Elimination communication: Can infants actually be potty trained?

Cate Prichard was pregnant with her first baby when she listened to a podcast about “elimination communication” (EC) and it sort of blew her mind. The idea behind EC, which is also known as infant potty training, baby-led potty training or “natural infant hygiene,” is that babies are born with an awareness of their need to pee and poop, and an instinct not to soil themselves. If parents could only pay attention to their baby’s cues to go, they could avoid diapers some or even all of the time and their babies would be cleaner, drier and happier. They’d probably be potty trained before their peers, too.

When Prichard’s son was five months old, she noticed one of these so-called cues. Her baby had been in the habit of “waiting” for a diaper change and then peeing or pooping right in the middle of one, and that’s when the idea really made sense. Why am I even bothering to catch it in a diaper, she wondered, when I could put him on a potty instead?

Evolutionarily speaking, parents around the world have always found resourceful ways to redirect little ones’ waste without diapers or even washing machines—whether it was holding them out to relieve themselves on the absorbent ground, using split pants or a sturdy pot. And while Western pediatricians have, since the 1950s, advocated the “readiness approach” to potty training—that is, waiting until your child is developmentally more independent—EC still remains the dominant method of baby hygiene in non-industrialized societies.

So, are the rest of us modern parents missing something? There’s no doubt the older way of doing things is harder. I mean, there’s no denying it sounds exhausting, not to mention messy AF. But EC enthusiasts think full-time diapering—that is, using diapers to not just catch something unpleasant, but to hold onto it, too—is also pretty gross.

What's the point of elimination communication?

ECers tout many advantages of going diaper-free or using them sparingly—and perhaps surprisingly, none of them are really about kids being fully potty trained sooner, says Jenn Philpott, a London, England-based bioscientist and potty-training educator, who launched the site Born Ready in 2010.

It’s cleaner and drier

Having their baby stay as dry as possible is a major selling point for people who practice EC. While many parents feel satisfied that diapers, disposable ones especially, do a pretty good job at keeping moisture away from the skin, ECers aren’t as convinced. “If people think their baby’s nappy locks away the wee and they can barely feel it, then to them that’s not important,” says Philpott. “But to me, that’s still important. I don’t think it really locks it away. I think it’s wet and sweaty and kind of disgusting.”

Infants using a potty instead of a diaper also means less poop gets on delicate private parts, and people who practice EC also say their babies rarely or never get rashes on their sensitive tushies.

It respects your baby

Many ECers see the method as an extension of attachment parenting—wanting to read your child’s needs and responding quickly. “Even when we have misses, because they were changed so regularly it felt like you were treating them the way you would want to be treated, like a proper little person and not like ‘Well, you’re on my schedule and I’m going to change you before lunch,’” says Philpott. “It’s about respecting that baby.”

This was the case for Prichard, who also thought EC would help with her eventual efforts into teaching her child to use the potty independently. “When my son started holding until I opened the diaper, it seemed like EC was the easiest way to respond to the need he was communicating—to avoid the feeling of having waste near his skin,” she says. “But it was also an opportunity to try something I thought would make life easier down the road.”

It saves the planet (and money)

If one baby goes through five diaper changes a day, that’s 1,825 changes a year and 4,563 diapers in landfills by the time they reach two a half years old, the average age that kids in North America are toilet trained. (And if your city allows plastic-coated disposable diapers in green bins, that doesn’t mean they’re magically biodegradable. The plastic and absorbent chemicals are sorted and sent to landfills. We’re still disposing around 30 billion diapers every year in North America alone. If you can cut that number of diapers even just in half—whether they’re cloth or disposable—you’re also saving hundreds of dollars or more on fresh changes and cleaning costs. Philpott says her kids pooped in a little over 20 nappies per kid, and Prichard says she cut down dirty diapers by 50 percent.

How to practice elimination communication

Learn the cues

There are plenty of books and courses that teach EC step-by-step, but the gist is that babies instinctively communicate when they need to pee or poop, just like they give signals for when they’re tired or hungry. They might make a funny face, fuss or squirm—every baby is different. So, if you can start picking up on the cues, when you think your baby needs to pee or poop, sit them on a potty, supporting them if they’re not yet sitting up on their own, or hold them in a seated or squatting position over a toilet. Some parents will even hold a container under a bare-bottomed baby while they’re feeding if that’s when they like to go.

Time it

Some parents like Philpott have even perfected the timing of their baby’s dream wees in the middle of the night, which, let’s be honest, is way over the top for most parents. But even if you’re not that committed, other parents will take a more scheduled approach. Prichard says she wasn’t intuitive at all about reading her baby’s cues and practiced EC by simply offering the potty whenever she would normally change a diaper.

Use diapers as back-up

Lots of parents who do EC still use diapers on their babies, but the goal is just to try to avoid soiling them. Instead of using diapers as a permanent, wearable toilet (as many ECers describe them), you can just use them as back-up to catch “misses.” That said, many EC enthusiasts still rely on diapers at night and during outings.

Just get started

Philpott insists babies are ready for EC from birth, and the easiest way to introduce it is by putting them on the potty first thing in the morning for a pee. “Everybody changes a nappy first thing in the morning, that’s a really easy one to give a go.” You should only have to keep them on the potty for less than 30 seconds, she says, depending on how old they are and whether they know what they're doing. If you know they always pee or poop on the potty first thing in the morning, then you can hold them a bit longer to wait for it. Eventually it will become routine.

