© 2020 Gwen Dewar, Ph.D., all rights reserved
Widely practiced in traditional cultures, infant toilet training is becoming more popular in Western countries. But what are the pros and cons of early training? How do you actually do it? And what does science tell us about the development of bladder control?
If you grew up in a culture that uses diapers, infant toilet training might seem unconventional and exotic. But in traditional societies throughout the world -- in Asia, Africa, Eastern Europe, Latin America, and the Arctic -- infant training is the norm.
When babies need to urinate or defecate, their parents hold them, bare-bottomed, over a preferred target (like a waste receptacle, or an outdoor latrine). The parents signal the babies to proceed, and the babies respond (Boucke 2003; Duong et al 2013a; Sonna 2006; deVries and deVries 1977).
How do parents know when their babies need to eliminate?
There isn't any magic here. The parents pay close attention. They learn to read their babies' cues. And eventually, after multiple trials, babies learn to hold back until their parents give them the signal -- usually a special vocalization, like "sheee-sheee," or "shuuuus" (Bouke 2003; deVries and deVries 1977).
In other words, it's all about communication -- what some folks call "elimination communication." And it's becoming more popular in Western countries, like the United States (Bender and She 2017).
But are these babies truly "toilet trained"?
That depends on what you mean. Young babies can't walk, wipe, or dress themselves. So they aren't "trained" in the sense of being capable of taking independent trips to the toilet. But toilet sessions become more coordinated, organized, predictable. And families can go "diaper free."
Is this a goal worth pursuing? When should parents begin infant toilet training? What procedure(s) should they follow? And what does research tell us about the development of bladder and bowel control? Is early training a good choice for your baby?
Here are the details to help you decide. I cover the potential benefits of infant toilet training, and outline the general procedure associated with elimination communication. In addition, I provide a link to an alternative method of infant potty training, and review some of the developmental (and cultural) factors that can make infant training difficult.
What are the benefits of infant toilet training?
Infant toilet training depends on establishing close communication about the baby's frequent needs to eliminate. It's time-consuming, but potentially rewarding in the same way that communication about feedings can be rewarding.
In addition, infant toilet training makes it possible for families to reduce -- or eliminate -- their usage of diapers. This means
- saving money on diapers and diaper paraphernalia;
- generating fewer non-biodegradable, disposable diapers; and
- using less energy to wash and dry cloth diapers.
It also means avoiding diaper rash and diaper-related infections.
And in the long-term? Parents who train early may avoid certain pitfalls, at least when compared with parents who delay training until children are over the age of two or three.
When kids have spent years wearing diapers, parents often face these difficulties:
- Older children have learned to ignore their own body signals and must re-learn them.
- Older children are used to wearing soiled diapers and may resist change.
- Older children are more likely to test your authority when you ask them to comply with potty training.
Finally, there's some evidence that infant toilet training helps babies learn how to completely empty their bladders when they urinate (Duong et al 2013b). This is potentially important, because residual urine in the bladder can lead to urinary tract infections.
So when should a baby start toilet training?
It isn't really a matter of "should." Some parents start right after birth (Duong et al 2013a; Boucke 2003). Others wait until 3-6 months (Schaefer and DiGeronimo 1997; Smeets et al 1985).
What's the procedure? How does infant toilet training work?
Typically , parents follow these steps:
1. Become familiar your baby's elimination patterns.
How does your baby behave just before he or she eliminates? Some babies may squirm or shudder just before they have to go. Others might change their breathing patterns, or begin crying, or adopt a particular facial expression.
In addition, pay attention to timing. Babies may tend to urinate shortly after a feeding. They may void just before -- or immediately after -- sleeping. Some babies may urinate pretty regularly, once an hour or so.
Watch for these patterns, and learn to anticipate when your baby is about to go.
2. When your baby shows signs of needing to eliminate, provide the opportunity: Hold your baby's bare bottom over an appropriate receptacle.
This doesn't have to be a toilet. For young babies, some parents use plastic tubs or bowls (Boucke 2003; Sonna 2006). In traditional cultures, babies often urinate outdoors, on the ground.
3. Teach your baby to associate the act of eliminating with a signal of your choosing.
In many parts of the world, parents make a characteristic sound or gesture while the baby voids. Babies learn to associate the sound with the action.
4. Once your baby has learned the signal, use it to encourage your baby to eliminate on cue.
Now you have some influence over the timing of toileting. For example, before you take your baby on an outing, you can ask your baby to void. Provide the opportunity, and give your baby the signal. Similarly, you can invite your baby to eliminate after meals, or just before bedtime.
Are there any alternatives to this method?
Yes. If your baby has reached the milestone of being able to sit up independently -- without being held in place, or propped up by objects -- you can try a different technique that makes us of an infant potty chair.
This approach has been investigated by Western researchers (Smeets et al 1985), and tested on a small number of babies -- with success. If you're interested, be sure to check out my Parenting Science guide to this alternative infant toilet training method,
How long does it take before a baby is "trained"?
