Elimination Communication, or Why My Babies Used the Toilet
Elimination Communication (EC) is the practice of paying attention to your baby’s timing and behaviour indicating the need to eliminate (pee or poo) in a similar manner to how you learn their rhythm and signals for hunger and sleep. Versions of EC are still practiced in various places around the world where there are more intact traditional cultures and less access to disposable diapers. And just a couple generations ago, North American and European children were out of diapers years before they are these days.
When I first encountered EC, it was a pretty niche hippie-granola idea in North America and Europe. News stories have started appearing about it more recently and they usually follow a similar formula: a basic explanation of what it is, a personal anecdote or two from a family who actually tried it and found it was amazing, followed by quotes from a series of pediatric doctors or other experts talking about why it is impractical and claiming potty training that young is developmentally impossible.
In terms of practicality in our society, it will be more challenging for families using daycare before age 1 than for those with a stay-at-home parent. But as far as what is developmentally possible, my suspicion is that these experts have little to no experience with EC’d babies because it is not widely practiced here and so they assume that EC babies have the same skillset as exclusively diapered babies.
Having practiced EC with both my children (we started at 2 weeks with one and 2 months with the other), I can categorically say it is the most civilised approach to the bottom-end needs. Unfortunately, most babies are trained out of a natural instinct not to soil themselves and trained to use a diaper. Then, a couple years later, the parents and child have to unlearn that approach with some form of potty training or toilet learning. Having seen EC fully through from baby to independent toddler twice now, it feels more respectful to nurture their awareness from the beginning.
Human babies have 3 basic physical needs: eating, sleeping, and eliminating. We are expected to learn our baby’s signs for the first two and many parents spend a great deal of time considering the various approaches for eating and sleeping. For eating, a parent might consider: Breastfeeding, bottle-feeding, formula, or a combination. Baby-led weaning or purees. Starting solids based on behaviour or waiting until 6 months. Introducing foods individually or sharing from the family meal. For sleeping, a parent might ponder: Co-sleeping or a bassinet or in a separate room. A floor bed or a crib. Sleep training or not. Regular nap times or just on-the-go. Waking a baby if they sleep longer than usual or leaving them to sleep. But when it comes to elimination needs, parents usually choose diapering by default and the only decision is between cloth or disposables. What a missed opportunity!
Babies do not eliminate randomly and with no awareness. They have predictable times: particularly after feeding, after sleeping, after being removed from a carrier or stroller, or when a diaper is removed. Additionally, each baby will have their own rhythm and signals for elimination just like for when they are hungry or tired. Newborns who appear to be crying due to a wet diaper may actually have begun crying BEFORE they eliminated and newborns frequently will eliminate DURING a diaper change or bath (a sign of the natural instinct to not soil themselves when clothed). These behaviours will disappear if you constantly diaper a child, but if you attempt to respond, babies will become more obvious with their signs and begin to give you more time to get them in an appropriate place and position. Even tiny babies DO have the ability to wait (a little bit) if they expect their needs will be met. The experts who claim that children don’t develop the awareness or ability to “hold it” until 18 months to two-and-a-half are surely talking about when a baby can re-learn these skills as EC’d babies never lose these instincts in the first place. Instead these abilities can be nurtured rather than ignored, lost, and later rebuilt.
How do you start?
We began by introducing a “cue” sound (We used the sound “psss” but any consistently used sound could work). In the beginning, whenever you see your baby pee or poo, acknowledge what is happening in a positive way (try not to yelp if they’ve peed on you!) and make the cue sound. If necessary, have some diaper-free time (on a waterproof mat or held with an open cloth diaper) and just wait to see when your baby goes. After feeding was the easiest time for us to catch it and introduce the cue sound. Very quickly, your baby will associate the cue sound with their elimination. Some signs to watch for are a baby suddenly going very still and focused, or alternately starting to wriggle after being calm, or a sudden cry shortly after feeding.
