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  • By Steve Hodges, M.D.

Elimination Communication: Bad News


Oh boy, here we go again: another mom extolling the virtues of placing her infant on the potty.

“My son was just 3 weeks old the first time he pooped in a toilet,” writes Katy Chatel in the Washington Post. “Now, when many his age are just being introduced to a baby toilet, my 19-month-old uses the adult one on his own.”

Kim Kardashian has been bragging all over town about her own 19-month-old’s “insane” feat of being “halfway potty trained.” But Chatel, adapting the “elimination communication” (EC) approach favored by Mayim Bialik and Alicia Silverstone, has one-upped her.

Or so it would seem.

I’d love to check back in with Chatel — and Kardashian, for that matter — a few years from now, because that’s when the repercussions of early toilet training tend to surface.

Early toilet training, whether facilitated via EC, potty bootcamp, or any other method, is risky business.

The arguments Chatel offers up in favor of EC — cutting down on “diaper waste, expenses and rashes” and improving “baby bonding” — sound reasonable but are far outweighed by the health risks to children who toilet train so early.

Early in my career I wasn't aware of these risks, but after a few years, the pattern became clear to me: the earlier children toilet train, the more likely they are to develop toileting problems. Eventually, my published research confirmed this association, finding that children trained to use the toilet before age 2 have triple the risk of later developing daytime wetting problems compared to children trained between 2 and 3.

(This doesn’t mean 24 to 36 months is the “magic window” for problem-free training. I personally advocate waiting until around age 3.)

Why Early Toilet Training is Bad News

Problems arise because babies and toddlers haven’t developed the judgment to respond to their bodies’ urges in a timely manner. Compared to children who train later, early trainers are far more likely to delay pooping and peeing.

These are dicey habits. When a child chronically withholds poop, stool piles up in the rectum, forming a large, hard mass that presses against and irritates the bladder. It’s a vicious cycle: pooping becomes more painful, so kids delay even more.

Holding pee compounds the problems, thickening and further irritating the bladder. Eventually the bladder can get so irritable that it empties without any input from the child.

Katy Chatel mentions that her son, Jessey, is often “dry in underwear for hours.” I don’t know whether she means he toddles over to the potty and pees on his own or whether he simply does not pee for hours. But if Jessey is holding his pee for more than about two hours at a stretch, he may be headed for trouble.

Parents tend to view potty training as a process, like learning to ride a bike, that has a finite ending: Once the kid catches on, there’s no going back. You’re all home free.

But this is a misconception. The holding habit can catch up with children years down the road. These potty prodigies may be kindergarteners, or older, when they show up at my clinic with the sudden onset of pee and poop accidents, urinary tract infections, or bedwetting. Their parents are stunned.

They’re also unhappy when I explain that only enema or laxative therapy will fix the problem.

The most significant risk factors associated with dysfunctional elimination are not emptying on time and not emptying completely. So, it only makes sense to remove the barriers to timely and complete peeing and pooping, especially during the years when the bladder is growing rapidly.

The only way to ensure kids pee and poop whenever and wherever they need to — and to keep pooping pain free — is for children to wear diapers well past age 2.

27.4 Billion Diapers a Year

Katy Chatel expresses understandable concern about the damage that billions of diapers do to the environment. But she also disses cloth diapers because of the “amount of water used to launder them.”

Look, I’m all for saving the planet. But as a pediatric urologist, my priority is saving kids from the pain, stress, embarrassment, even abuse that can define life when you’re a 6th grader who pees in his pants.

Many children trained early via EC or other methods end up fine; others end up in my urology clinic. I routinely see 9-year-olds who have poop accidents, 8th graders who have monthly UTIs, and high-school juniors who wet the bed.

These problems almost always stem from habits these kids developed in or before preschool.

Arguing in favor of EC, Chatel also mentions that the diaper-free lifestyle is commonly practiced in other cultures. True enough. But as I explain in It's No Accident, being a toddler in rural Botswana typically doesn’t involve snacking on mac-and-cheese-flavored goldfish and going to daycare. You can’t simply say: It works for them, so therefore it works for us.

Chatel concludes with a hope that more parents will practice elimination communication so we can “cut down on diapers and improve baby bonding.”

My hope: parents will stop putting their babies on the toilet. (It would be excellent if they stopped bragging about it, too.)

There are countless ways to bond with your infant and help the environment without raising your child’s risk of developing bladder problems.

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Must-read books for kids by Steve Hodges, M.D.

• Bedwetting and Accidents Aren't Your Fault

• Jane and the Giant Poop

CONTACT​ US

Feel free to contact Dr. Hodges or Suzanne directly:
shodges@wakehealth.edu
suzanne@bedwettingandaccidents.com

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