Wednesday, May 27, 2009

Smart Potty Training

Why all the chatter about toilet training lately? It seemed like this was one thing everyone agreed on, all the books said pretty much the same thing, and most people were doing it. You were supposed to look for signs your child is ready, introduce a system of positive feedback or rewards, and happily go on with your life.

Now you see headlines all the time about “Infant Training”, “Diaper-Free Babies”, “don’t use too much pressure but don’t wait too long”……….Ugh. Another parenting dilemma, and it feels like just another chance to mess things up before your kid even hits preschool.

The good news, to start with, is that you are not going to mess up your child psychologically based on when you toilet train them. In fact, ALL of the many excellent studies that have been done over the years to establish some sort of a relationship between toilet training methods and the personality development of the child have failed to show any link. Obviously, we are talking in the context of some baseline good parenting. But the specific question of will your child have some sort of psychosexual trauma as a result of the age that you toilet train them has been asked and answered. And, happily, the answer is no.

The first question that you probably have is why have I heard so many people say otherwise? Many fantastic psychologists and Pediatricians (including me!) have been trained that too-early or “pressured” toilet training will lead to refusal, later regression (going back to having accidents), constipation, or even general resentment. The idea seems to make intuitive sense, and of course if you’re talking about traumatizing a child we all want to avoid that. The problem is that this type of thinking was very theoretical when first introduced, and is now being applied literally and generally. Why is it called “pressure” for a toddler to wear cotton instead of a disposable diaper? It’s not, of course, and so there are some important distinctions about what we are talking about and the vocabulary we use.

Before the widespread use of disposables, most kids were trained in the first year of life. Then, throughout the 1950s and 60s in this country, people started waiting until the second year of life, with the general idea that children were trained when they turned two. Dr. Brazelton introduced the idea of “readiness”, and he originally argued that once a child is walking well (around 18 months), they are ready to be trained. That was considered a pretty radical delay at that time (1960s), when toilet training was done much earlier. And it really just caught on as a general idea. Many parents today are being advised to wait until their child has the verbal and motor skills more common in a three year old before they even think about it.

Meanwhile, the rest of the (underdeveloped) world has gone on happily training their babies without disposables and without any undue pressure, punishing, or other psychological ills in the first two years of life (unless you think all of China, India and Africa are doing something wrong here). It is just part of baby care, really just part of life with another little human being, and perhaps that is a little closer to how it should be. When you consider that throughout history, all over the world, in every culture without disposable diapers, children have been and still are trained much earlier, you have to question what is natural, and what is best. Added to this is a huge increase in the number of children with constipation problems and recurrent urinary tract infections that are widely believed by medical experts (including urologists and gastroenterologists) to be DUE to the delayed training.

Another complicating factor is that now there are disposable products available that are so absorbent that kids and parents are really not aware of what is going on with regard to toileting needs. Those gel liners that are capable of holding incredible amounts of fluid have only been around since the 90’s. Before then, even kids who were in disposables could feel when they were wet, and their diapers would leak if not changed regularly. Today’s disposables can easily hold a day’s worth or urine without leaking or even getting too bulky, all held in a petrochemical-based gel matrix right next to your baby’s skin! I’m not totally sure that is a good idea, and the truth is that neither is anyone else! Whenever I hear parents talk about how inconvenient toilet training is (and, of course, it is not convenient!), I think how tough it must be for kids who haven’t even seen the adults that care for them figure out a way to get them dry after they wet. How are they supposed to, just because they happen to turn three?

Finally, it is essential in the world we live in to consider the environmental impact of our decisions. There are materials that are unhealthy and even toxic in many diapering products. The effects on our babies and our planet of how we toilet train in an important part of the discussion.

I know from my practice and experience that it is possible to live in our culture, to have the same sense of cleanliness and hygiene that most Americans share, and to manage to get everyone to school and work and piano and hockey and baseball and church……..without leaving children in diapers until they are three or four. You don’t have to swear off all of your disposables, or let your children pee all over your sofa. It is so much easier than all that, and there is lots of room for compromise. And I think it is totally, completely worth the effort.

Jill Lekovic, MD

For more information on Jill Lekovic's class at The Pump Station & Nurtury click here.


Unknown said...

Do you mean to imply that people in the "underdeveloped world" have less of a sense of cleanliness and hygeine? Let us not confuse lack of resources with a lack of sense of cleanliness/hygeine. America the land of plenty has a lot to learn from traditional cultures like the Chinese, Indian and African - most importantly how to derive maximum benefit from dwindling resources. The earth can oly sustain a finite amount of waste and pollution generated and resources consumed - the rest of the "underdeveloped world" has been subsidizing America's wasteful lifestyle habits.

Jill said...

You misunderstood and I am so sorry to offend! That is totally the point, that throughout history and in all of the "non-Western-defined underdeveloped world" today, people necessarily practice more natural child rearing. And, in fact, I assert that all the evidence shows that it is not only better for the Earth, but much better for children! The health benefits of avoiding the toxic materials in disposable diapers (or at least trying to limit their use) ADD to the benefits to humanity as a whole. There is really no argument whatsoever for leaving children in diapers until they are 3 or 4 to avoid "accidents", when all of the world considers that a normal and perfectly healthy part of childhood. I absolutely think WE are the ones that have gotten off course here, and I passionately believe that letting Diaper companies tell us that centuries of traditional child-rearing is mistaken is totally unacceptable. Best wishes to you! Jill Lekovic MD

Unknown said...

No, I am sorry for my knee-jerk reaction earlier. :-/ Yes, you and I are certainly on the same side arguing that Americans need to re-evaluate the environmental impact of their lifestyles. I guess I just reacted to the phrasing in your last paragraph, "..that it is possible to live in our culture, to have the same sense of cleanliness and hygiene that most Americans share, .." That, to me, seemed to imply that Americans subscribe to a higher level of cleanliness and hygiene standards than the rest of the world. I may have been reading too much into a harmless comment.
Thanks for you wishes. My husband and I (and later also my son's nanny) have been practicing Elimination Communication with our son since he was 3 weeks old. He is 14 months old now and signing to let us know that he needs to pee/poop. He usually poops once a day, usually right after waking up in the morning. We are down to using about 3 or so cloth diapers on average, per 24 hours. We believe parenting has been a more rewarding journey for us because of EC. We wash his diapers at home and air dry in the sun.

Anonymous said...

I don't think that the environmental issues are as important as the possible health risks to our baby from waiting for 'readiness'. Instead of calling Dr. Lekovic & EC approaches 'early' potty-training, shouldn't we be talking about the 'readiness approach' as DELAYED potty training??

Charndra at Part Time Diaper Free said...


Another resource about Baby Pottying is my new site Part Time Diaper Free, all about easing into EC gradually - adopting the natural and gradual, relaxed and cooperative approach used in other countries, and thoughout time.


Potty training nanna said...

That's a comprehensive history! Thanks a lot for sharing this!

Anonymous said...

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Anonymous said...

I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.