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 diaper-less 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, although it can be started with babies of any age. The practice can be done full-time, part-time, or just occasionally.
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 the United States, it remains the dominant method of baby hygiene in all non-industrialized countries.
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 most mothers would carry their diaperless babies constantly, yet 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.
Prior publications introducing Western parents to this ancient practice include the booklet Conscious Toilet Training, by Laurie Boucke (1979), 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 it 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.
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" and "elimination communication" used synonymously.
According to "The Diaper-Free Baby" by Christine Gross Loh, EC offers a large 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: diaper rash; diaper change battles; not being able to explore this area; vulnerability to urinary tract infections; potentially delayed or difficult potty training. Gross Loh also reports that EC creates a unique and wonderful bond between babies and caregivers.
Parents report that the squat or ‘potty’ position that parents tend to hold their baby in order to go is very comfortable for babies. 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.
Conventional potty training advice is based on the research by T. Berry Brazelton who introduced the idea of 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. 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. His neutrality on the subject has been questioned since he has worked as a consultant for Proctor & Gamble, manufacturer of Pampers, and has appeared in a commercial for Pampers size 6 diapers.
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. Parents also offer the potty at various times according to routine, e.g. after a feed, after waking, just before bath or bed. In the west, infant potty training historically relied on timing as the main method of training.
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, and include a certain facial expression, a particular cry, squirming, a sudden unexplained fussiness, as well as others. Signals are most effectively observed without diapers for the first couple of weeks of starting elimination communication. Babies who are nursing will often start delatching and relatching repeatedly when they need to eliminate. For defecation, many babies will 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.
Cueing consists of the caregiver making a particular sound or other cue when the baby is in an appropriate place to urinate or defecate, in order to develop two-way communication. At first, the caregiver can make the cueing sound when the baby is eliminating, to develop an association. 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 can serve as a cue, or the sign language 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.
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.
- Attachment parenting
- Infant potty training method
- Baby-led Potty Training
- Dunstan Baby Language
- Open-crotch pants
- Toilet training
- Practicing Elimination Communication - DiaperFreeBaby
- EC Simplified
- 'Diaper Free! The Gentle Wisdom of Natural Infant Hygiene (2001)
- Search for medical journal articles by Boucke et al.
- "The Diaper-Free Baby" by Christine Gross Loh (Los Angeles: Regan, 2007)
- Instruction, Timeliness, and Medical Influences Affecting Toilet Training by T. Berry Brazelton, MD et al.*
- A new/old way to toilet-train baby Deseret News Archives, by Berry Brazelton and Sparrow]
- Lekovic, Jill M. Diaper-Free Before 3. New York: Three Rivers Press. 2006.
- Schaefer, Charles E. and Theresa Foy DiGeronimo. Toilet Training Without Tears. New York: Signet. 1997.
- "The Diaper-Free Baby" by Christine Gross Loh (Los Angeles: Regan, 2007)
- American Sign Language - Bathroom
- Tribal Baby - Excellent resource on EC including a free eBook, Discover the 7 Secrets to Elimination Communication
- "Nappy Free Baby" Comprehensive UK information site
- Natural Infant Hygiene - Ingrid Bauer's article summarizing EC
- International Board for the Study, Research and Promotion of Assisted Infant Toilet Training - Supportive pediatricians, medical journal articles and research
- Born Ready A UK site providing a complete guide to EC in the modern world.
- EC App - A mobile app for tracking elimination communication cues and timing
- Happy No Nappy a how to guide for modern mums to start EC https://itunes.apple.com/gb/app/happy-no-nappy/id708832890?mt=8
- "EC Simplified" - EC Simplified: Infant Potty Training Made Easy, free online informational resource for Elimination Communication
- Start Elimination Communication Elimination Communication from A-Z with Andrea Olson.