1. How it all began: Method & Philosophy
Dan & I are parents to four wonderful children: Isabella 6, Sophia 4, Danny 2 & Helena 7 months. We created this video to educate parents on their child’s natural ability to communicate their elimination needs to us, allowing us to respond to those needs in a caring, loving manner.
When our first daughter, Isabella was born in October 1997 she almost immediately had a diaper rash which continued to worsen in her first few weeks of life. I tried the stereotypical protocol of using every diaper rash cream, powder and ointment out there. By the time Isabella was only 25 Days old, I ended up at Dr. DeStefani’s, Chairman of Pediatrics at Loyola. I asked why this was happening to my daughter and he simply said “No one’s skin is made to be in direct contact with fesses and urine.” It just made so much sense to me (think about it!). He also suggested that I allow her as much “air” time as possible. Well, I walked out of his office with the GREAT misconception that I would have urine and waste all over my house…but I didn’t. By allowing my daughter to be diaperless (even in intervals) I was able to see what happened immediately prior to her eliminating~ her vocalizations and non-verbal communications allowed me to respond to her and take her to the toilet, just as I would instinctively respond if she were hungry or tired. Elimination is the third and forgotten basic need! I NEVER THOUGHT I WAS “TOILET TRAINING” my daughter. I was only doing what I had to do in order to protect her skin. Imagine my surprise and delight when at 12 months she wore underwear all day and at 15 months she wore them at night and was completely out of diapers. Naturally, like most first time parents, we thought she was a genius. Then, our second daughter Sophia was born in January 2000. I responded to her in the same way and guess what ~ out of diapers at 15 months (another genius!?) By the time our third child, Danny was born in October 2001, we thought it was a little too coincidental and decided to do a little bit of research. We were totally shocked to learn that 80% of the children in our world TODAY are completely toilet trained between 12 – 24 months with 18 months as the average. It is only in the U.S. and other “disposable diaper” countries where toileting is pushed back so late and completed as late as 36 – 48 months. Also, this is the way it WAS in the United States prior to the mid 50’s which directly coincided with the introduction of disposable diapers.
What we are actually doing by putting a diaper on a child is training him/her to use the diaper as a TOILET. Babies try to communicate their needs to us from the minute they are born; if we continue to ignore their elimination needs they will eventually give up the desire to communicate their needs to us and realize that you want them to use the diaper as a toilet. They are being conditioned to use the diaper as a toilet.
Dr. DeStefani, the Chairman of Pediatrics at Loyola University Medical Center, supports our methodology stating in our video that the sphincter muscles which control bladder and bowel moments start developing while the baby is in utero and reach their FULL maturity between 12 – 24 months with 18 AS THE AVERAGE. This is when toileting should be COMPLETED, not started. When parents start toilet training AFTER these muscles reach full maturity, the muscles have become flaccid from not having the opportunity of practicing eliminating. It is our job as caring, loving parents to provide these opportunities and respond to these cues as soon as possible ~ preferably from BIRTH. We do know that there are several windows of opportunities or “sensitive periods” prior 18 months of age and thereafter will become increasingly difficult.
Our methodology is not about wearing disposable diapers or cloth diapers, (although we encourage the use of cloth because of the health and environmental benefits) but rather being receptive and responsive to your child’s natural elimination communication. As a matter of fact, our first two daughters wore disposal diapers (gulp) because we were unaware of all potential hazards of using them. Once we started doing the research to create “TTBB”, we immediately made the switch. If someone told me back in 1997 that I would be using “cloth” diapers and washing them myself, I may have considered the idea laughable. Imagine cloth diapers in my designer diaper bag in my “top of the line” stroller! Well, it’s true and it’s me today. Although I only have a diaper on Helena when I am out of the house and it’s for MY convenience…she is 7 months old and will signal me while we are out and about. I will of course immediately respond, while acknowledging her by saying or whispering “you need to go pee-pee” and do my best to get her to a toilet as quickly as possible. While we are home, she need not be in a diaper because Helena will signal me when she needs to eliminate and I immediately respond by taking her to the washroom. I don’t stand around waiting for her signal, just like I don’t wait around for her to signal me when she’s tired or hungry…but, when she is, I respond. I could name a million scenarios which this occurs each and every day; when I’m reading to my children, cooking dinner, doing laundry, talking on the telephone, etc… The only time we have a “miss” is due to MY lack of response. I generally don’t make blanket statements or generalizations, but I think it is fair to say that we, as a society, greatly underestimate the intelligence and capabilities of our babies. When Helena was about 4 ½ months old she would reach for the Velcro tabs on the diaper wrap and try to take it off. Well, if this isn’t a sign, I don’t know what is. She literally “screams” when we try to diaper her. I do acknowledge her communication by stating “you don’t like to wear diapers, do you? I’m sorry”.
