our situation to the doctor. He glanced at the rash, said it didn't look like any sort of typical diaper rash but assumed it was a yeast/fungus rash. He recommended an over-the-counter antifungal. We used it for a week with no results. Then I contacted a friend of mine who is a nurse practitioner that specializes in dermatological issues. She recommended that we try some hydrocortizone cream on a small spot. She said that if it was inflamed that would help it. It did. We used it for quite some time, but every time we stopped using it, the rash returned. We finally made an appointment with our family doctor. She diagnosed it as a type of contact dermatitis. She prescribed a stronger steroid and a compounded diaper cream made only at our pharmacy. Finally, after using those for about a month, we are to the point that Asa only has one small red spot on his leg.

I do have to say that looking back I cannot believe how long it took us to put things together. This has been a very long, drawn out issue for us. :(

Think a diaper rash is a diaper rash is a diaper rash? Tell that to Casey.

Tomorrow: Dissection and analysis (we swear)

That's it for today. For those who have been waiting patiently for us to tell you what we think might be wrong with Dry Max diapers, you don't need to be patient for much longer. We'll publish our diaper dissection and analysis of possible causes of rashes by tomorrow at noon. Thanks for reading, and please feel free to comment below with your thoughts. [Update: Here it is!]

Move on to Part 3 of this series, in which we dissect pre- and post-Dry Max diapers and discuss potential sources of irritation. Or jump back to Part 1, in which we discuss the history of disposable diapering and Pampers' role in it.

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Pampers' Dry Max diapers, touted by the company as disposable diapers' greatest innovation in 25 years, have launched far more buzz than the company could have hoped for, but for all the wrong reasons. Less than one month after the product's official launch, but over a year since it the company being introducing it to consumers both through test groups and surreptitious product swaps, the company is facing an investigation by the Consumer Product Safety Commission, an anti-Dry Max 8,000-plus-member Facebook group whose members answer consumer questions on Pampers' own Facebook page faster than P&G marketers do, and a class-action lawsuit. It's a tangled web, and we were determined to get to the bottom not only of the potential problems with Dry Max but the hype that has swirled around the product from both supporters and detractors.

We have organized the results of our research in a series of three four posts on what has become for us a fascinating if somewhat disturbing topic.

In this post, we'll offer a brief history of the competition between Pampers and Huggies that has, in our assessment, led directly to the introduction of Pampers Dry Max. In doing so, we'll touch on the advances in disposable diapering technology that will give you the background you need to get the most out of our second post in this series. In that post, we will dissect both pre- and post-Dry Max Pampers, discuss the scope of the Dry Max diaper rash problem, and highlight some possible product features that could relate to what appears to be an increased incidence of extreme diaper rashes. In a third and final post, we'll explore the social media and corporate damage control that have helped make this story a media feeding frenzy, and we'll look ahead to the future of sustainable disposable diapering, and Procter & Gamble's surprising role in it. (Update: The series has been expanded to four installments; the second, which covers the scope and nature of the problem, is now online.)

Our position regarding the safety of Pampers Dry Max has not changed. We'll explain our impressions of the scope of this problem - as well as narrowing the field of possible sources of it - in our next post, but if all you need is our recommendation, look no further.

On to some ancient history.

Diaper science and diaper marketing

The secret of disposable diapers is that they are highly engineered products that are designed to work in simple ways. Shielding a human being from the potential hazards of his or her own waste while keeping it contained in a package that does as little to offend the world outside as possible is a daunting task, and most of us would agree that every bit of R&D is money well spent.

After the initial invention of disposable paper diapers in the 1940s, advances in diapering technology were fairly incremental for four decades. The deployment of "nonwoven fibers" like plastics and cellulose in the 1950s and 1960s, the evolution of elastic waistbands and stretchy adhesive tabs from the 1960s onward, and the layering and quilting of layers of wood or cellulose fibers to maximize absorption all proceeded along a relatively predictable path. Like astronomers tweaking Ptolemy's model of an Earth-centered universe, engineers perfected the sandwiching of layers that drew wetness from the baby's skin, locked it in absorptive layers, masked odors, and even adjusted skin pH to discourage diaper rashes or used dyes to advertise wetness and needed diaper changes from the outside of the diaper's well-sealed chamber. By the late 1970s, disposable diaper companies, led by Pampers, were putting the final nails in the coffin of widespread cloth diapering in the United States.


