Babies Go Diaper-Free With the 'Elimination Communication' Potty-Training Method

CC BY 2.0. Todd Morris

It's an old technique that was practiced by previous generations, but has been lost in the U.S. since the 1960s.

As Rosemary She and Jeffrey Bender prepared for the birth of their third child, they worried about the waste created by several years’ worth of disposable diapers. Surely there was another, better way to deal with a baby’s excretions that wouldn’t send thousands of plastic diapers to landfill for the next half-millennium? Cloth diapers were not an option, apparently, as the energy and water required to wash them was viewed by the pair as wasteful, as well as “triple the amount of work.”

Eventually She, a pathologist at the Keck School of Medicine at the University of Southern California, and Bender, a pediatric infectious-disease specialist at Children’s Hospital Los Angeles, discovered Elimination Communication (EC), a.k.a. natural infant hygiene. They used the method to great success, and on June 21, published a paper in Pediatrics about the experience.

The idea behind EC is to use an infant’s natural timing and cues to recognize when he or she needs to go to the toilet. Caregivers learn to “coordinate” elimination, rather than allowing it to happen in a diaper.

“Contrary to the notion that infants relieve themselves randomly and constantly throughout the day, infants naturally eliminate at predictable times, such as on waking or after feeding. Caregivers can incorporate audio cues (soft whistle or hum) to associate with the act of eliminating. With practice, many children learn to eliminate when they are in proper position and hear the cue.”

While this concept may seem mind-boggling to Americans, statistics suggest that the rest of the world knows something about potty training that we do not. Roughly half of babies elsewhere are trained by one year, and 80 percent between twelve and eighteen months of age. Meanwhile, in the U.S., the current average age of toilet-training completion is between three and four years of age.

It wasn’t always this way. Prior to the 1960s, American parents, too, trained kids young. My favorite parenting book, The Baby Whisperer Solves All Your Problems by Tracy Hogg, explains that, in the 1950s, 92 percent of American children were trained by 18 months – but then things changed. Disposable diapers were introduced in 1955, making it easier and more comfortable for children to remain in diapers for prolonged periods of time; and, in 1962, a popular pediatrician named T. Berry Brazelton discouraged parents from pushing kids to toilet-train prematurely, saying that parents didn’t have sufficient time at home in the post-partum months to learn those skills.

In the process, a valuable practice was lost, and is only just coming to light again. As She writes in her paper:

“When we talk about EC with others, many are shocked that that early toilet training is even possible. Interestingly, it is the grandparents and great-grandparents that are most familiar with EC and are the biggest supporters of using it.”

Bender advocates for it from a medical standpoint, saying that it reduces the incidence of urinary tract infections and the highly contagious, antibiotic-resistant MSRA abscesses that he commonly sees in his practice as a result of prolonged time spent in soiled diapers.

I did not try EC with my children, though now I wish I had. Fellow TreeHugger writer Derek has done it with his kids and speaks highly of the method. Tracey Hogg recommends starting at nine months of age, once a child can sit up independently, although some parents start soon after birth. One interesting suggestion that Hogg makes is not to let kids carry around a sippy cup all day long, because this makes urination erratic. “Limit drinks to regular times – after meals, two hours between as a snack – so that the liquids at least come out at predictable times.”

Bender and She hope that their paper will spread the word about EC’s benefits, since many parents are entirely unaware that such a method exists:

“For young families interested in protecting the environment for future generations, who want to save some money and keep their kids healthy, this is a good option. It’s not for everyone, and we don’t want people to feel bad if they can’t do it. We really want people to hear about it as an option.”