Lastly, one of the most incredible statements I have ever heard was stated by Dr. DeStefani (referring to Dan & I) “Some of the greatest advances in medicine came from parents like you in the trenches” –TOO COOL!
Thank you for your support!
Founder, The Complete Child
2. Positions & Duration of Time on Toilet
Birth to three months you can cradle the child’s back to chest and straddle over the toilet. Put your dominant arm wrapped under their armpits and other arm under the child’s knees. When holding the baby over the toilet we should give the infant 1-2 minutes to start eliminating if you are expecting a bowel movement. If they have recently had a bowel movement and expect only pee, 30-45 seconds is an adequate amount of time.
Four months and up you can place the child on a baby toilet seat and hold them under the armpits, while adult is seated on a step stool. The step stool allows the adult to sit comfortably, while staying eye to eye with the child. When we have our child sitting on the toilet seat we should allow 1-5 minutes to start eliminating if we are expecting a bowel movement. If they have recently had a bowel movement and expect only pee, 45 seconds to a minute is an adequate amount of time. As children get older they like to spend more time looking at things or “playing” with their parents while on the toilet (they know they have the undivided attention of their parent and take advantage of it). Adults must be aware of babies that will arch their backs on the toilet. This will often indicate that your child is finished (Another non-verbal communication that your child shares with you). Always ask your child if he is finished. When your child is finished and your hands are still under their armpits, lift him up and onto your less dominate arm to wipe him and then show him what he has done. Say something like “Good job Danny – poopoo potty, bye-bye poopoo potty,” and then flush.
The “Prepared Environment”: Change diapers exclusively in the bathroom, by doing so your child will understand early on that the bathroom is the place to take care of elimination needs. It is preferable to change the baby on a low pad placed in the bathroom. Changing tables are entirely unnecessary and potentially dangerous. Changing tables raise the baby to adult height, requiring that the baby then be restrained at a height, which is unsafe for the child. Babies like to move and can easily fall off a changing table.
The most effective step toward toilet learning is to allow the child to wear underwear. Thick or waterproof training pants protect your carpet and furniture better, but thin cotton underwear allows the child to feel and see what is happening. After 18-24 months old, DO NOT provide diapers any more and express your confidence in the child’s toileting ability.
When going out of the house simply place a Velcro wrap or plastic cover over your child’s underwear. Also, remember to keep an extra toilet seat, pair of underwear and change of clothing in the car.
3. Recognizing Baby’s Elimination Cues & Timing
Begin holding your baby over the toilet after every feeding, before and after naps, before bathing them, first thing in the morning, and last thing before sleeping at night. Hone in on baby’s signals (grunts, crying, fidgeting) immediately before every bowel movement. Parents will begin to notice the looks that their children will give them before they need to urinate or have a bowel movement. They will become very focused and serious as they communicate their elimination needs to their parents. You will begin to distinguish the difference between their grunts, crying, and fidgeting, whether it’s for hunger, elimination, or sleep. An infant’s siblings will even begin to recognize the elimination signals. Also look for the obvious signs such as your child crawling or walking over to the toilet. This is usually a good indication that they have to use the toilet. The first time a parent holds their 2-3 month old over the toilet and asks, “Do you have to go pee or poop?” and their child does eliminate on the toilet, we are completed elated. We will even think it’s a fluke and that we just got lucky. After the 3rd or 4th time we become very proud of our child and ourselves for achieving this task. After the 3rd or 4th week of your child eliminating in the toilet, we wonder how we ever allowed our children to eliminate and live in their waste!
