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Paraphilic infantilism is a paraphilia characterized by the desire to wear diapers and be treated as an infant. or toddler One who engages in infantilistic play is known as an adult baby (AB). About one in three adult babies is also a diaper lover (DL), so they are collectively known as AB/DLs. The majority of infantilists are heterosexual males.
Paraphilic infantilism and diaper fetishes differ in self-image and the focus of attention. They can coexist in individuals, however, and they have some similarities. Neither includes a sexual preference for children There is no singular, archetypical infantilism, but a range. Some fantasize about being free of guilt, responsibility, or control, whereas others might not. Some act indistinguishably from a baby at times, while others practice in a way that would be unnoticed by passers by on the street. The desires and tastes of infantilists vary around common themes of diapers and babyhood.

One way to describe paraphilic infantilism is to contrast it with a diaper fetish, and this contrast is most clear in fantasies. Although there is no typical AB/DL fantasy, they often fall within two extremes. One extreme involves the fantasy of being an infant or small child; adorable, sexually innocent, and powerless. The infant fantasy might involve diapers, baby clothes, and toys to help define the infant's role. In the end, the infant might drift off to sleep in a soft crib. The other extreme is the erotic lover. The lover fantasy would focus on diapers as fetish items, sexually charged objects and might also end in orgasm and ejaculation.
Most individuals who have these fantasies do not seek psychotherapy. According to the American Psychiatric Association, if there is significant distress or impairment for a period of over six months, paraphilic infantilism or fetishism might be diagnosed, depending on the focus. The urges and fantasies caused by diaper fetishes focus on the diapers themselves, while infantilism focuses on becoming a baby. (Please note that many published cases are only tangentially related to infantilism and diaper fetishism and should not be confused with the basic paraphilias.
In practice, the distinction between the two is much narrower; both involve diapers and adults. Those who try to act out the infant fantasy or similar ones are called Adult Babies (ABs). This may involve adult sized diapers and baby clothes, etc. If their partner is willing, they may engage in mother/baby roleplay. The adult baby may choose not to engage in sex while they are in the baby role, since it isn't babylike. In contrast, diaper fetishes are much more practical. They may involve adding diapers to otherwise ordinary sexual activities. Those who do are called Diaper Lovers (DLs). Neither are adult baby practices exclusive to paraphilic infantilists, nor diaper lover practices exclusive to diaper fetishists. Many AB/DLs describe themselves as 'mostly AB' or 'mostly DL,' based on which they engage in more frequently. Those with urophilia and coprophilia may enjoy similar practices.
To quickly summarize the theoretical differences, adult babies might have paraphilic infantilism, their interests are self-image or alter-ego focused, and might refrain from sexual activities during adult baby play. In contrast, diaper lovers might have a diaper fetish, their interests are directed at a sexual fetish object, and don't inherently involve roleplay. In practice, the differences among AB/DLs are much less well-defined.

Confusing infantilism with pedophilia is a common misunderstanding. Pedophilia is a sexual preference for pre-pubescent children. In contrast, infantilists have a desire to be infants themselves, and those with a diaper fetish have a sexual interest in diapers. Generally, they have ordinary heterosexual or homosexual sexual experiences otherwise. Inside the AB/DL communities, a sharp distinction is observed. Most AB/DL organizations will expel child molesters.

'Paraphilic infantilism' is usually shortened to 'infantilism.' This can lead to some misunderstandings, since 'infantilism' can also mean 'lacking development.' Mental retardation involves never having achieved an average maturity, in contrast to adult babies, who actively set their maturity aside. In turn, psychosexual infantilism, a term coined by Freud, referred to those who haven't "matured" through the psychosexual stages into heterosexuality. Psychosexual infantilism includes paraphilic infantilism as well as other paraphilias and sexual orientations. Finally, regression is a broad term with many meanings. Adult babies regress, but those who regress aren't necessarily adult babies.

Those who wear diapers because of incontinence are probably not AB/DLs. While they may wear and use diapers, they aren’t necessarily doing it to express an alternate self-image or indulge a fetish. This also applies to those who use diapers for practical reasons, such as astronauts and scuba divers. Finally, there are some who start wearing diapers as a "new kink."
There are many that wear diapers but are not paraphilic infantilists or diaper fetishists in the strictest sense. Their motivations and underlying mechanisms are different. However, those who share AB/DL interests and practices are generally welcome in the communities, and may sometimes be counted as AB/DLs.

Force or coercion is sometimes present in AB/DL fantasies. This can range from the inclusion of S&M or B&D play into AB scenarios through to more specifically AB scenarios such as the Diaper Discipline, or Petticoat Punishment in which a supposed older child or adult is regressed into a baby-state as punishment for misdemeanors. This can sometimes form a validation activity, where the AB mitigates their guilt for having AB desires with the fact that they are only in diapers as a punishment. AB/DLs may enjoy looking at pictures showing whom they want to be, as opposed to whom they want to be with. For example, a heterosexual male adult baby may enjoy looking at pictures of men in diapers: he may be imagining himself as the men in the diapers.
A common fantasy among adult babies involves a permanent return to a more infantile position. This is a special case of a desire to regress, common among adult babies. This may involve being put back in diapers or returned to the nursery for the rest of their life. These fantasies may be enjoyed even by ABs who are consciously aware that they would not want to give up their adult lives.
Modesty and self-consciousness are not expected from infants and small children. Babies can be out in public in just a diaper and t-shirt, and can have their diaper changed in public. There are no local, state, or national laws that prohibit adults from wearing diapers, t-shirts, diaper covers, or body suits (onesies).
Just as a baby has no responsibilities, they also have no privacy. The inclusion of scenarios where the AB is not granted genital privacy and has no rights of complaint or choice of activity can provide a return to a baby-state and can allow deep immersion in the baby mindset. In this context the AB is usually not allowed to touch themselves, but may have their diaper changed, their body cleaned, their genitals examined, and even be internally examined, such as being given enemas and suppositories, without any warning, choice of circumstances or control over who is present. Their right to control access to their genitals is completely disregarded.

A sissy baby is a male AB/DL who mixes gender play with infantilism. This cross-dressing might involve stereotypical or exaggerated "little girl" clothing, such as frilly panties or dresses. Sissies are not necessarily transsexual in that, while some might be expressing an alter ego that is a baby girl, they might not wish to be an adult woman at other times. Alternatively, some transgender people simply participate in ageplay as their gender identity as a logical extension of their transgender life.
A separate group enjoys the masochistic demasculinization of being dressed as baby girl, analogous to non-AB/DL masochists who enjoy being cross-dressed by force.
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