But just as Pampers had vanquished its primary competition, everything changed again. The catalyst was a new brand that out-pampered Pampers: Huggies.

The gospel of superabsorbents

In the 1980s, diaper manufacturers gained access to USDA-developed superabsorbent polymers, which could absorb up to 500 times their weight in liquid, and rapidly introduced them in their products. Suddenly, the quantity of wood pulp or cellulose fibers in disposables, could be drastically reduced, as it was far less effective in absorbing urine and fecal liquid than the SAPs. (Current estimates for wood pulp absorption are 4x its weight; Pampers cites is own current SAP as holding up to 25x its weight.) For Procter & Gamble, the arrival of this technology in the manufacturing supply chain couldn't have come at a better time. After decades in business as the top cat of disposable diapers, P&G executives watched as paper company Kimberly-Clark introduced Huggies in 1978 and by the mid-1980s was regularly wiping the church nursery floor with the tear-streamed face of the once-proud Pampers brand. (Pampers, if only by virtue of its attachment to a global industrial giant, still dominates the European diaper market.) Kimberly-Clark, which had built its brand on Kleenex, toilet paper, and newsprint, turned its expertise to the task of building a better diaper, and consumers fled Pampers in droves. When it came to paper products, K-C could beat P&G to a pulp.


Even a quarter of a century ago, Pampers appears to have hoped that SAPs could help them get out from under a competitor that knew its paper. The full story of how Huggies wiped out Pampers as the leading U.S. diaper brand remains to be told, but one notable difference in their branding, marketing, and product development strategies was that Huggies embraced the image of the engorged, load-carrying diaper, flaunting its bulk on happy, oblivious babies. Pampers, in contrast, campaigned relentlessly on the merits of thinner diapers; no other brand embraced this gospel as completely as the engineers at Pampers did. Browsing the commercials available in the scattershot archives of YouTube reveals the fascinating fact that Pampers' story with Dry Max - touted as the company's "biggest advance" in diapering "in 25 years" - is, in fact, an old saw indeed.




Prior to the entrance of SAPs, for all the minor innovations that gilded the lily, premium diapers were thicker diapers; more padding meant a company wasn't skimping on materials, and that diapers could simply hold more. It was natural that P&G, a company with deep links to the chemical industry, could leverage polymer chemistry more rapidly and more fully than Kimberly-Clark, a recent entrant to the diaper market that didn't divest itself of its own wholly-own timber reserves until 1999. Through Pampers, P&G marketing spent thirty years attempting to link sagging, bulky diapers to both physical and emotional constriction, tapping into parents' anxieties about sensitive stages of child development.

The problem was, parents didn't seem to prioritize diaper thinning as much as Pampers did. Year after year, Huggies competed with Pampers for the same premium customers who valued the latest incremental advances and recycled feature additions and were willing to pay for them, and Huggies won the battle every time. For three decades, Pampers has sat in the #2 slot in a product category it helped define in the 1960s.

The diaper war abroad

Ironically, the struggle for the U.S. baby bottom is not as important to these companies as it might appear to us. Sure, Procter & Gamble and Kimberly-Clark battle for market share through misleading television advertisements and premium-listed prices undercut by a river of manufacturers' coupons and loyalty programs. Certainly, priorities shift greenward as rethinkers like Seventh Generation push the behemoths towards just enough corporate responsibility to combat their message, and if cloth diaperers could vote in the Diaper Awards they might have a sleeper on their hands. But what's happening here is just a skirmish compared to the spoils to be had in the developing world.

You see, the U.S. disposable diaper market is what industry analysts would term (if you'd forgive the unavoidable pun) "saturated." Fully 95% of American families use disposable diapers, and the market grows only when births rise, diapers get used more quickly, or parents are upsold to from economy to premium brands. The rest of the world, however, is full of people who don't wish to use disposable diapers, or don't wish to use diapers at all, and convincing them to do so in countries like China, India, and Latin America is as potentially lucrative as the African continent was to Nestle formula in the 1980s. Speaking of Africa, the most recent figures we've seen pin diaper "penetration" on the African continent at 15%. In short, the business of diapering in the next decade is the classic international chess game of carefully cultivating a nascent potential "need" using relevant local cultural vibes to create a new baseline of progress that includes a highly profitable product people seem to be doing fine without.

