Elimination Communication (part 3): Frequently asked questions

In this last part we will look at some commonly asked questions about EC:
• Potty pauses
• EC when outside
• EC at night
• What are the advantages of EC

Read part one (what is EC) here and part two (how to do EC) here.

My journey with EC had lots of ups and downs. I used to get frustrated every once in a while, when I had days with lots of misses or baby was refusing to sit on the potty. I later read that potty refusals (called potty pauses) are actually quite common at certain ages.
Potty pauses are when a baby who was consistently going in the potty suddenly refuses to sit on the potty anymore. They usually happen when baby is working on new developmental skills, (like crawling and walking). Many babies between 9 and 14 months want to practice crawling, cruising and walking and will refuse to sit on the potty even though they were willing to sit before.
What can you do?
 Know that this normal and expected. Try not to stress about the refusal to sit on the potty.

 Keep offering the potty every once in a while. Many babies will consent to sit on the potty first thing in the morning and continue to poop in the potty as well.

 If you are getting too stressed, back off for a day or two.

 Keep baby in cloth diapers so that misses are easy to clean up. I never tried to go diaper free during potty pauses; it was too frustrating. It was much easier to just throw the diaper for a wash.

 A change of scene helps.
Try a different bathroom (this worked very well for my second baby)
Try switching up between the floor potty and toilet seat reducer.

 Read or sing to the baby or provide some special toys to play. (My mother used to play a game of “where is the wall”, “where is the door” with my kids to keep them happy).

 Never force baby to sit on potty . If they are clearly unwilling to sit, just let them be.

 Mostly, my two would be happy to sit after a couple of days.

What about EC when going out? I took my babies to the potty when out only after 18 months old. In India public toilets are quite dirty and I did not feel comfortable taking young babies.
I would always offer potty right before leaving and as soon as I got home.
Some people choose to carry small travel potties along with them. I never did because it was too much for me. I had enough stuff to carry anyway. It’s really up to you to decide what to do.

EC at night:
I (mostly) did not take my babies to pee at night till about 2 years old. I preferred to nurse to sleep before that. In case they were not settled by nursing, I would try the potty.

At about 2 years old, I took them potty right before bed time and again when I went to bed (they would pee when half asleep). That helped them remain dry at night.

Both my daughters were fairly consistently dry at night by2.5 years or so. They rarely woke to pee after 2.5 years old.

You can certainly take younger babies to pee at night as well, my two were quite unhappy to be taken therefore I never really pushed it. As always, follow your baby’s cues.

Advantages of EC:
Whatever your EC journey looks like, EC has certain advantages over conventional potty training.
 The most important is that baby does not get diaper trained and then later have to unlearn everything. Conventional potty training often begins at age 2, the age when toddlers are at their most defiant. EC on the other hand is often ending by age 2 to 2.5 years. EC Babies and toddlers simply view the potty as a regular part of their day to day life, rather than a power struggle.

 EC babies poop on the potty from early on.

 EC is environment friendly, as poop goes in the potty and lesser diapers are used and washed.

 EC babies need fewer diaper changes

 EC babies seldom get diaper rash.

To sign off, I would like to talk about why EC works. There is not much research done on EC. Conventional potty training wisdom says that kids less than 18 to 24 months old do not understand the sensation of a full bladder or wanting to poop.

However, anecdotal data on EC seems to indicate otherwise. Many EC babies regularly communicate the need to go from very young ages. EC babies also seem to learn to control their bladders and bowels earlier. With so many advantages of EC, why not give it a try? I personally liked that there was one lesser power struggle with my 2 year olds!

Happy Potty (P)Oops Parenting!
Aparna
13/1/2015

References:
1. Duong TH1, Jansson UB, Holmdahl G, Sillén U, Hellström AL. Urinary bladder control during the first 3 years of life in healthy children in Vietnam–a comparison study with Swedish children. J Pediatr Urol. 2013
2. Duong TH1, Jansson UB, Hellström AL Vietnamese mothers’ experiences with potty training procedure for children from birth to 2 years of age. J Pediatr Urol. 2013 Dec
3. Rugolotto S1, Sun M, Boucke L, Calò DG, Tatò LToilet training started during the first year of life: a report on elimination signals, stool toileting refusal and completion age. Minerva Pediatr. 2008 Feb;60(1):27-35
4. Sun M1, Rugolotto S. Assisted infant toilet training in a Western family setting. J Dev Behav Pediatr. 2004 Apr;25(2):99-101.

