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Elimination Communication

(Natural Infant Hygiene)

Natural Infant Hygiene Frequently Asked Questions
Copyright © 2000 by Ingrid Bauer

Though Natural Infant Hygiene has been around for eons, you may never have heard much about it. Many people have misconceptions or believe it is possible only in other cultures. Here are answers to some common questions, adapted from the book DIAPER FREE! The Gentle Wisdom of Natural Infant Hygiene.

What exactly is Natural Infant Hygiene?

Natural Infant Hygiene is a gentle, compassionate, and practical way to care for a baby's elimination needs from infancy.

Rather than teaching a baby to eliminate into his or her most intimate clothing and cleaning up after the fact, mothers and fathers learn to listen and respond in the present moment to the baby's needs and communication.

Observation and close bonding interaction help the parent understand the baby's signals, body language, and timing rhythms. Many parents find that their intuitive responses also become enhanced. When the baby has to go, the parent holds him or her in a comfortable position over an appropriate toilet place and makes a cueing sound (perhaps a gentle "sss").

In this way, parents can lovingly meet their baby's needs, deepen their communication, and significantly reduce diaper use. This gentle and ancient practice is the most common way of caring for a baby's hygiene needs in the non-Western world. Ideally, Natural Infant Hygiene is part of a larger continuum of gentle and responsive infant-care, such as breastfeeding and co-sleeping.

I thought a baby's muscles aren't developed enough to control elimination until they are 18 months or even older. Isn't this forcing a baby to toilet train before they are ready?

The simple answer is no. For one thing, Natural Infant Hygiene is quite different than "toilet training", early or otherwise. Because babies never learn to ignore their elimination needs and sensations, they do not have to be re-taught to recognise them again later. There is no need to relearn not to use their clothing as a toilet.

In Natural Infant Hygiene, the focus is not on the baby retaining or "holding in" body functions. Rather, the baby communicates a need, and relaxes and releases it at will. The ability to retain develops easily and quickly, at the baby's pace, as a natural consequence of their awareness.There is no forcing involved or even possible.

Contrary to popular belief, babies are aware of and able to exercise their sphincter muscles almost from birth. "Toilet training readiness" is a very recently created myth based on a misunderstanding of an infant's capabilities. Millions of mothers world-wide can attest to the fact that babies clearly can voluntarily regulate their elimination without any coercion or negative effects.

What's the best age to begin?

Beginning in the first days or weeks of life is ideal. In non-industrialised cultures, mothers most commonly begin this practice between birth and about 3 months, though there are accounts of up to a year. For Western mothers, beginning as early as possible seems to facilitate the process.

The best "window of opportunity" seems to be prior to five or six months of age, before the baby loses awareness of elimination because of diaper use. Parents have successfully started Natural Infant Hygiene with older babies; it requires more effort, time, and an especially gentle approach.

Is there any way to learn my baby's rhythms while still using diapers at the beginning?

Many mothers prefer to use diapers at least part-time at the beginning, as they are still learning the baby's rhythms. It can be less stressful for parents who are worried about missing a lot of pees.

It's obviously easiest to notice the baby's elimination patterns when they are diaper-less, and having them bare-bottomed occasionally during the day is really helpful and obviously more comfortable for baby. If the baby is young and not mobile yet, it can work well to have the baby on the diaper instead of the diaper on the baby. You can carry the baby with a diaper or cloth under her bottom, or line your sling with it. Unfitted flat or prefold diapers, flannel blankets, or old towels cut to size usually work better for this (and dry quicker!) than the newer fitted diapers.

Using cloth diapers without a diaper cover, so that the wetness is immediately apparent, is also useful. Remember to make the cueing sound every time they go! Using diapers as a back-up, you can also simply remove them before and replace them after "peeing" the baby. You may feel more confident leaving the diaper off entirely when you are able to make do with only one or two diapers a day.

What are some of the common body signals or other communications that infants give when they need to pee?

Some common signals that indicate a need to pee in a young infant are: squirming, "fussing", tensing the face, frowning or having a look of "inner concentration", becoming quiet or pausing in activity, a sudden increase in activity, looking intently at or reaching for mother, and waking from sleep.

An older baby may also signal his need by: coming to you, moving towards the toilet place, crawling in or out of your arms, struggling to get out of a sling or carseat, moving off the bed, calling you insistently, holding the genital area, making the cueing sound, or moving into his regular peeing position in your arms. If the baby is naked, you may see a tension in the abdomen, or in boys, the scrotum may contract and the penis enlarge slightly.

With some babies, the signals will be subtler than with others. They will likley change over time, as your baby grows. By watching your baby closely, you'll soon be able to recognise her "need-to-go" behaviours.

What if I'm trying to observe my child's signals and I just don't seem to notice any? What if I don't feel very in tune with his signals?

Keep trying. Be gentle with yourself and baby. It's a process, especially as we don't have the support and examples that mothers in traditional cultures have. Although many mothers experience success the first day, full communication doesn't happen overnight, or even in the first days or weeks. It will come with time, patience, and practice.

