Go read the Disclaimer again. I am not a doctor. This is not medical advice. Seriously.
If you are contemplating reproduction, pregnant, or have a new baby, toilet training seems a long way off. But as with many other decisions you make as a parent, what you do now can have far reaching consequences that could be inconvenient to you and potentially harmful to your child.
Once upon a bad old day, breastfeeding was rare, formula feeding was normal, and there wasn't a lot of research to tell you that this was a problem. We're currently in a transition of ideas about infant sleep. And we're just barely beginning to understand that diapers are not wholly natural, and there might be other, better ways to handle infant elimination.
The following discussing is based on a summary of the experts found in Jane Rankin's book about parenting experts, plus my reading of Laurie Boucke, Ingrid Bauer and Linda Sonna, with occasional reference to our own personal experiences, and what we have been told by other parents.
My cousin said she potty trained her son at around a year. She could tell when he was about to poop, so she removed his diaper and put him on a potty. Things progressed quickly from there.
My mother-in-law tells similar stories about her children.
Researchers uniformally ignore these stories; parenting experts, and many parents today, assume these women are misrepresenting the past, whether intentionally or otherwise.
Boucke describes the history of pottying in America and across cultures. In essence, mothers (almost invariably) begin by holding their baby (as young as birth, more typically a month or two old) over an appropriate potty to eliminate. Some did this as soon as their baby woke up (as they generally woke up dry after the first month or two) and/or while they were nursing (as they generally pooped and or peed while nursing, due to the gastrocolic reflex). When the babies were old enough to sit up, they were sat on a potty (which might be a pot, and might be mama's feet). When they were old enough to walk, they were expected to walk to an appropriate potty location (either the pot, or outside of the house) to eliminate. Misses and messes were handled matter-of-factly, although mobile babies might be shooed vigorously when they started to go. This entire strategy revolves around older babies and young toddlers spending a lot of time either naked from the waist down, or wearing clothing that exposes their parts to air when squatting (Chinese crotchless pants). It relies an mama (or someone as attentive as mama, and similarly attached) being a constant presence before the baby is mobile, and it assumes that mama (or the attentive other) springs quickly into action.
This is distinctly different from potty training as defined in our culture, which is based upon adult toilet etiquett. Children must be able to get themselves to an appropriate location, use appropriate facilities (which are generally quite large and high off the ground for an older toddler, and really freaking dangerous for a baby), remove their clothes, clean themselves with paper, clean their hands with soap and water which are so high off the ground as to be unreachable for even many young children, and to accomplish all of this at as long an interval as possible, because their freedom is constrained. No wonder potty training in our culture happens late.
However, parenting experts persist in acting like it's all about sphincter control and readiness, which is based on dodgy research by a guy who was shilling for disposable diaper manufacturers.
As a result, parents assiduously teach their infants to go in their diapers, so much so that most babies quit going as soon as their diaper is opened and the air hits them when they are two or three months old (which goes to show their sphincter control is a whole lot better than the research claims, especially when they go immediately into the clean diaper, which they have been taught is the appropriate potty location). And when they finally reach an age and body size that might enable them to use a toilet (with a seat and a step) and reach the sink to wash up after), and get their clothes on and off, their parents breathe a sigh of relief and somehow expect to be able to teach them to do so in a day (no joke; there's a hugely popular book by Azrin and Foxx with basically that title). Potty training in this cultural context is so frustrating for all parties involved that it is one of two parenting issues that generates the most incidents of fatal child abuse.
Most parents are not intentionally cruel, and they've noticed this happening; the obvious solution is to back off and wait and wait and wait until the child figures it out on his or her own. This can work once the child is in day care, if they learn from their peers. It can also work if an older sibling teaches them. But if neither of these happen, that child might get older and older and then come under a lot of severe, debilitating peer pressure, mockery and humiliation when they continue to wear diapers at four or five years of age or later.
The research in this area by people not beholden to disposable diaper manufacturers (who obviously would compromise research in much the same way that cigarette manufacturers concealed the health risks of smoking, and formula makers concealed the health risks of formula, and pharmaceutical companies conceal the dangerous side effects of their products and so forth) has the cultural get self to the bathroom, use toilet (or potty), wipe self, undress and redress self, wash up as its critera for success, so potty learning at a younger age is basically impossible and largely uninvestigated.
Furthermore, because parents and other caregivers limit the physical freedom of children (strapped into carseats, gated into safe play zones, requiring hall passes to go to the bathroom, etc.), our toilet training notions are largely based on the idea of waste retention until the bladder or bowel is nearly full, then emptying, rather than on the idea of relaxation to empty whatever waste is in the bladder or bowel whenever it is convenient. There are many moments when a bored toddler might be willing to relax (if they'd been shown a model how) on a potty and release a small amount of waste. There are few moments when a toddler has a full bladder or bowel, and those moments might coincide with a play agenda of their own, leading to struggles and accidents.