Use it or lose it. If a baby’s natural elimination signals are ignored, they will eventually lose the ability and desire to communicate this to their parents at around 12 months. The ability for an infant to communicate their elimination needs begins the day they’re born and will continue as long as we respond to their signals.
This ability to communicate will grow along with the bond between infant and parent as we apply the TTBB methodology to their toilet training. When a child becomes verbal, peepy and poop will be one of their first words following Mama and Dada. Charting the time period between each bowel movement will allow you to better meet your child’s needs; although not at all necessary once you have developed the intimate elimination bond. Try not to get lazy and ignore your child’s signals that they’re ready for the toilet.
I remember in the early days with Isabella when she was going poop on the toilet and a friend stated, “Oh, Isabella is not toilet trained, her mother is.” Indeed, I was and am trained to recognize my child’s elimination communication. I am blessed with four children and have NEVER changed a poopy diaper past four months of age. She is now a mother herself and has the esteemed pleasure of changing her 2-½ year old daughter’s soiled diapers every day.
4. Positive Reinforcement
Always stay positive when you’re taking your child on the toilet. Ensure that you use “your” term for urinating or defecating within your positive re-enforcement statements. Of course, once they reach that fabulous milestone of “TOILET TRAINED” congratulate them each morning for waking up dry. Your child will smile and laugh after going on the toilet and receiving the praise from their parent/caregiver.
When we allow children to care for themselves, they are proud! Let your child have this sense of accomplishment, rewards are not necessary. The primary motivation is pride in caring for themselves. This alone gives the encouragement to continue to use the toilet rather than the diaper.
5. Stick to the Method and Have Patience
Anything worth doing is worth doing right. There will always be accidents but don’t show disappointment or frustration with child. Continue to reinforce the proper place and means for your child to eliminate. Most babies will discontinue solid waste in the diaper around 3-4 months of age altogether. Urination is more difficult to detect and train, but will begin to happen more and more often on the toilet. Using this method of toilet training will have children trained (completely out of diapers) between 12 and 24 months. Your child may naturally show a preference toward one parent or caregiver. In this scenario your child may arch or refuse to let the other parent take him, and once the other parent comes to take him that little stinkers will eliminate.
Unless our child has some physical abnormality, there is no reason, other than a lack of effort and patience on the parents part, that their child shouldn’t be having over 80% of their bowel movements on the toilet after 1 month of using the TTBB methodology (after 3-4 months of age). Once parents realize through their own experience that this is an effective and sensitive manner to toilet train their children, they will want to convince their friends and family as well.
6. Nighttime Dryness
Once your child begins to go accident free during the day for about one-week, we can begin to focus on keeping them dry at night. This will happen anytime between 10 and 20 months, depending on each child’s development of their elimination muscles. Children’s sphincter muscles reach full maturity between 12 and 24 months, with 18 months as the average. This means that the children will have full control of their elimination muscles during this time, including during the night.
Just as we should keep our children in cotton underwear as often as possible during the day in order for them to feel the wetness and receive the message that they are finished with diapers, we must implement this same practice at night. It is recommended that we put some protection between the sheets and mattress such as plastic for the inevitable accidents. It may take 1-2 weeks, but the fact that she feels the wetness will encourage her to stay dry. Also try to be more attentive to your child during the night these 1-2 weeks. If she wakes-up, it’s probably because she has to urinate. Keep it as peaceful as possible. Have only a dim nightlight on in the bathroom, take her to the toilet and put her back in bed. Say nothing other than your “key word/phrase” (i.e. “ssssssssssssss” sound.) Keep in mind that some children’s sphincter muscles mature later than others, which may delay nighttime dryness a bit. We realize how important uninterrupted sleep is, and are only offering a possible scenario. A child waking at night to eliminate does not happen that often, but may occur for those children whose sphincter muscles aren’t fully matured.