Many women give up breastfeeding in the first days or weeks due to initial difficulties. Those who persevere almost always have a very positive experience. It's the same with Natural Infant Hygiene. Like breastfeeding, this process both natural and instinctive while requiring patience and commitment to learn.

Remember that there are several tools to diaper freedom. If reading baby's signals and following intuition don't seem to be working for you, try to get a sense of your baby's timing patterns and rhythms. For example, does your baby pee just after waking, or 10-15 minutes after nursing? Offer peeing opportunities (by holding your baby in position and making a cueing sound) at the times when you anticipate your baby may need to go.

Once a communication between mother and baby is established, the baby will begin to cue more strongly. Don't forget to make the cueing sound every time you notice your baby going, even if you're "too late", so your baby learns to connect this sound with the opportunity to eliminate.

How can I use the method if my baby poops or pees during nursing?

This is one the easiest ways to practice Natural Infant Hygiene, because the baby has a very reliable and clear timing pattern. Simply have a small potty, bucket or bowl to hold on your lap, between your thighs or beside you on the couch or bed that the baby can eliminate into while you nurse. The baby goes into the receptacle rather than in a diaper.

Alternately, you can have a diaper or absorbent cloth on your lap under the baby. Make the cueing sound as soon as you notice your baby going so she learns to associate this "language" with elimination.

Doesn't a young infant pee or poop the minute she needs to? Do you have more than a second to run with her to the proper place to go?

Babies, especially babies who are experiencing Natural Infant Hygiene, usually signal their need before the "point of no return" is reached. Certainly, the younger the baby, the shorter the interval between the baby's awareness of the need and the releasing of the sphincters. The parent's awareness of baby's timing can help here too.

Remember that Natural Infant Hygiene is about relaxing and releasing the sphincters and not about "holding it in". When the mother is in tune with the baby's needs and rhythms, she provides a peeing opportunity at a timely moment, rather than expecting the child to hold it in.

What do you do when you will be out in stores or anywhere where you don't trust yourself to stay in tune with your child?

Interestingly, quite a few mothers, actually feel more in tune when out and about! There is a heightened sense of protective awareness of the baby, as well as an extra motivation to avoid "accidents". These parents may rely on using public bathrooms, or bring along a container such as a tight-lidded bucket. Being aware of your baby's timing patterns and providing regular peeing opportunities is helpful. Staying close to home in the first weeks and months allows you time to establish a relaxed and close communication with your baby.

Some parents feel more comfortable using diapers on outings, especially in the beginning. With or without diapers, it helps to familiarise yourself with public facilities, and to make sure to have regular "pitstops".

What do you do at night, or when the baby is napping?

There are several approaches to naps and nighttime (I go into detail in my book).

Babies rarely pee while in a deep sleep. They almost always stir first, usually enough to wake the mother, so she can either take them to the toilet, or hold them over a potty that is kept right beside the bed. Babies who "fuss" at night may just need to pee!

Some mothers pee the baby before, during or after a night-time nursing. You can cradle your baby in a nursing position while holding her over a bowl or potty resting on your lap, between your thighs, beside you on the bed, or on the floor by the bed.

Having an absorbent wool or cotton pad under the baby helps to prevent a wet bed in case the baby does pee in the bed.

Of course, you can always use diapers. Most mothers find that after using Natural Infant Hygiene for a while, the baby is often dry for long periods or even completely at night from a very early age.

Can partners who don't spend as much time with the baby be successful with the signals?

Certainly! How ell this works depends very much on the situation, the relationship between caregiver and child, how relaxed the person is with the concept, and sometimes the stage the child is at. Many fathers participate actively in the process and are very successful at tuning in, though the mother may understand the baby's cues easier at first.

In many countries, babies are "peed" by several members of the family or community, including grandparents and older siblings.

At what point or age can an infant be expected to reliably hold his pee?

In some ways, this is rather like the question: "At what age can a child be expected to wean?" There is a large variance and it's a shifting and gradual process.

Natural Infant Hygiene does not focus on "holding" or retaining the elimination when the baby needs to go. Rather the focus is on recognising that the bladder or bowels need emptying, and on relaxing and releasing the muscles. As these muscles are used and toned, being able to "hold it" for longer periods becomes a natural consequence.

While the ability to release the sphincters seems to be present at birth, most parents who practice Natural Infant Hygiene say that their babies are able to retain their urine for periods of time beginning by the age of a few weeks to about four to six months. However, this may not be consistently reliable until closer to one year. While every child is unique, on the average, these babies usually achieve day and nitghttime continence somewhere between about 15 to 20 months.

More Information about Elimination Communication:

Potty Training Basics
   We provide comprehensive potty training articles to accomplish the struggle
  you're experiencing with your kids. Read more about it here.

Diaper Free!
Diaper Free! The Gentle Wisdom of Natural Infant Hygiene
by Ingrid Bauer

Trickle Treat
Trickle Treat
by Laurie Boucke