Elimination communication (Part 2):How to do elimination communication

Part two of our series on elimination communication. Read part one here

One way to start is to put the baby in simple cotton nappies for a day or two and then observe their elimination patterns and signals. Many babies give certain cues when they are about to eliminate. Cues may be:

• Unexplained crying
• Grunting
• Squirming
• Have a distant look or certain expression on their face.
• Difficulty settling down to sleep.
• Intuition: A feeling that baby has peed or is about to pee

My second baby would pop on and off the breast while feeding when she wanted to poop. It took a few times of her pooping in the middle of a feed to help me understand this signal.Take baby to potty if you notice your baby giving these cues.

Some parents make a cue sound like “ssss” when baby is peeing. Over time baby may become conditioned and pee when they hear the cue. I did not do this consistently, but it works well for some babies.

If you feel it’s difficult to notice cues, you can take baby to potty based on timing. Almost all babies pee immediately upon getting up from a nap (most babies do not pee while sleeping). My babies would generally pee a lot, every 15 minutes or so after morning wake up and slowly taper down their frequency to 30 min to an hour.Frequency would be least in the evenings and at night. Offer the potty first thing in the morning after waking up and then every 30 minutes or so. Offer the potty at each diaper change.

You can choose to use any combination of the above methods. There is no one best way to do EC. Do what works for your family and leave the rest. And do not take it personally if baby refuses to sit on the toilet and 5 minutes later pees in their diaper. Just say pee belongs in the potty and clean baby up. Never force baby to sit on the potty either, respect their autonomy.

When you start, it is a bit of a hit or miss. But pretty soon you will figure out your baby’s signals. Baby will also come to expect that they will be taken to the potty and will slowly learn to “hold” their pee or poop. My babies could hold poop from very early on. They would not poop in the diaper if at all possible. Once when my first daughter was 17 months old, she told me she wanted to poop and there was no place for me to take her (we were on vacation). She refused to go in the diaper and was able to hold her poop for nearly 30 minutes till we got back to the hotel. I used to take a portable toilet seat reducer when traveling. That brings me to the next point. Which is better; the floor potty or the toilet seat reducer?

With my first daughter, I started with a floor potty and later transitioned to the toilet seat reducer. My second daughter directly went to the toilet seat reducer after she was sitting up.Before she was sitting up, I held her over the sink to pee. Like this:

You will have to experiment and see what works for you and your baby at different ages. So when can we start EC? I started at 2 months and 2 weeks with my two. It’s fine to start EC as soon as you want after birth. In the first few weeks we mothers are recovering from birth and concentrating on establishing breastfeeding. Therefore 6 to 12 weeks postpartum is a good time to start. Some people start at 5 to 6 months when baby is sitting up. Some people start even later, beyond 12 months old. If you do start beyond 12 months, expect some resistance. Baby is used to eliminating in the diaper, so will need some time to get used to the idea of using the toilet. Don’t force the baby at all. Just provide plenty of potty opportunities especially at predictable times, like upon morning wake up or after naps and your baby will get it soon. It helps to provide toys or books to baby when they are sitting on the potty.

The progression of EC is never linear. My second daughter refused to sit on the potty (for pees) when sick. My oldest was inconsistent when traveling. It’s normal to have setbacks. Just keep the communication open and move on. My babies timeline went something like this:

Consistent with poop (6 and 13 months) →Fairly Consistent with day time pee (2 years old) → Night dry ( 2.5 and 2 years) → Completely consistent with day time pee ( 2.6 and 2.3 years old).

This seems to be the case with most EC babies, that they are consistent with poop much before pee. Not changing poop diapers? Win win in my book. EC was worth it just for that. In the next and last part of EC, I will deal with potty pauses, EC when out and at night and the advantages of EC.

