Elimination communication

Last updated

Elimination communication (EC) is a practice in which a caregiver uses timing, signals, cues, and intuition to address an infant's need to eliminate waste. Caregivers try to recognize and respond to babies' bodily needs and enable them to urinate and defecate in an appropriate place (e.g. a toilet). Caregivers may use diapers (nappies) as a back-up in case of "misses" some or all of the time, or not at all. EC emphasizes communication between the caregiver and child, helping them both become more attuned to the child's innate rhythms and control of urination and defecation. The term "elimination communication" was inspired by traditional practices of diaperless baby care in less industrialized countries and hunter-gatherer cultures. Some practitioners of EC begin soon after birth, the optimum window being zero to four months in terms of helping the baby get in tune with their elimination needs,[ citation needed ] although it can be started with babies of any age. The practice can be done full-time, part-time, or just occasionally.

Contents

Origins

Keeping babies clean and dry without diapers is standard practice in many cultures throughout the world. While this practice is only recently becoming known in industrialized societies, it remains the dominant method of baby hygiene in non-industrialized ones.[ citation needed ]

The terms elimination communication and natural infant hygiene were coined by Ingrid Bauer and are used interchangeably in her book, Diaper Free! The Gentle Wisdom of Natural Infant Hygiene (2001). Bauer had traveled to India and Africa, where she noticed that while most mothers carried their diaperless babies constantly, she saw no elimination "accidents" as would be expected in industrialized countries where babies wear diapers almost continuously from birth. Subsequently, she raised her own children with minimal use of diapers, and eventually began to share her approach with other mothers and caregivers—initially through Internet-based parenting support groups and eventually through her book and website. [1]

Prior publications introducing Western parents to this practice include the booklet Conscious Toilet Training, by Laurie Boucke (1979), the book Trickle Treat: Diaperless Infant Toilet Training Method, by Laurie Boucke (1991), a pamphlet entitled Elimination Timing, by Natec (1994), and the more extensive Infant Potty Training: A Gentle and Primeval Method Adapted to Modern Living, by Laurie Boucke (2000). Boucke was influenced by an Indian friend who taught her how mothers in India care for babies without diapers, and she adapted the method to fit her Western lifestyle. Boucke later co-produced an in-depth DVD entitled Potty Whispering: The Gentle Practice of Infant Potty Training (2006) and co-authored articles for medical journals. [2]

While the terms elimination communication and infant potty training have become synonymous, many caregivers who practice EC do not consider it to be a form of "training", per se. "Nappyless technique" is a term some mothers in the UK prefer to describe babies who use a potty. EC is viewed primarily as a way to meet the baby's present needs and to enhance attachment and communication in general. In that sense, EC is often likened to breastfeeding. "Toilet mastery is, of course, an inevitable consequence", writes Bauer, "Yet it's no more the goal of Natural Infant Hygiene than weaning is the goal of breastfeeding" (2001, p. 217).

Today, one often hears the terms "natural infant hygiene", "infant potty training", "nappy-free", "infant pottying" and "elimination communication" used synonymously.

Benefits

According to The Diaper-Free Baby by Christine Gross-Loh, EC offers a wide range of advantages. Because EC lessens families' reliance on diapers, this helps reduce the environmental impact of discarding disposable diapers and/or washing cloth diapers, and saves families hundreds, if not thousands, of dollars in disposable diapers. EC babies are free from the problems of conventional diapering such as diaper rash, diaper change battles, not being able to explore diapered parts of their bodies, vulnerability to urinary tract infections, and potentially delayed or difficult potty training. Gross-Loh also reports that EC promotes a unique and wonderful bond between babies and caregivers. [3]

Parents report that the squat or "potty" position that they tend to use to hold their baby in order to go is very comfortable for the baby. The position aligns the digestive tract and supports relaxation, as well as contraction of the pelvic floor muscles, helping babies to release their urine or stool and simultaneously build control of the urinary and anal sphincter muscles. This especially helps babies who are suffering from mild constipation. Many babies find defecating to be an unsettling process, especially as they transition to solid food. With EC, parents hold their infant in a supportive position as they defecate into the toilet or a suitable receptacle, offering loving emotional and physical support during this process.[ citation needed ]

Criticisms

Conventional potty training advice is based on late 1990s research by Thomas Berry Brazelton, who introduced the "readiness approach". He writes that "widespread acceptance of readiness and independent toileting have since been supported by clinical experience and resulted in agreement that a child should be ready to participate in toilet training at approximately 18 months of age and be trained completely by 2 or 3 years old." He argues that trying to toilet train before this age could be coercive and therefore psychologically damaging. [4] Brazelton acknowledges that elimination communication is both possible and desirable, but he believes it is difficult to perform in Western society. In particular he cites a mother's return to work as an obstacle to elimination communication. He also argues that parents should not be made to feel guilty if they cannot communicate with their babies in this way. [5] His neutrality on the subject has been questioned since he has worked as a consultant for Procter & Gamble, manufacturer of Pampers diapers, including appearing in a Pampers commercial. [6]

Components

The main components of EC are timing, signals, cueing, and intuition.