Dry Max: A marketing innovation with real-world consequences

Given the obsessive focus with which manufacturers must attend to marketing products that are in many ways the same, it should not be too surprising to learn that the real innovation behind Dry Max is not one of new technology, but of turning an old solution to a new stated purpose. In short, the thinness Pampers once strove for as a mark of convenience is now being sold as sustainability. "If every Pampers mom switches to Pampers with Dry Max, together they could save almost 20 million pounds of trash every year - That's the weight of 63 Statues of Liberty!" states the Procter & Gamble sustainability website Future Friendly. The pitch below by Pampers R&D's Kerri Hailey is typical of the promotional push Pampers has made for Dry Max, although it is colored by the emerging outcry over diaper rashes that have stolen Pampers' thunder as its rollout unfolded. At about 4:00 Kerri gets into the environmental stuff - a 20% thinner diaper means lower pulp content, fewer resources used, lower transportation costs, and so on - things that moms "as a mom" can feel good about.


Procter & Gamble announced last month that it had formed a "Sustainability Expert Advisory Panel" to advise the company on greening practices throughout the company. Some of those same contacts are now being leveraged to help combat consumer claims of increased incidences and severity of diaper rashes caused by the new Dry Max diapers.

In our next installment, we'll turn a critical eye on P&G's assessment of the Dry Max diaper rash connection. Then a third post will share findings from a dissection of Dry Max and pre-Dry Max Pampers Swaddlers, discuss the design changes behind the new diapers, and catalog some potential sources of irritation in Dry Max diapers that could cause Pampers wearers who never experienced rashes from the older version to suddenly get severe ones. Then, in a fourth and final installment to this investigative series, we'll discuss the public outcry over Dry Max diaper rashes, evaluate the fairness of P&G's falsely-marketed rollout and aggressive response to consumer complaints, hint at new directions for diapers and P&G's real prospects for sustainable disposable diapering, and explore the evolving role of social media activism in confronting potentially hazardous consumer products. Stay tuned!

Part 2 is now online. Read it here! Love this in-depth consumer reporting? Get free RSS or email delivery, connect with us on Facebook, or follow @ZRecs_Safety, @ZRecsMom, and @JMcNichols on Twitter and you won't miss a thing.

You may have heard over the last two weeks about Pampers diapers causing some pretty nasty rashes after the company changed both their Swaddlers and Cruisers diapers to a slimmer design. We've been doing our own research on the issue, and are working on what we hope will be the most definitive assessment of the problem you'll see unless and until the company issues a voluntary recall or offers some form of consumer advisory.

[Part One of our three-part series on Pampers Dry Max is now online.]

For the moment, however, the steady stream of new accounts of children suffering from serious rashes is urging us to publish a few notes now.

First, we have some frank advice. If you are looking for a diaper brand for a new baby, we'd advise you to try an alternative to Pampers Swaddlers or Cruisers for the time being. Additionally, if you are currently using Pampers Swaddlers or Cruisers (even if they are not promoted as "Dry Max" diapers, they probably are), we encourage you to consider an alternative, even if you have already used the new version of these diapers and your child has not had a reaction.

We say this because we have read impossible-to-verify but worrying reports of infants and toddlers wearing these reformulated diapers for weeks and only then breaking out into serious, painful diaper rashes. If these accounts are accurate, it means that children may develop rashes only after prolonged use of the new diapers, or after certain unusual conditions are met, and that it can happen even after you have tried the new diapers and think your child is fine in them. It is difficult to calculate the incidence of these rashes (if you believed Pampers' story, they are very rare) but based on the severity of the reported rashes (blisters, blood, persistence for a week or more after discontinuing use) we'd advise anyone with options to consider them. We've read from many parents that Target brand diapers are a pretty close match to the Pampers fit and function.

Second, although the CPSC has launched an investigation, that fact does not prove that there is going to be any action, and there may not be an action they are in a position to take. Recalls are voluntary and the companies that cave to pressure from the CPSC under circumstances like these are typically not those with the legal muscle of Proctor & Gamble. P&G may be using perfectly legal materials and chemicals in ways that cause an an increased incidence of severe rashes - severe enough that children are suffering and parents are angry enough to take action, but perfectly legal nonetheless.

We'll have much more to say on this matter in the next few days, including a rundown of possible sources of the problem, Proctor & Gamble's handling of the issue, and the central - yet in some ways problematic - role social media has played in this issue so far.

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