7. Myths of Toilet Training
MYTH: “I was told to wait until after 2 years old to begin toilet training because the muscles aren’t ready yet”…
MYTH: “I don’t want to put any pressure on my child to toilet train early”…
Psychological effects of potty training your baby too early are harmful…again this is myth and completely untrue. Look at all of the children who are toilet trained at the ages of 3 and 4 who are afraid to go on the toilet. Some children need to have a diaper on to have a bowel movement because that is what they were trained to do for the first 3-4 years of their life. Children who are trained from infancy to go on the toilet will not have a fear of the toilet and will not have that over-dependent need for their parents. They also will be more independent and confident at a young age.
Who are disposable diapers convenient for, parents or children? The convenience is strictly for the parents. What human, or any animal on earth, likes living with their own waste on their bottoms? Parents and/or their caregivers need to give a child the attention and care they need to be properly toilet trained from birth. In our fast-paced society, we need to slow down to attend to our children’s needs for eating, sleeping, and elimination.
My doctor says it is best to wait…Most doctors in Western civilization were trained in the disposable method of training that began less than 50 years ago along with everyone else. Ignorance is the #1 reason that disposable diapers and “diaper training” took hold of our society.
“Late Starters Guide” (18 months & up)
Provided by Susan Tracy, M.Ed.
Timeline – Let’s talk about what’s possible when-
Birth to 10 months
It is possible for the baby to eliminate into the toilet or a potty chair if they are helped and supported by the adult, as demonstrated in this video. This prevents irritation to their skin, and they learn from early on where their bodily waste belongs. If parents can tune into their child’s signals, as parents in many other parts of the world do, they will notice the grunts, movements and facial expressions of a baby that needs to urinate or defecate. This can save everyone the unpleasantness of a wet or dirty diaper. The less time in diapers, the better, and cloth diapers are preferable.
10 to 15 months
At this age a child can sit on a potty chair independently, or use the toilet with a small seat and step stool. The baby may signal when he needs to use the bathroom, or the adult might notice signs. It is not necessary that the child be able to talk. I teach babies to pat their pants as a sign.
At 12 or 13 months I see beginning interest in undressing. Usually children tug on the front of their pants or lift their shirt repeatedly. Undressing comes months before dressing. They can learn to pull down their pants if parents will dress them in clothing that is loose and easy to manage, like elastic-waist pants. At home, the child could be in just underwear and a shirt.
15 to 24 months
During these months, the toddler enters a sensitive period for toileting. Children this age fight to get into the bathroom. They follow family members in. You can hardly go by yourself!
Children this age ASK for routine and are able to imitate.
A toddler can learn the toileting routine: pants down, sit on the toilet or potty chair, wipe, pants up, flush, and wash hands.
Toddlers need routine for the day as well, (like a morning routine and a bedtime routine). Toileting can become part of the routine of the day. We use the bathroom when we wake up; before we go out, before a bath, before nap and bedtime… children are less likely to argue if it is what they always do.
Toddlers love to get their hands in water, and this is some of the appeal of the toilet. Provide a stepstool so they can reach the sink, and allow lots of hand washing AFTER they sit on the potty chair or toilet.
By the second birthday any child with normal development has the capability for bladder and bowel control. It is obviously no mistake that the muscular development and the intense interest occur simultaneously.
After the second birthday, the sensitive period is missed and learning is more difficult. If diapers have been used constantly for the first 2 years, eliminating in the diaper is a well-established habit to be broken. The child is also in a defiant, non-compliant stage. At 2, many parents start strongly encouraging their child to use the bathroom and the child is likely to say “NO”.
At age 3, the situation is worse, because the 3-year-old thinks about things – he is able to outsmart the adult. Having worn a diaper for so long, he is not confident that he can learn to use the toilet. He may tell you that he can’t. He has been well-trained to use the diaper.
There are many similar examples. If a child has been spoon-fed, or given a bottle, or dressed by an adult, or taken everywhere in a stroller, and then he is asked to be more independent, he will say, “I can’t”. Parents need to be careful not to treat a toddler or 2 or 3 or 4- year old like a baby. Treat him as a capable human being. Allow him to make attempts at independence at the moment that he first tries. Allow practice and even mistakes. The child will persevere and learn and say, “I DID IT!”
This can-do attitude must develop early in life so that the child is ready for the bigger challenges of the future. Which attitude are you encouraging in your child?
