This is an original study to investigate the impact of disposable diaper (DD) usage on voiding signaling (VS) expression and bladder control in 2-year-old children in China. It is hypothesized that prolonged disposable diapers (DD) usage will inhibit the expression of voiding signals (VS) in infants, thus delaying the development of autonomous bladder control[1] . The aim of this study is to investigate the impact of disposable diaper (DD) usage on VS expression and bladder control in 2-year-old children..

This retrospective questionnaire survey was conducted from June to December 2024, recruiting 450 two-year-old infants from Henan Province China. After screening, 374 cases were included and divided into three groups: the DD group (infants continuously using disposable diapers without regular toilet training), the DDT1 group (infants who began regular toilet training at 1.5 years of age and gradually reduced diaper use), and the DDT2 group (infants who started toilet training at 1 year of age or earlier with progressive reduction in diaper usage). Primary caregivers completed a structured questionnaire covering basic demographic information, the onset of disposable diaper use, the timing for initiating toilet training, and the frequency of six pre-urination signals (VS1: verbal expressions indicating a need to urinate; VS2: frequent touching of the genital area; VS3: interest in the toilet; VS4: sudden cessation of activity during play; VS5: avoidance behaviors; VS6: awakening during sleep). Additionally, the questionnaire recorded whether infants had achieved day and night urination control. Data were analyzed using SPSS26 software, with chi-square tests for univariate comparisons and logistic regression for multivariate analysis; a significance level of p < 0.05 was set for statistical relevance.

The statistical analysis indicated that four key signals—VS1 (verbal expression), VS2 (genital touching), VS4 (activity cessation), and VS6 (awakening during sleep)—were significantly less frequent in the DD group compared to the DDT1 and DDT2 groups (p < 0.001). Daytime bladder control rates were 42.3%, 55.7%, and 69.6% in the DD, DDT1, and DDT2 groups, respectively; nighttime control rates were 38.7%, 53.3%, and 67.8%, with significant intergroup differences (p < 0.001). Logistic regression confirmed that early toilet training initiation enhanced VS1, VS2, VS4, and VS6 expression (p < 0.05).

These findings suggest that the high absorbency and comfort provided by disposable diapers may mask the infant’s perception of bladder fullness, leading to reduced expression of key pre-urination signals (VS1, VS2, VS4, and VS6) and a subsequent delay in achieving autonomous bladder control.

Continuous use of DD after 1 year old inhibits the expression of critical pre-urination signals in two-year-old infants  significantly and is associated with lower rates of day and night bladder control. Early toilet training and a reduction in diaper dependency effectively enhance the recognition of these signals, promoting the development of autonomous bladder control.

Xu P C, Wang Y H, Meng Q J, et al. Delayed elimination communication on the prevalence of children's bladder and bowel dysfunction [J]. Scientific Reports, 2021, 11(1). DOI: 10.1038/s41598-021-91704-3.