No diaper? No problem

AT an age when most children’s parents have just started to consider toilet training, Samuel and Hannah had already completed the task. By 21 months of age, the Rothstein children no longer needed to be reminded to go to the bathroom, and they never had toileting accidents -- day or night.

Their mother, Melinda, had taken a somewhat unconventional approach to toilet training. She started her son when he was only 8 months old and her daughter right from birth.

Within months of beginning the process, both of her children were diaper-free.

To most parents, the idea of going diaper-less from infancy sounds crazy. It runs counter to the most popular approach to toilet training -- the “child-oriented” method -- which suggests that children must display a marked readiness and interest in the toilet before they’re trained to use it.

The approach also leaves many people wondering if starting too early might backfire and lead to toileting problems down the road.

Even Rothstein was a bit skeptical when she first considered infant toilet training, also known as “elimination communication.” But the signs she was getting from her son at the time seemed clear. “From the time Samuel was only about a week old, it was fairly predictable to me when he was going to poop,” she recalls.

Infant toilet training has been practiced successfully around the world for centuries. Although relatively few parents in the United States use this approach, a growing number swear that it works.

Infant toilet training is based on the belief that babies are aware of their elimination needs from birth, and can learn to consciously release their bladders and bowels within the first several months of life. When babies sense that they have to go, they communicate the need through various signals, many parents say, such as making a specific sound, squirming in a certain way or grimacing.

When infants show these signs, parents position them over the toilet and make a specific cueing sound, such as “psss” or “whiss.” Babies gradually learn to release their toileting muscles in response to the cue and, over time, develop complete bladder and bowel control.

It typically takes close to two years before a child is fully toilet trained using this method. However, some children train much faster, sometimes before they can even walk.

Advocates of infant potty training argue that the method’s most important benefits extend beyond simply finishing early. “The most exciting benefit is the communication that takes place between parent and child,” says Laurie Boucke, author of “Infant Potty Training: A Gentle and Primeval Method Adapted to Modern Living.”

Parents are forced to tune into their infants’ behavior and promptly attend to their needs, advocates say, building the groundwork for a strong, trusting relationship with their children.

Advocates believe that it is easier to toilet train a younger child than an older one. Training before toddlerhood removes the likelihood of a potty training struggle, they say, adding that it’s also better than dealing with years of diapers and mess. And, by eliminating diapers, they point out that it is far less expensive and better for the environment than the more conventional approach.

Even its strongest proponents acknowledge, however, that infant potty training is not for everyone. “It’s not something that people should do if they don’t enjoy it or feel they’re too busy,” says Boucke. “We don’t say ‘yuck’ or ‘eww’ to people who use diapers.”

They also recognize that a full-time commitment to infant potty training isn’t feasible for many people. “You can do it part time,” says Boucke. “It’s not an all or nothing thing.”

Although there are no documented side effects associated with infant potty training, some pediatricians have reservations about starting so early. They worry that parents will find the process frustrating. “It may not be harmful unless it enhances a negative interaction between parent and child,” says Mark Wolraich, editor in chief of the American Academy of Pediatrics “Guide to Toilet Training.”

“Toilet training is a normal developmental process that children go through,” says Wolraich. “It really ought to be done when the child is developmentally ready.” He takes the position that most children are not consciously capable of controlling their bladders and bowels until 18 months of age, and believes that many need even more time before they’re ready for toilet training on a cognitive and emotional level.

He suggests parents wait for signs that their infant is interested in toilet training and that they possess the skills to do it successfully. For example, children might begin to communicate the need to use the bathroom through expressions, actions or words. Other signs of readiness might include complaints about soiled diapers and requests to wear big-kid underwear.

Rothstein begs to differ. Her experiences with infant toilet training were so compelling that she co-founded DiaperFreeBaby, a network of support groups promoting toilet training in infancy. And, with a third child on the way, she is thrilled about the opportunity to do it again.

While I am convinced that it’s possible to toilet train an infant, I don’t believe that it is the right approach for most families. Infant toilet training is clearly demanding and, to be done properly, must be executed with tremendous -- if not superhuman -- patience.

Rothstein was with her children full time when she was training them. Although it didn’t keep her from leaving the house, she always had to make certain that there was a toilet nearby or that she brought a portable one with her.

It also seems like a large investment of time and energy without substantial gain. Personally, I never considered my children toilet trained until they no longer needed my assistance with any part of the process. In fact, it was only after my children turned 4 or 5 that their cries for help from the bathroom subsided and I considered myself out of the woods.

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Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in L.A. She can be reached at themd@att.net. The M.D. appears the first Monday of the month.