In my lectures, I tell parents and educators that to truly understand the needs of a child, we must observe. We observe that the one year old is fighting to get in the bathroom and to learn to undress; the child of two and up is fighting to avoid doing what you want. This is the clearest evidence for a sensitive period.
If your child is past the second birthday, past the sensitive period, a parent’s most effective action would be to stop providing diapers.
Any time we put a diaper on a child, we are saying, “I don’t think you can control your bladder and bowel.” “I think you can’t.”
But, unless there is some physical abnormality, your child has full muscle development by the second birthday, and most likely, many months earlier.
If your child is 2 or older, turn the responsibility for toileting over to her. Become less involved. Don’t provide diapers. Wet pants are a natural consequence. She may use the bathroom because her peers do.
Many preschools have a rule that a child may not attend until she is using the bathroom. It would be best for the school to allow the child to attend, and tell her “Here all the children use the toilet.” Within a few days or weeks, children would learn on their own just to fit in. A 2 ½ or 3 year-old is aware of social approval.
Let’s talk about muscle development. Muscular control develops from the head down. Babies first gain voluntary control of their eye and mouth muscles, and they can lift and turn their heads. Then at around four months of age, they are gaining control of their arms. Moving on down the body, typically at 6 months of age babies can sit, at 7 or 8 months they crawl, and on average, they walk at 12 months. Once a child walks, she becomes a toddler, and actively works to refine the use of her muscles and to do the things that she sees bigger people doing.
Now, where in that head-down development are the muscles for bladder and bowel control? They are at the same level as sitting, 6 months. So, some beginning control of these muscles is in place very early, and through use, the muscles can develop better control.
Answers to some commonly-asked questions:
Which supplies do you recommend for diapering and toileting at home?
I recommend a mat on the floor for changing, perhaps with a kneeling pad. No changing table is needed, unless you are physically unable to sit or kneel on the floor. Falling off a changing table is a common accident, and is avoidable. Put the changing mat in the bathroom so they get used to going there for this type of care.
Provide a 2-step stool for the sink and a 6-8″ stepstool at the toilet.
Toddlers can use a small toilet seat or a potty chair. Boys need a shield in the front until they learn to aim!
I strongly recommend cloth diapers. I believe that natural cloth is safer, and that it is helpful for babies to feel wet when they urinate, so they make the connection. There are diaper covers available that have eliminated the need for diapers pins. Natural, breathable fibers are better than plastic and vinyl. Wool is best because it allows evaporation and doesn’t retain wetness. I have included more details in the booklet that accompanies this video.
When should we stop using diapers?
Young babies need some time out of diapers every day. The amount of time should increase as your child gets older and as you tune into their need to eliminate. At age 12 to 18 months, toddlers can spend much of the day in underwear. Or, some do better bare-bottomed. You can put plastic pants or a wool soaker over underwear at times. Completely eliminate diapers between 18 and 24 months. Your child does not need diapers after 24 months unless there is a physical abnormality.
What about night wetting?
Some children wet at night for months, or even years, beyond the time they keep themselves dry during the day. But I must emphasize that this is the exception. Assume that your child can be dry at night, and do not use diapers at night. Allow your child to use cloth underwear at night, and have him help launder the sheets in the morning if necessary. If this seems unmanageable for you, then your child could wear plastic pants, or even better, a wool soaker over thick cloth underwear at night. You might use these same suggestions for anytime you worry about accidents, times like going out of the house.
It can help to give lots of water to drink throughout the day, and then no more drinks after dinner. Talk with your child about staying dry at night. Let him practice getting up from bed and hurrying to the toilet. Never shame your child for wetting. Let your doctor know that your child still wets at night, in case further help is needed.
My child will use the toilet to urinate but still insists on a diaper when he has a bowel movement. What should I do?
Sometimes there are stronger habits associated with bowel movements than with urination. If toilet learning begins early enough, this habit would be avoided. But if your child is older as you start this process, it can help to hurry your child to the toilet at the moment you become aware that they need to have a bowel movement. If they have success 2 or 3 times, the habit is broken. If you do not make diapers available in your house, then they won’t ask for one.