In cultures that practice traditional infant training, infants complete training between 6-12 months (Duong et al 2013a; Boucke 2003; deVries and deVries 1977).
And in a study testing the alternative (potty chair) method, the participating infants completed training before they were 12 months old (Smeets et al 1985).
But hang on...how is any of this possible? Aren't babies supposed to be incapable of bladder and bowel control?
Granted, babies aren't miniature adults. They can't control elimination to the extent that we can. For example, in one study, researchers found that only 20% of children attained "complete" bladder and bowel control by the age of 2 years (Largo et al 1978).
But infant potty training does not require "complete" control. For training to be successful, babies need only follow some predictable patterns, and be capable of partial control.
These requirements are met rather easily for bowel movements. After the newborn period, bowel movements are relatively infrequent, and the warning signs of an impending bowel movement are pretty easy to read. Parents and babies have time to react.
And for urination?
Granted, bladder training is more difficult. Infants have small bladder capacities and process large volumes of liquid. They urinate frequently, and it can be hard to tell when they are about to pee.
In addition, some young infants may have trouble coordinating their muscles.
They can contract the bladder wall (which increases pressure inside the bladder) and they can relax the urinary sphincter (which opens the urethra and permits urine to flow outside the body). But they may have trouble doing both at the same time. As a result, they may not completely empty their bladders with every voiding (Yeung et al 1995; Sillén et al 1996; Bachelard 1998).
But this doesn't mean that babies urinate in a random, haphazard way. On the contrary.
As noted above, babies are more likely to urinate at certain times during the day.
They are more likely to urinate after feedings. They are also more likely to pee when they are fully awake, or transitioning to waking. Babies tend not to urinate when they are in "quiet sleep" -- an infant sleep stage analogous to our adult stage of "deep" sleep (Yeung et al 1995; Wen and Tong 1998).
And just as importantly, baby bladders aren't hopelessly weak or erratic.
The muscles of the bladder wall are usually stable, contracting only around the time of urination (Yeung et al 1995; Wen and Tong 1998). And when researchers have tried to provoke healthy newborns to urinate by manually pressing their bladders, it didn't work. The bladders didn't leak (Gladh et al 2000).
So research refutes the notion that baby bladders are totally uninhibited (Sillén 2001; Yeung et al 1995).
Infant urination is not merely an automatic reflex (Sillén 2001; Yeung et al 1995). And that's why infant potty training -- relative dryness achieved through parental supervision -- is possible.
What about the burden on parents? Isn't infant toilet training time-consuming and messy?
The short answer is: Yes.
Infant toilet training depends on the close proximity and vigilance of the caregiver. It is unquestionably time-consuming.
At birth, the average infant pees approximately 20 times a day (Geoller et al 1981). The frequency decreases over time, so some authors recommend that parents delay infant training until the third month (Schaefer and diGeronimo 1997).
However, bladder capacities vary, and some infants void very frequently throughout the toddler period. Other infants dribble soft stools throughout the day. Parents must weigh these factors accordingly.
Next, consider the mess.
Although infant waste is less smelly than toddler waste (Sonna 2006), it's still messy. Some advocates argue that infant toilet training is less messy than diapering, because diapering forces the parent to clean up every time a baby poops (DiaperFreeBaby.org 2006).
But I think this misses the point that concerns most Westerners, which is that diaper-free babies may soil furniture, rugs, and other items that are rather difficult to clean.
Parents can minimize the mess by keeping babies away from such items.
Alternatively, they can adopt the potty chair-based method of infant toilet training.
Or simply keep their babies in diapers during the early phases of training.
Yet millions of people practice infant toilet training without using diapers at all. How do they do it?
Toddler in Shanghai wearing open-crotch pants. Image by Kolumbusjogger.I think it likely comes down to a difference in attitude and social support.
From Kenya (deVries and deVries 1977) to Bali (Diener 2000), parents don't consider the occasional accident a big deal. Nobody minds much if a little baby urine gets on their clothes or floor. Accidents happen. Cleaning up is part of parenting.
In addition, traditional, "diaper-free" societies are often more tolerant of small children eliminating in public. Local customs make it easier for parents to train.
For example, in China, young children wear pants with an open seam in the back so kids can squat and go when the need arises.
And among the Ifaluk of Oceania, toddlers can pee just about anywhere as long as it's outside (Le 2000).
Attitudes and customs in the West are less supportive of infant potty training. This needn't deter motivated Western parents. But it's obvious that infant training isn't for everyone.
Whether you plan to train early or late, you will need to exercise patience, good humor, and gentleness. There will be accidents and setbacks. No one should attempt infant toilet training without a clear understanding of the work involved.
Lessons for the West?
Despite the difficulties, some parents are proving that it's possible to practice infant toilet training in the West. Books, websites, and online communities offer advice and psychological support. Savvy parents swap tips about where to buy Chinese-style training pants or how to survive car travel.
For these parents, the advantages of infant toilet training -- no diapers, no rashes -- make the extra work worthwhile.