Timing

Timing refers to identifying the infant's natural timing of elimination. Newborns tend to urinate every 10–20 minutes, sometimes very regularly, which makes timing extremely useful. Older babies may still be very regular, or may vary in timing based on when they have last eaten or slept. As infants get older, the time between eliminations will increase. By six months, it is not uncommon for babies to go an hour or more without urinating while awake (babies, like adults, rarely urinate during a deep sleep). Timing varies radically for defecation, as some infants may have several bowel movements a day, while others may only have one every few days. Parents report that some babies as young as three months will appear to hold all their bowel movements until they are held in a particular squat position, as long as this is offered regularly enough.[ citation needed ] Parents also offer the potty at various times according to routine, e.g. after a feed, after waking, just before bath or bed.[ citation needed ] In the West, infant potty training historically relied on timing as the main method of training. [7] [8]

Signals

Signals are the baby's way of informing a caregiver of an elimination need. Some babies signal very clearly from the beginning, while others may have very subtle signals, or no signal at all. These signals vary widely from one infant to another. Examples include a certain facial expression, a particular cry, squirming, or a sudden unexplained fussiness, among others. Signals are most effectively observed if the baby is left without diapers for the first couple of weeks of starting elimination communication.[ citation needed ] Babies who are nursing will often start unlatching and relatching repeatedly as they feed when they need to eliminate. For defecation, many babies may grunt or pass gas as a signal. As babies get older their signals become more conscious and babies often point to, or look at, a caregiver or potty to indicate need. Older babies can learn a gesture or baby sign for "potty". Later they may learn a word as part of their early acquisition of language. [3]

Cueing

Cueing consists of the caregiver making a particular sound or other cue when they provide the baby with an opportunity to eliminate. At first, the caregiver can make the cueing sound when the baby is eliminating to develop an association between the sound and the action. Once the association is established, the cue can be used to indicate to the baby that he or she is in an appropriate potty place. This is especially useful for infants who may not recognize public toilets or unfamiliar receptacles as a "potty". Common sound cues include "psss psss" for urination and "hmm hmm" (grunting) for defecation. Older babies (late starters) may respond better to more word-like cues. Cues do not have to be auditory; the act of sitting on the potty itself or being held in position can serve as a cue, or the sign language sign for "toilet" can be a cue. The American Sign Language sign for "toilet" involves forming a hand into the letter "T" (a fist with the thumb inserted between the first and middle fingers) and shaking the hand side to side from the wrist. [9]

Intuition

Intuition refers to a caregiver's unprompted thought that the baby may need to eliminate. Although much intuition may simply be subconscious awareness of timing or signals, many parents who practice EC find it an extremely reliable component.[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Toilet humour</span> Type of off-colour humour dealing with defecation, urination and flatulence

Toilet humour, or potty or scatological humour, is a type of off-colour humour dealing with defecation, diarrhea, constipation, urination and flatulence, and to a lesser extent vomiting and other bodily functions.

<span class="mw-page-title-main">Diaper</span> Undergarment for incontinence containment

A diaper or a nappy is a type of underwear that allows the wearer to urinate or defecate without using a toilet, by absorbing or containing waste products to prevent soiling of outer clothing or the external environment. When diapers become wet or soiled, they require changing, generally by a second person such as a parent or caregiver. Failure to change a diaper on a sufficiently regular basis can result in skin problems around the area covered by the diaper.

<span class="mw-page-title-main">Infant</span> Very young offspring of humans

An infant or baby is the very young offspring of human beings. Infant is a formal or specialised synonym for the common term baby. The terms may also be used to refer to juveniles of other organisms. A newborn is, in colloquial use, an infant who is only hours, days, or up to one month old. In medical contexts, a newborn or neonate is an infant in the first 28 days after birth; the term applies to premature, full term, and postmature infants.