Adults in our culture (probably because of the way they were trained as children, but definitely as a result of cultural etiquette) are very shy about being seen eliminating, even by close family members. Some adult members of our society (and others) are unable to urinate if another person might hear them (pee shy). Many adult members of our society become constipated if they are too long away from their home, familiar, toilet, as they are unable to relax enough to empty their bowel anywhere else. As a result, many babies, toddlers and young children have never seen anyone else use the toilet, other than, perhaps, a doll model, unless they see a sibling or fellow attendee at day care.
Our facilities require sitting. We have been trained to sit to defecate, not realizing that this is physiologically quite difficult; squatting is much easier, and requires less straining. Once accustomed to sitting, cultural notions of hygiene that prohibit touching public facilities make bowel emptying at unfamiliar toilets particularly difficult.
Anyone who has been in an unfamiliar town looking around at the shops knows how difficult it can be to find a public toilet in our society. Finding one with a potty seat for a toddler or young child, and a step to help them onto and off of the toilet, and perhaps push against is basically impossible.
It is, in fact, quite shocking we aren't all peeing and pooping in our clothes all of the time.
In general, we learn to use whatever potty location we have used in the past. This is as true for babies as it is for adults, although that first month or three of life after term is difficult to adjust to in so many ways, that one might reasonably conclude that no particular learning is happening with respect to toilet locations.
Here, then, it is helpful to include many potty locations, so as not to exclusively diaper train infants. Hold them over the sink; sit them on a potty when they are able to sit up with assistance. Hold them over the bushes when outdoors. Let them run around naked from the waist down when weather permits. Put down a tarp if you need to. Anyone willing to gate off a room for an infant should be willing to change the flooring as well. Breastfed baby waste isn't that hard to clean up, and if you have a bowl or potty handy, you can probably catch a good amount of it. Once you've spent time with your naked baby, you'll start to have a sense of when they're about to go, which means you'll be able to put some clothes on them and get them off in time at least some of the time.
In most cultures that do this normally, caregivers make a characteristic sound (a shhh, or ssss sound, or blowing across the top of the head) when the infant is peeing, to encourage an association that will then help the baby to relax and empty their bladder on cue even when it is not full. The crucial element is relaxation. Relaxation can be modeled. A deep breath and a sigh. Releasing your own pelvic floor and relaxing your belly while holding your baby may help your baby do the same. You can also model by holding your baby in your lap (with or without diaper) while you use the toilet.
Older babies who are developing more ability to retain waste may be able to relax if tickled, sung to, or played with on the potty until they giggle.
While it might seem nasty to have to clean up a baby that has just pooped on the potty, believe me when I say, it's a whole lot messier than cleaning that poop out of a diaper; often it is little more than wiping just as one will have to with an older child. Starting earlier means you are probably dealing with breastfed baby poop, which is inherently less nasty.
Babies who run around naked, who do not sit in their waste, and who use a potty, do not develop much if any diaper rash, and require no product other than a little water to keep clean and healthy. This also minimizes the possibility of UTIs, bladder infections, and other negative health consequences.
Breastfed babies don't get constipated. Bowel toilet learning is a lot easier before solid foods are introduced. Extended breastfeeding makes early potty learning much easier. But even a breastfed baby might want to stand and squat a few times to get the poop moving along. Exercise does help, as do fluids, but that up and down (especially the squatting) helps us all defecate. Letting your baby make those movements near the potty can help bowel learning. Requiring babies, toddlers and young children to sit quietly on the potty (when so many adults squirm like mad, rock back and forth, get up, walk around, come back, etc.) to defecate is so physiologically unreasonable, I had a hard time believing that the experts really focussed so much energy on teaching toddlers to do this. Just because they have taken leave of reality does not mean you should, too. Think hard about what you do in order to get a difficult BM moving, and make sure you allow your baby, toddler and young child to do the same; trust that they are trying, not just squirming to play. Assuming enough fluids, exercise and a diet with enough fruits and fiber, squirming, and making up and down movements, are what help humans avoid constipation. You can replace this natural, physiological approach with laxatives; I can guarantee you that does not contribute positively to long term health.
I believe our goal for toilet learning should be toileting autonomy. When a baby, toddler or child wants to go to the toilet, they should be able to go to the toilet. They may require an adult's assistance to do this, and a caregiver's role is to provide that assistance to young ones unable to do things entirely by themselves. Toileting independence -- being able to go to the toilet entirely by oneself -- is an unreasonable goal for even toddlers (we strap them into car seats, and drive them to unfamiliar locations, and speak sharply to them when they attempt to go somewhere we aren't). It's somewhat unreasonable even for adults in our society, as when we travel we rely upon toilets controlled by others (shopkeepers, municipalities, airplanes which require us to be in our seats during turbulence, etc.).