And for parents who don't plan to train their infants, "elimination communication" is nonetheless instructive.
It reminds us that diapers are not a necessary or natural part of infancy. Nor is diaper rash or diaper dependency. Babies who never wear diapers won't have to be cajoled back out of them when they are older.
Postscript: Unwarranted claims
I've seen a few questionable claims made about infant toilet training that merit discussion. So I want to address them here.
First, I can find no evidence that infant toilet training makes people into better, more sensitive parents.
Nor have I run across any studies suggesting that potty training of any kind--infant or otherwise--improves the parent-child relationship.
Second, I've not found any studies suggesting that infant toilet training -- when carried out in the manner noted above -- has any meaningful, long-term, developmental impact on a child's life.
As noted above, there's evidence that it helps babies develop healthy voiding patterns at an earlier age (Duong et al 2013b). And it's logical to assume that trained infants would be less at risk for developing rashes and diaper-related infections (Bender and She 2017).
But there's no reason to think that infant toilet training will alter your child's psychology, for better or for worse. You can read more about it in this Parenting Science article about the timing of toilet training.
Finally, it bears repeating that "infant toilet training" is a potentially misleading term.
Babies don't get trained in the way that older children do. Instead, parents learn to anticipate when their babies are ready to void and babies learn that a specific sound means "go ahead and urinate now."
If not during infancy, when?
When it comes to timing the onset of toilet training, parents have many options. What does research tell us about delaying training until your child is 12 months old? 18 months old? 24 months old? Or even older? My Parenting Science article about the timing of toilet training will help you compare the pros and cons associated with different ages.
Books about infant toilet training
Laurie Boucke provides a detailed account of infant toilet training in her how-to book, Infant Potty Training: A gentle and primeval method adapted to modern living (2002; White-Boucke publishing).
Her book includes photos and sketches illustrating techniques, as well as a section on cross-cultural studies. An abridged version of this book is available under the title Infant potty training: With and without diapers—the natural way (2003; White-Boucke publishing).
Copyright © 2006-2020 by Gwen Dewar, Ph.D.; all rights reserved.
For educational purposes only. If you suspect you have a medical problem, please see a physician.
References: The science of infant toilet training
Bachelard M, Sillen U, Hansson S, Hermansson G, Jodal U, and Jacobsson B. 1998. Urodynamic pattern in infants with urinary tract infection. Journal of Urology, 160: 522-6.
Bender JM and She RC. 2017. Elimination Communication: Diaper-Free in America. Pediatrics. 140(1).
deVries MW and deVries MR. 1977. Cultural relativity of toilet training readiness: A perspective from East Africa. Pediatrics, 60: 170-177.
Diener M. 2000. “Gift from the gods: A Balinese guide to early child rearing,” in A world of babies: Imagined childcare guides for seven societies (J. DeLoache and A. Gottlieb, eds.) New York: Cambridge University Press, pp. 199-231.
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.
Geollner MH, Ziegler EE, and Fomon SJ. 1981. Urination during the first three years of life. Nephron., 28: 174-178.
Gladh G, Persson D Mattsson S and Lindstrom S. 2000. Voiding pattern in healthy newborns. Neurourology and urodynamics, 19: 177-184.
Largo RH, Gianciaruso M, and Prader A. 1978. Development of intestinal and bladder control from birth until the 18th year of age. Longitudinal study. Schweiz Med Wochenschr, 108: 155-160.
Largo RH and Stutzle 1977. Longitudinal study of bowel and bladder control by day and at night in the first six years of life. I: Epidemiology and interrelations between bowel and bladder control. Dev Med Child Neurol, 19: 598-606.
Le H-N. 2000. “Never leave your little one alone: Raising an Ifaluk child,” in A world of babies: Imagined childcare guides for seven societies (J. DeLoache and A. Gottlieb, eds.) New York: Cambridge University Press, pp. 199-231.
Schaefer CE and diGeromino TF 1997. Toilet training without tears. New York: Signet.
Sillén U. 2001. Bladder function in healthy neonates and its development during infancy. Journal of Urology, 166(6): 2376-81.
Sonna L. 2005. Early-start potty training. New York: McGraw-Hill.
Smeets PM, Lancioni GE, Ball, TS, and Oliva DS. 1985. Shaping self-initiated toileting in infants. Journal of applied behavior analysis, 18: 303-308.
Wen JG and Tong EC. 1998. Cystometry in infants and children with no apparent voiding symptoms. British Journal of Urology, 81: 468-473.
Yeung, CK, Godley ML, Ho, CK, Ransley PG, Duffy PG, Chen CN, Li AK. 1995. Some new insights into bladder function in infancy. British Journal of Urology, 76:235-40.
Content of "Infant toilet training" last modified 9/2020
title image by SeventyFour / istock
image of parent holding baby over a plastic tub for urination by shutterstock
Image of toddler wearing traditional, open-crotch pants by
Kolumbusjogger / wikimedia commons
Portions of this text appeared in a previous version of this article, written by the same author.
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