Infant toilet training: An evidence-based guide
While using the toilet is a pretty straight-forward action, toilet training is a bit more complex. There may not be too many different ways to go about using the potty, but there are a variety of ways to teach this important life skill. It’s no wonder that parents are sometimes unsure how to approach it, as even the experts disagree.
by Gwen Dewar, Ph.D.
2006-2010 Gwen Dewar, Ph.D., all rights reserved Throughout much of the non-Western world, infant toilet training is the norm. In India, China, Southeast Asia, Eastern Europe, the arctic, and parts of Africa and Latin America, parents leave baby bottoms uncovered (Boucke 2003; Sonna 2006; deVries and deVries 1977). Diapers are considered unnecessary, even disgusting. When babies have to eliminate, parents hold them over a preferred target (e.g., a toilet, an outdoor latrine, or simply open ground) until business is done. How do parents know when their babies need to go? By paying close attention. In these “bare-bottom" cultures, babies spend much of their days being carried around. Parents learn to read their babies' cues, and (eventually) babies learn to hold back until their parents give them the signal—usually a special vocalization, like “sheee-sheee" or “shuuuus" (Boucke 2003; deVries and deVries 1977). Sometimes called “elimination communication," this method is now being adopted by some parents in the United States and other Western countries. Are these babies toilet trained? Yes, if by “toilet trained" we mean that infants go where their parents want them to go. But babies can’t walk, wipe, or dress themselves. Clearly these infants are NOT completely toilet trained in the sense of being capable of taking independent trips to the toilet. Full toilet independence comes later, after the kids learn to walk, follow verbal instructions, manipulate clothing, wipe, and so forth. So "elimination communication" is not what most Western parents mean by “toilet training." Nevertheless, for some people, it has many advantages. Benefits of infant toilet training Infant toilet training depends on establishing close communication about the baby's frequent needs to eliminate. It's time-consuming, but potentially rewarding in the same way that communication about feedings can be rewarding. Infant potty training also means:
- Eliminating diaper rash and diaper-related infections
- Saving money on diapers and diaper paraphernalia
- Generating fewer non-biodegradable, disposable diapers
- Using less energy to wash and dry cloth diapers, and—very possibly—
- Reducing rates of urinary tract infection later in life (for details, see this evidence-based article about the timing of toilet training)
- Older kids have learned to ignore body signals and must relearn them
- Older kids are used to wearing soiled diapers and may resist change
- Older kids are more likely to test your authority (the “terrible twos")
- Older kids’ urine is stinkier, making accidents less pleasant to clean
- Observe the baby’s body signals before he voids. For example, your baby may squirm, shudder, make faces, or change his breathing patterns. Many parents keep their baby’s bottom uncovered to make observation easier. If so, parents can keep an absorbent cloth under the baby’s bottom to make clean-up easier. But parents may also keep their baby in diapers while they learn to identify the signals. Either way, you’ll need to invest time in close observation. In many parts of the world, this comes easily because parents carry their babies most of the time.
- Once you recognize your baby’s body signals, hold your baby over a preferred receptacle while she eliminates. For very young babies, some parents use bowls or sinks (Boucke 2003; Sonna 2006). If your baby can sit up by herself, consider placing her directly on a potty chair. But before seating her, get her to look at the chair first. This will help her learn to associate her urges with the potty. This infant toilet training method was used very successfully in a Dutch study of 4 infants aged 3-6 months (Smeets et al 1985). I provide a more detailed account below.
- Teach the baby to associate certain cues with elimination. In many parts of the world, parents make a characteristic sound or gesture while the baby voids. Babies learn to associate the sound with the action and, eventually, parents can use the signal as an invitation to void. In the Dutch study reported by Smeets et al, parents used the potty chair as the cue.