Infant potty training: An alternative to "elimination communication" for babies who can sit up by themselves

© 2008 -2019 Gwen Dewar, Ph.D., all rights reserved

When people speak of "infant potty training," they're often thinking of method called elimination communication. It works like this.



  • A parent notes those times of day when a baby typically eliminates. The parent also pays attention to the sounds and movements that a baby makes shortly before voiding. 
  • Having learned the baby's patterns, the parent uses this information to anticipate. Is the baby ready to urinate or defecate? If so, the parent holds the baby's bare bottom over a toilet or other suitable receptacle.
  • As the baby voids, the parent makes a distinctive sound to signal elimination. Over time, the baby learns to associate this sound with the deed.
  • Once the baby has learned the signal, the parent can use it to encourage elimination at a convenient time. For instance, if you are about to leave for a walk in the park, you might hold your baby over the toilet and make the sound. The baby gets the message, and empties his bladder.


In rough outline, this is the approach used in many traditional cultures around the world.

Does the approach work? Parents are satisfied with the results, which may include "graduation" to the use of a potty chair by 9 months (Duong et al 2013a). In addition,  babies may develop healthy voiding patterns at an earlier age (Duong et al 2013b).

And Western advocates argue that going diaper-free reduces a baby's risk of infections and dermatitis (Bender and She 2017).

But the traditional approach to infant potty training isn't for everyone.

As I note in this evidence-based review of elimination communication, the practice requires lots of vigilance, and messy accidents are inevitable.

So are diapers the only alternative? No. Not exactly.

Decades ago, another potty training method was investigated by developmental psychologists and pediatricians. 

This method should only be used on babies who have developed the ability to sit up -- straight and steady -- without assistance. So it isn't a complete substitute for diapers. Depending when your baby reaches the milestone of independent sitting, you might have to use diapers for 3-6 months.

But once your baby has mastered the ability to sit up unaided, you might find success with this approach to infant toilet training, and reduce your dependence on diapers.

Is it worth attempting? That depends on your personal preferences and goals.

Like most toilet training methods, this one requires that parents spends lots of time each day attending children on the potty. But if you want to dump the diapers before your baby is 12 months old, this is one way to get there. When Paul Smeets and his colleagues tested it on four children, ranging between 3 and 6 months in age, the researchers found it was both safe and effective. 

Here's the procedure.

Shaping self-initiated potty training in babies (Smeets et al 1985) 

Infants were trained by their own parents. To accommodate busy parents, researchers accepted that infants would skip training on some days.

A “training day" was defined as a day when parents spent at least 2 hours training their infants.

Before training began, parents observed their infants to learn what body signals precede voiding. Then they progressed through three phases of training.

Phase I.

The goal of Phase I was to teach the baby to associate his own body signals with using the potty.

Parents kept babies within visual range of a potty chair throughout the session. When parents judged that babies were ready to eliminate, they tapped the potty chair to get their babies attention, then sat their babies on the potty.

If babies eliminated within 3 minutes of being placed on their chairs, parents showed their enthusiastic approval. Otherwise, parents removed their babies from the chairs and tried again later (when the babies showed more signals).

When babies had accidents, they were changed without a show of emotion. Parents continued these sessions until their babies had at least 18 bowel movements in the potty chair and had experienced at least 8 out of 10 training days without bowel accidents (Smeets et al 1985).

Phase II.

After graduating to phase II, babies were kept within 30 cm of potty chairs throughout the day (by placing baby and potty chair in a playpen, for instance).

When the babies showed body signals of elimination, babies were prompted to touch or grab the potty chair. If babies didn’t touch the chair after they were verbally prompted, parents gently guided their hands. Then babies were placed on the potty chair as in Phase I (described above).

Babies were also placed on the potty chair if they spontaneously touched or grabbed the chair, or if they showed no signs but were overdue for a voiding.

Phase II continued until babies started to reach for the potty without prompting for more than 50% of the trials for 4-6 days running. Babies were also required to have a low rate of accidents—no more than 10% of the total eliminations.

Phase III.

Training continued as in Phase II, except that the potty chair was moved farther away (up to 4 meters, depending on the baby’s crawling skills) and parents were told to “keep the number of daily prompts to a minimum" (Smeets et al 1985).

Training ended when babies had completed 15 out of 18 consecutive training days without an accident and at least 80% of reaching/grabbing responses were followed by eliminations.

As noted above, all four infants completed this infant potty training program before they were 12 months old--before any of them could walk. Moreover, no negative side effects were reported.

Questions

Can you combine elimination communication with the potty training technique tested by the Smeets team?

I can't see no reason why not. When you place your baby on the potty chair, use your family's designated elimination signal to encourage your child to void.

When exactly can I begin elimination communication? How early can babies be potty trained?

You can start elimination communication during the newborn period. But if you want to try the Smeets method, you'll need to wait until the baby can sit upright without assistance -- a milestone that most babies don't reach until they are 3-6 months old.

What about fast-track methods? Can I potty train a baby in 3 days?

That's not realistic, not if by "baby" you mean a child under the age of 20 months. In the Smeets study, babies took around 4-5 months to complete training. 

You might have heard of "3 day" programs, but these are typically aimed children who are at least 20 months old. You can learn about "fast-track" potty training methods here.

More information about infant potty training

For a more general discussion of infant potty training, including methods for infants who cannot yet sit up by themselves, see my article on infant potty training. Besides "how-to" information, it also discusses infant bladder physiology and infant potty training attitudes around the world.

If you're wondering how the timing of potty training might effect your child, see this article about on the benefits and disadvantages associated with training at different ages.

For a review of toilet training methods for older children, see this article on potty training techniques.


References: Infant potty training

Bender JM and She RC. 2017. Elimination Communication: Diaper-Free in America. Pediatrics. 140(1).

Duong TH, Jansson UB, Hellström AL. 2013a. Vietnamese mothers' experiences with potty training procedure for children from birth to 2 years of age. J Pediatr Urol. 9(6 Pt A):808-14.

Duong TH, Jansson UB, Holmdahl G, Sillén U, Hellström AL. 2013b. Urinary bladder control during the first 3 years of life in healthy children in Vietnam--a comparison study with Swedish children. J Pediatr Urol. 9(6 Pt A):700-6.

Smeets PM, Lancioni GE, Ball, TS, and Oliva DS. 1985. Shaping self-initiated toileting in infants. Journal of applied behavior analysis, 18: 303-308.

Title image for "infant potty training" by lkonstanski /flickr


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