<span class="mw-page-title-main">Defecation</span> Expulsion of feces from the digestive tract

Defecation follows digestion, and is a necessary process by which organisms eliminate a solid, semisolid, or liquid waste material known as feces from the digestive tract via the anus or cloaca. The act has a variety of names ranging from the common, like pooping or crapping, to the technical, e.g. bowel movement, to the obscene (shitting), to the euphemistic, to the juvenile. The topic, usually avoided in polite company, can become the basis for some potty humor.

<span class="mw-page-title-main">Baby sign language</span> Signed language systems used with hearing infants/toddlers

Baby sign language is the use of manual signing allowing infants and toddlers to communicate emotions, desires, and objects prior to spoken language development. With guidance and encouragement, signing develops from a natural stage in infant development known as gesture. These gestures are taught in conjunction with speech to hearing children, and are not the same as a sign language. Some common benefits that have been found through the use of baby sign programs include an increased parent-child bond and communication, decreased frustration, and improved self-esteem for both the parent and child. Researchers have found that baby sign neither benefits nor harms the language development of infants. Promotional products and ease of information access have increased the attention that baby sign receives, making it pertinent that caregivers become educated before making the decision to use baby sign.

<span class="mw-page-title-main">T. Berry Brazelton</span> American pediatrician and author (1918–2018)

Thomas Berry Brazelton was an American pediatrician, author, and the developer of the Neonatal Behavioral Assessment Scale (NBAS). Brazelton hosted the cable television program What Every Baby Knows, and wrote a syndicated newspaper column. He wrote more than two hundred scholarly papers and twenty-four books.

The Neonatal Behavioral Assessment Scale (NBAS), also known as the Brazelton Neonatal Assessment Scale (BNAS), was developed in 1973 by T. Berry Brazelton and his colleagues. This test purports to provide an index of a newborn's abilities, and is usually given to an infant somewhere between the age of 3 days to 4 weeks old. The test is designedf to describe the neonate's response to the environment after being born. This approach was innovative for recognizing that a baby is a highly developed organism, even when just newly born. The profile describes the baby's strengths, adaptive responses and possible vulnerabilities. This knowledge may help parents develop appropriate strategies for caring in intimate relationships to enhance their earliest relationship with the child.

<span class="mw-page-title-main">Toilet training</span> Training an infant to use the toilet

Toilet training is the process of training someone, particularly a toddler or infant, to use the toilet for urination and defecation. Attitudes toward training in recent history have fluctuated substantially, and may vary across cultures and according to demographics. Many of the contemporary approaches to toilet training favor a behaviouralism- and cognitive psychology-based approach.

Baby talk is a type of speech associated with an older person speaking to a child or infant. It is also called caretaker speech, infant-directed speech (IDS), child-directed speech (CDS), child-directed language (CDL), caregiver register, parentese, or motherese.

<span class="mw-page-title-main">Potty parity</span> Equitable provision of public toilets or men and women

Potty parity is equal or equitable provision of public toilet facilities for females and males within a public space.

<span class="mw-page-title-main">Potty chair</span> Toilet for young children

A potty chair, or simply a potty, is a proportionately small chair or enclosure with an opening for seating very young children to urinate and defecate. It is a variant of the close stool which was used by adults before the widespread adoption of water flushed toilets. There are a variety of designs, some placed directly over the toilet called "Toilet Training Seats" so the egested fecal material drops directly into the toilet bowl thereby eliminating manual removal and disposal of the said waste from a receptacle beneath the hole which is often a bag or receptacle similar to a chamber pot. Potty chairs are used during potty training, a.k.a. toilet training. These are very useful for young babies.

<i>Infant Potty Training</i> Book by Laurie Boucke

Infant Potty Training: A Gentle and Primeval Method Adapted to Modern Living is a book about toilet training by Laurie Boucke. It is an expansion of ideas that were originally presented in a small self-published volume called Trickle Treat in 1991. Infant Potty Training was first published in 2000, is now in its third edition (2008), and has editions in German, Dutch, Italian and Japanese. Infant potty training is traditionally used in at least 80 countries.

Sleep training is a set of parental intervention techniques with the end goal of increasing nightly sleep in infants and young children, addressing “sleep concerns”, and decreasing nightime signalling. Although the diagnostic criteria for sleep issues in infants is rare and limited, sleep training is usually approached by parent(s) or caregivers self identifying supposed sleep issues.