In addition to providing that assistance, we need to be sensitive to when that assistance is needed. When babies are very small, we may have to rely upon timing cues (after waking up, some period of time after feeding, and so forth). When babies are older, we may have to rely upon gestures or actions that indicate a need to go. But when toddlers are able to tell us they need to go, we should not deny them, and we should do everything in our power not to delay them (recognizing, of course, that constraints on our actions do exist, for example, airplanes during turbulence). And we should listen to our toddlers, not constantly shush them when it is inconvenient for us. It will be a lot more convenient to take them to a doctor to deal with constipation, or clean up a puddle.
Parents who do not want to get up to feed a small baby, are not going to be enthusiastic about getting up to take a small baby, a toddler, or a young child to the potty. Those who understand the crucial need to feed small babies during the night might be able to accept the following ideas.
Night time dryness for many, if not all babies, is easier to attain than daytime dryness; it happens later in our culture because of our peculiar notions of infant sleep. We do everything in our power to get them to stay asleep, rather than letting them wake up, addressing the need they have, and letting them fall back asleep. And then we wonder why some of them die in their sleep (SIDS) and some of them don't wake up when their bladder is full, even when they are older children or teenagers (nighttime enuresis, or bedwetting).
It is easier to stay dry at night, because our bodies (even as babies, although possibly not as newborns) produce a hormone that slows the production of urine while we are asleep. This is why a lot of babies wake up from even a long nap dry, but then pee shortly thereafter. Copiously.
In much the same way that families in which the breastfeeding mama sleeps with or near her baby tend to get a lot more sleep, I think (I'm testing this now) that babies who are helped to a potty when their bladder wakes them up will fall asleep longer and sleep more deeply than babies whose diaper is left wet. More importantly, we are modeling a choice for our babies. When we feel a strong need to pee, we should wake up, leave our nest, go to an appropriate potty location, pee, then return to bed and sleep. When we teach them instead to go back into a deep sleep and pee in the bed (albeit in a diaper, but a sleeping brain just isn't that good at fine disctinctions), we are training them to a habit they will have to break when they are older, and wearing underpants instead of diapers. And almost everything is learned more easily when very young, than when older.
I do not know what fraction of our society rises in the night to use the toilet. I know I do. I know my husband does. I know nearly everyone else I've lived with did, if not every night, certainly on many nights. Sleeping through the night uninterrupted is not something a large fraction of adults do. Expecting it of babies, toddlers and young children is bizarre.
There have been a number of studies about starting toileting early versus later. If you decide to look into this research yourself, pay close attention to the following:
Some people say that starting later means finishing faster. This is sort of true. In general, starting toileting later means fewer months devoted to toilet learning/toilet training. But the age of toilet independence or autonomy may be overall later than starting (much) earlier.
The definition of success can vary widely by study. Day and night are two axes; urine and bowel are two axes. This gives four possible times of completion. Also to be considered is how accidents are treated. Some definitions of training completion allow for a substantial rate of accidents, and therefore are not directly comparable to definitions that do not.
Most important, if the definition of success involves being able to use a full size toilet without any assistance from an adult or devices such as potty seats, step stools and so forth, particularly if it includes being able to wash hands after at a regular height vanity, it is absolutely impossible for a child shorter than a certain height (and, therefore, younger than that height) to be potty trained, even if they can successfully stay dry throughout the night and communicate their needs to an attentive adult caregiver.
I tend to think that deciding between toileting strategies is best based first upon what is possible, something that only the caregivers can decide. That said, a caregiver should not assume that elimination communication is not worth doing solely because they cannot go entirely diaper free right from birth; partial efforts have been shown by several researchers to make later toileting easier. When deciding among strategies which are possible, the most important consideration is the bond of affection. After that, cost, the environment, and convenience are all worth thinking about.
As with many parenting decisions, I have been struck by how attention to the bond of affection is healing for me. Seeing naked parts, even on a baby, was initially unusual enough to make me worry whether I should even be looking. Then again, not only is Teddy a baby, he's my baby. I can't very well avert my gaze from his parts, and doing so seems psychologically harmful. Way to give my son a bunch of hang ups he'll just have to work out later on. But I am noticing that I am more comfortable in unfamiliar bathrooms when I take him there on outings. All those times peeing on a stick for prenatal appointments got me over any residual hang ups about my own urine. I'm slowly getting over that reflexive ew, gross, dirty I had about human waste. I'm still extremely sensitive about disease vectors (I'm not an idiot), but I no longer have some bizarre fear I could catch a disease from myself that I did not already have. It is my sincere hope and desire to pass along a similar set of feelings and attitudes to my son. Better that the shame and phobia that potty training apparently gave a lot of us.
A General Discussion of Baby Bodily Fluids
A General Discussion of Diapering
Our Experience with Elimination Communication
Elimination Communication Gear
A Look Ahead: Toilets and Toddlers
Copyright 2006 by Rebecca Allen.
Created April 17, 2006 Updated April 19, 2006