Happy Potty (P)Oops Parenting.

Aparna

12/1/2015

References:
1. Duong TH1, Jansson UB, Holmdahl G, Sillén U, Hellström AL. Urinary bladder control during the first 3 years of life in healthy children in Vietnam–a comparison study with Swedish children. J Pediatr Urol. 2013

2. Duong TH1, Jansson UB, Hellström AL Vietnamese mothers’ experiences with potty training procedure for children from birth to 2 years of age. J Pediatr Urol. 2013 Dec

3. Rugolotto S1, Sun M, Boucke L, Calò DG, Tatò LToilet training started during the first year of life: a report on elimination signals, stool toileting refusal and completion age. Minerva Pediatr. 2008 Feb;60(1):27-35

4. Sun M1, Rugolotto S. Assisted infant toilet training in a Western family setting. J Dev Behav Pediatr. 2004 Apr;25(2):99-101.

Elimination Communication: part 1

When I had my first daughter in 2008, my two biggest worries were about whether I would be able to breastfeed successfully and how to potty train her? We had a rough start with breastfeeding, but got over the initial hurdles and I nursed her for over 3 years. This was in spite of trying to read up about breastfeeding before birth. In hindsight, I see my problems were because of lack of knowledge about how babies behave in the first few weeks. I will be blogging about breastfeeding too. Watch out! However potty training, I hadn’t read much about. All I knew were stories of my friends struggling to train their toddlers and moaning about how hard it was. I knew nothing about elimination communication at all. When my daughter was about 7 weeks old, my mom started taking her to pee in the sink. I used to laugh at mom and say, what are you doing? But fortunately for me, my mom persisted, and I (very halfheartedly) continued when my mom left. My main motivation was to avoid diaper changes since I was using cloth diapers. To my surprise, it worked very well. My baby was pooping in the potty consistently by 13 months and was diaper free day and night by 2.5 years old. I was a convert! I later read that what my mom did had a formal name “elimination communication”. I started elimination communication very slowly at about 2 weeks with my second daughter and she was consistently pooping in the potty by about 6 months and was diaper free day and night by about 2 years old.

What is elimination communication or EC? Elimination communication is a thought process that infants are aware of the sensations of wanting to pee or poop from birth. Newborns often cry and squirm when they want to pee or poop. EC helps our babies retain this innate knowledge of their sensations. Parents and caregivers tune into baby’s signals and help baby pee or poop in the toilet. It is a gentle way of helping babies and toddlers understand that peeing and pooping are done in the toilet and not in the diaper.

It is also important to know what EC is not. EC is not “toilet training”. EC does not believe in rewarding babies for sitting on the potty or forcing babies to sit on the potty. The goal is not to catch each and every pee and poop. The goal is to help our babies and toddlers recognize and keep in touch with their bodily sensations. The most important aspect of EC is the communication between the baby and caregiver. Each miss is a communication. So maybe we parents were too busy to catch the baby’s cues or simply were in no position to respond to their cues. Or there are phases in which babies are not interested in sitting on the toilet even when we know they have to go. The so called potty pauses. That is fine.

I suggest using cloth diaper back up with EC to keep the pressure off. In case of a missed pee or poop, you only need to change diapers. There may be days when you barely catch anything, but it is ok. Good and bad days happen and are par for the course. EC is not a miracle “potty train in 3 days” method. EC is an ongoing communication between baby and caregiver.

EC is not all or nothing. There is nothing like 100 percent perfect EC, so please do not stress over any misses. You can choose to do as much or as little as you want. Part time EC is also possible. If you can take your baby to the potty only before and after work, that is fine too. With both my daughters, I had phases lasting from 1 to 3 months, where I was using disposable diapers a lot, and only took them to potty a couple of times a day. They still got back to more or less full time EC after I was able to take them more often. So don’t put undue pressure on yourself. Relax and go with the “flow”. Pun intended.

In the next part I will talk about the “how” of elimination communication.

“Happy Potty (P)Oops Parenting”.

Aparna
11/1/2015