After offering the potty in the morning, continue to put your baby on whenever you notice a signal that they need to go (see “learning the cues,” below).

Does elimination communication really work?

“In practical terms, early potting seems a lot of effort with not much reward,” says Penelope Leach, a British psychologist who has researched and written extensively on parenting issues and takes an academic approach to child development in her book Babyhood. According to Leach, the majority of children will be more or less reliable in the daytime between two and three years old, whether they are first put on the potty at six days, six months or 16 months. Among pediatricians as well, the consensus for the last several decades has been to start potty training only after 18 months.

And for most parents, even getting a toddler to do expedited three-day potty training is intense—so why start from birth if you will inevitably just be dragging out the time you'll obsess over getting your kid to use the toilet independently, adding many difficult months to the process?

Some people simply prefer to start sooner rather than later. Prichard says her son, who’s now six, was only potty trained at two and a half, typical for any toddler, but she doesn’t count that as failure because early training wasn’t actually the goal. “For us, it was developing the learning ahead of time and avoiding the power struggles that I’d heard about,” she says. “Once he was a toddler and very sensitive to coercion, and also very reluctant to change, I realized that if we'd done it another way we would have been in for a really long process with potential for a lot of anxiety and conflict. But [with], he was able to make the transition very smoothly.”

Prichard says she also practiced EC with her second child, now four. Her daughter started from birth and picked it up much quicker, not soiling a diaper in any way since she was 16 or 17 months old.  “The journey was very different with each of them, but in both cases I didn't have to change many poop diapers after six months or any after 15 months for either of them. Of course I did have to clean the potty, but I found that easier,” she says. “It definitely resulted in a low-stress toilet learning experience for both of my kids.”

But in some cases, it can be high-stress for parents—too high. Unsettled by the thought of heaps of landfill-bound diapers, Sue Hobson read EC bible Go Diaper Free by Andrea Olson when she was pregnant, and planned to start introducing the potty from day one. But with the newborn learning curve as steep as it is, she didn’t even take the potty out of storage until four months into parenthood. But even then, it didn’t go well.

Hobson quickly found herself overwhelmed and exhausted by the process. “I was obsessing way too much, writing down each pee and poop, constantly on high alert watching my babe for signs,” she recalls. “When I couldn’t read his signals I felt discouraged; I had thought that it would be instinctual, and then found myself doubting my abilities as a mom.”

Hobson backed off completely, and when she restarted about three months later, she kept it simple, only putting her infant son on the potty first thing in the morning or when she was certain he was going to poop. By the time he was a year, she says she was still “catching” most bowel movements. Her son, who’s now three, was fully potty-trained at 21 months and Hobson believes that EC helped the process go smoother.  “I liked that my child was familiar with the toilet from a very young age,” she says. “I also found it encouraging to learn that EC is the norm in many cultures, and that I wasn’t completely off the wall in wanting to ditch diapers early.”

Ultimately, many parents who have tried EC say it helps with potty training in the long run, even if they’re just using a potty a couple times a day and a diaper the rest of the time. “They know what the potty is for, they recognize when they need to poo and they know that they’re going to go there,” says Philpott. “They don’t have to make up rituals for themselves, like standing in the corner to poop.”

What do critics of elimination communication say?

It’s harder to find medical professionals who are just as positive about EC, and they’re often skeptical it’s worth the effort. There is also concern that early potty training can lead to issues with chronic constipation and accidents in childhood. Steve Hodges, a pediatric urologist in North Carolina who has been openly critical of baby potty training, cautions that any type of early training can cause kids to hold their pee and poop and not empty their bladder and bowels completely when they do go to the toilet, which can lead to “dysfunctional elimination” issues. “The moment you remove their freedom [to], almost all of them will hold it to some degree, not empty all at one time, and that’s when the problems start.”

Hodges says that if you’re looking at EC from an evolutionary perspective, it’s diapers—not EC—that actually mimic the most natural way to go. “The most natural way that a kid can empty their bowels and bladder is whenever they want and completely, so any barriers to that are bad, that’s the main thing.” While Hodges isn’t a fan of EC, he also doesn’t see ECers in his clinic. (Many of the families he sees in North Carolina that practice early potty training do so for financial reasons.) He says that if parents are committed to any type of toilet training process, it’s fine as long as there are no barriers to eliminating, no history of accidents in the family and no pooping issues for the kid.

“I don’t want to judge anybody, but I can tell you that the only problems I see in kids are due to delayed emptying of the bowel and bladder,” he cautions. “I don’t see UTIs in girls until they start being potty trained, until they start holding. I don’t see accidents in terms of the backing up of poop, until they start holding. If kids and babies all emptied on time and completely, I would lose half of my patients overnight.”

Common mistakes parents make when practicing elimination communication

If you want to give EC a try, Philpott says not to expect too much right away because you’ll wind up frustrated and disappointed—success doesn’t go in a straight line. And once you start, make sure you’re giving them that chance to go on the potty often so they don’t get constipated.

“Some people think they can have their baby done and dusted at 13 months and it’s just unrealistic,” she says. “People get despondent and they think it’s not working for them and really it’s because they’ve got a little baby—they haven’t got a machine.”