In combination with observing your baby during diaper-free time, you can also try offering at the most obvious timings (after feeding, after sleeping, after coming out of a carrier or stroller, when removing a diaper, and before bathtime). You can hold them over an appropriate place when you think they will need to go and make the cue sound. I started by holding my babies over an open cloth diaper, then over a small bucket or potty, or over a toilet. If we were outside without access to a toilet, I figured that anywhere a dog was allowed to go was fair game for my baby. Obviously we tried to be discreet (and we carried little baggies just like you would if walking a dog). The more time you can spend to get the routine established earlier, the more easily you will get started. You will need some time to observe your baby’s rhythm. Once you and your baby know what to do, it will be quick and as easy or easier than changing a diaper. Some people are so in tune that they skip diapers altogether but for us it was a better balance to use diapers as a backup. With my second baby (ie. I was more experienced), I was able to get us “up and running” after about 3 days of observing during one “round” of feeding and awake time by having them diaper-free on a wet protector mat on my lap or the floor. Within a week, our EC routine was fully established.
How does a toilet opportunity work?
I mostly held my babies with my hands around their thighs and their body supported between and along my arms with their back towards my body. It actually holds their legs into a squatting position which is a more comfortable position for elimination. Once they are able to support their head, you can help them sit on a small potty if you or they prefer. With very young babies, it may be simpler to rest them over an open cloth diaper rather than hold them up in the air. You can make your cue sound once they are in place and being held in the same way becomes enough of a routine that they will often understand even without the cue. If you have the timing right, then they will usually go immediately or within 30 seconds. If they don’t go, just try again later. Your baby may express a preference for different locations at various developmental phases. For example, they might stretch their legs straight if they do not want to go where you offer (or if they simply don’t need to go when you thought they did). Both mine went through a phase where they preferred to be held over a potty sitting in the bathtub rather than over the toilet. Being flexible and adaptable and following your baby’s cues is an important part of EC success.
Is it harder than diapering?
It depends what you find hard. The work of EC is different. With EC, the work is spread out more evenly (and more mess-free) rather than batched together. If you diaper your baby, then you can ignore their elimination for hours at a time. However, eventually you may have both an unhappy child and a very messy bottom to deal with. And in a couple years you will have to train them out of diapers (which can be stressful for both children and parents). With EC, you have to pay attention and make more opportunities for the baby to eliminate (the younger and smaller they are, the smaller their bladder and waiting ability), but it is cleaner for the baby (no diaper rash!), facilitates another way to connect and respond to their needs, and avoids unpleasant clean-up jobs after the inevitable. Once your routine is established, using EC is generally quicker than a diaper change. And in the long-run, you will avoid much of the work of potty-training because your child will never have been diaper-trained. Like any parenting choice, whether you diaper or EC or something in between, you will probably feel strongly that your way was the best because it’s what worked well for your family.
What can you do if your baby goes to daycare?
I have read that even a consistent, but part-time approach can maintain their inborn awareness. If you practice EC with a specific caregiver, at regular times (e.g. with parents during evenings and weekends) your baby will probably learn that routine just as a baby might breastfeed at home and take a bottle at daycare.
When will they be fully independent with the toilet?
My experience with my children was that they were “mostly” trained by a year or earlier, but not fully independent about the process until 2–2.5 years (i.e. the time that conventional training often takes place). In terms of clear self-initiation, one of my children began using a baby sign for “toilet” at 10 months and the other used a baby word for potty at 14 months. But long before that, we were already catching 95% of elimination in the toilet based on the rhythm and awareness we had developed. There were still some misses of course and for our convenience we used diapers as a back-up, then training pants once misses became rare.
What is inconvenient about it?
EC is another thing to pay attention to in the already busy baby time. You may not meet any other parents following this approach. There are times you will need a toileting place on short notice. And when you have “misses”, even if your child is in a diaper, you may feel quite bad about it as you will be so used to keeping your baby clean.
What is so amazing about it?
EC is so much more civilised for both caregivers and babies. It is very convenient during travel (such as on airplanes or in places where changing facilities are rare). You won’t need to use diaper creams and your baby will avoid the discomforts of diaper rash and dirty diapers. You will use fewer diapers (either cloth or disposable) even if you still use them in combination with EC, like we did. EC is the most environmentally conscious option and probably the best fit for low-waste or zero-waste lifestyles. The transition to independent toilet usage will likely be earlier and a more gradual and natural progression for your baby as they will have always used a toilet or potty, at least part-time.