Is there a difference in toilet learning between boys and girls?
I see some slight differences. Girls may learn a few months earlier than boys. Follow the age guidelines we provide.
I must emphasize that all of this should be done with patience and cheerfulness, without giving the child negative messages about his or her body and waste. Treat your child’s learning process as an opportunity for them to care for their body’s needs, just like learning to eat or go to sleep. Talk to them about how their body works, in very basic, realistic terms. Treat your child with the same respect you’d like them to have if they care for you someday when you are old!
8. Physical Risks of Prolonging Children’s Time in Diapers &
Possible Risks Associated with Disposable Diaper Usage
(Some of the studies that have been referenced in this section contain hypothesis that have not been proven yet).
Toilet Training Begins at Birth requires the use of cloth diapers while following its early toileting methodology. It is commonly known that children who wear cloth rather than disposable diapers are out of diapers 12 months earlier because they can feel the wetness when they urinate. There are also the obvious comfort issues. As stated on the National Association of Diaper Services web-site, “It’s a matter of comfort and health. The comfort is something you know about from your own clothing. It stems both from cotton’s soft touch on sensitive skin and from its breathability — which ventilates the skin and helps evaporate the potentially irritating ammonia that starts to form as soon as a baby wets. As for cotton’s health for babies, it has thousands of years of history behind it. Cotton is the fabric of choice for use directly on the skin. Like its comfort, its natural absorbency is the polar opposite of the combination of paper pulp, plastics, and “superabsorbent” chemicals in disposables.” We strongly encourage the use of cloth diapers for the health and environmental benefits; however, our method still works if you elect to use disposables.
A. Incidence of diaper rash increases
According to the Journal of Pediatrics, 54% of one-month old babies using disposable diapers had rashes. Of those 16% were severe rashes. Study done by Procter & Gamble (manufacturers of Pampers® and Huggies®) concluded that the incidence of diaper rash increases from 7.1% to 61% with increased use of disposable diapers.
Widespread diaper rash is a fairly new phenomenon that surfaced along with disposable diapers. Reasons for more rashes include allergies to chemicals, lack of air, higher temperatures because plastic retains body heat, and babies are probably changed less often because they feel dry when wet.
B. Safety of Chemicals in Disposable Diapers Questioned
High-Absorbent chemical used in disposable diapers, Sodium Polyacrylate, was removed from tampons in 1985 because of its link to Toxic Shock Syndrome. This chemical has also been linked to severe irritation to the child’s skin and can also be fatal to a child who has ingested less than 5 grams of the substance.
In a study performed by Anderson Laboratories, Inc. published December 7, 1998, it stated, “The results demonstrate that some types of disposable diapers emit mixtures of chemicals that are toxic to the respiratory tract. Disposable diapers should be considered as one of the factors that might cause or exacerbate asthmatic conditions.”
C. Bladder Problems
Study published in British Journal of Urology in August 2000, revealed that increases in the age at which children begin toilet training could cause permanent urinary dysfunction or incontinence. This relates to children whose parents don’t begin toilet training until after 24 months old. Their elimination muscles are flaccid and underdeveloped because they are not given the opportunity to exercise the control over these muscles that they normally would while toilet training.
D. Increased scrotal temperatures may lower sperm count later in life
In a study published May 15th 2000 by C-J Partsch, M Aukamp, and G Sippell of the Department of Pediatrics, Chrisian-Albrechts-University of Kiehl, Germany they concluded, “Scrotal hypothermia is an important factor for normal spermatogenesis. This study shows that scrotal temperature is increased in boys wearing disposable plastic lined nappies (disposable diapers). The physiological testicular cooling mechanism is blunted and often completely abolished during plastic nappy use. The present results establish the basis for further research on the impact of increased testicular temperature in infancy on later spermatogenesis.” The study also states, “We propose a new hypothesis: exposure to increased testicular temperature for prolonged duration during early childhood as a result of the use of modern disposable plastic lined nappies (diapers) could be an important factor in the decline in semen quality and increasing incidence of testicular cancer in adult age.”
9. Environmental Impact of Disposable Diaper Use