<span class="mw-page-title-main">Open-crotch pants</span> Worn by Chinese children during toilet training

Open-crotch pants, also known as open-crotch trousers or split pants, are worn by toddlers throughout mainland China. Often made of thick fabric, they are designed with either an unsewn seam over the buttocks and crotch or a hole over the central buttocks. Both allow children to urinate and defecate without the pants being lowered. The child simply squats, or is held by the parent, eliminating the need for diapers. The sight of the partially exposed buttocks of kaidangku-clad children in public places frequently astonishes foreign visitors, who often photograph them. They have been described as being "as much a sign of China as Chairman Mao's portrait looming over Tiananmen Square."

A wetness indicator is a common feature in many disposable diapers and toilet training pants. It is a feature that reacts to exposure of liquid as a way to discourage the wearer to urinate in the training pants, or as an indicator to a caregiver that a diaper needs changing.

Baby-led potty training is a system for meeting babies' toileting needs. The main feature of the system is that care-givers 'hold babies out' or support them on a potty in order for them to void in an appropriate place outside their nappy. The method is typically started before the baby is six months old. Care-givers use a combination of timing, and observing babies' own signals, to decide when to hold them out. In many countries it is the norm for parents to care for their babies without nappies from the first days of life. The term Baby-led potty training describes the method being used by a growing number of families in the UK. It is an adaptation of the techniques used in Africa, India and China amongst others, to fit into a modern Western life-style. It is similar to the US movement Elimination Communication, though UK proponents of the method emphasise its pragmatic approach with no strict rules, and it can be used by any type of parent. Some parents use the technique just occasionally, others as an alternative to full-time nappies, and some as a route to toilet independence.

<span class="mw-page-title-main">Open defecation</span> Humans defecating outside (in the open environment) rather than into a toilet

Open defecation is the human practice of defecating outside rather than into a toilet. People may choose fields, bushes, forests, ditches, streets, canals, or other open spaces for defecation. They do so either because they do not have a toilet readily accessible or due to traditional cultural practices. The practice is common where sanitation infrastructure and services are not available. Even if toilets are available, behavior change efforts may still be needed to promote the use of toilets. 'Open defecation free' (ODF) is a term used to describe communities that have shifted to using toilets instead of open defecation. This can happen, for example, after community-led total sanitation programs have been implemented.

Diaper need is the struggle to provide a sufficient number of clean diapers to ensure that each diaper user can be changed out of wet or soiled diapers as often as necessary. An adequate supply of diapers is a basic need for all infants, as necessary for health and well-being as food and shelter. Adults and older children experiencing incontinence may also suffer from diaper need if they or their caretakers cannot acquire an adequate supply.

<span class="mw-page-title-main">Infant food safety</span>

Foodborne illness is any illness resulting from the food spoilage of contaminated food, pathogenic bacteria, viruses, or parasites that contaminate food. Infant food safety is the identification of risky food handling practices and the prevention of illness in infants. Foodborne illness is a serious health issue, especially for babies and children. Infants and young children are particularly vulnerable to foodborne illness because their immune systems are not developed enough to fight off foodborne bacterial infections. In fact, 800,000 illnesses affect children under the age of 10 in the U.S. each year. Therefore, extra care should be taken when handling and preparing their food.

<span class="mw-page-title-main">Infant crying</span> Medical condition

Infant crying is the crying of infants as a response to an internal or external stimulus. Infants cry as a form of basic instinctive communication. Essentially, newborns are transitioning from life in the womb to the external environment. Up to 27% of parents describe problems with infant crying in the first four months. Up to 38% identify a problem with their infant crying within the first year. Parents can be concerned about the amount of time that their infant cries, how the infant can be consoled, and disrupted sleeping patterns. Colic is used as a synonym for excessive crying of infants, even though colic may not be the cause of excessive crying.

References

  1. Diaper Free! The Gentle Wisdom of Natural Infant Hygiene (2001)
  2. pubmeddev. "boucke rugolotto – PubMed – NCBI". nih.gov.
  3. 1 2 "The Diaper-Free Baby" by Christine Gross Loh (Los Angeles: Regan, 2007)
  4. Instruction, Timeliness, and Medical Influences Affecting Toilet Training by T. Berry Brazelton, MD et al..*
  5. A new/old way to toilet-train baby Archived 2015-04-02 at the Wayback Machine Deseret News Archives, by Berry Brazelton and Sparrow.
  6. Goode, Erica (18 February 1999). "Two Experts Do Battle Over Potty Training" via NYTimes.com.
  7. Lekovic, Jill M. Diaper-Free Before 3. New York: Three Rivers Press. 2006.
  8. Schaefer, Charles E. and Theresa Foy DiGeronimo. Toilet Training Without Tears. New York: Signet. 1997.
  9. ""bathroom" American Sign Language (ASL)". lifeprint.com.