http://www.nytimes.com/2005/10/09/nyregion/09diapers.html?emc=eta1&pagewanted=print

October 9, 2005
A Fast Track to Toilet Training for Those at the Crawling Stage
By TINA KELLEY

Hannah Rothstein, 7 months old, has double thighs and a dimpled bottom, but very svelte German underwear. She can still fit into her birth-to-3-month-old clothes because she lacks her peers' familiar bulge in the rear. She can sleep all night without a diaper. And during the day, every so often, after her mother, Melinda, of Newton, Mass., places her on a plastic potty and makes a little "pss-wss-wss" sound like the one used to call a cat, Hannah uses the toilet.

For many parents in the United States, the idea of potty training before a baby is able to walk, or even before age 2, is not just horrifying but reprehensible - a sure nightmare for parents and baby, not to mention a direct route from the crib to the psychiatrist's couch. But a growing number of parents are experimenting with infant potty training, seeing it as more sanitary, ecologically correct and likely to strengthen bonds between parent and child.

About 2,000 people across the country have joined Internet groups and e-mail lists to learn more about the techniques of encouraging a baby - a child too young to walk or talk - to go in a toilet, a sink or a pot. Through a nonprofit group, Diaper Free Baby (www.diaperfreebaby.org), 77 local groups have formed in 35 states to encourage the practice. One author's how-to books on the subject have sold about 50,000 copies.

"It's just so simple," said Lamelle Ryman, who recently attended a support meeting at an apartment on the Upper West Side. Ms. Ryman, the mother of 7-month-old Neshama, added, "I feel like it's been such a gift in our relationship."

Adoption of the approach in the West is in its infant stage, so to speak. Moreover, the philosophy behind it flies in the face of conventional wisdom. Dr. Benjamin Spock, the last word in child rearing for many American families through much of the 20th century, recommended against any training in the first year, believing that it could lead to rebellion later through bedwetting.

Once, however, breastfeeding also was a rarity.

With early toilet training, there is a broad body of knowledge and experience to draw on. Parents in at least 75 countries, including India, Kenya and Greenland, embrace the practice, with Chinese babies often wearing pants with split bottoms for easy squatting (available for $1 in Chinatown, according to savvy mothers in New York).

Some parents who adopt children from other countries say they are startled to find that their babies arrive ready to use the toilet. More than 50 percent of the world's children are toilet trained by the time they turn 1, according to Contemporary Pediatrics magazine.

From birth, the reasoning goes, infants are aware of their needs to eliminate, and although their muscles are not developed, they can soon learn to go on cue. Conversely, by relying on disposable diapers, modern parents are in effect teaching babies to ignore the signs that they have to go, making potty training at a later age more difficult.

Ingrid Bauer, author of "Diaper Free! The Gentle Wisdom of Natural Infant Hygiene" (Natural Wisdom Press, 2001), believes it is easiest to begin toilet training in the first six months. To start, parents are taught to hold the baby by the thighs in a seated position against their stomachs and to make an encouraging hiss or grunt. With practice, parents learn their child's rhythms; some parents sleep next to their children and keep a potty at arm's reach, or diaper their babies overnight.

For families who practice the technique, the advantages are many: savings in the cost of diapers, which can reach $3,000 a child; less guilt about contributing to the 22 billion disposable diapers that end up in landfills every year; no diaper rash, and a nursery that doesn't reek of diaper pail. They also note that age 2, a common age for toilet training, is a time of notorious willfulness and a terrible age to start teaching any child anything.

Most important, they say, is an increased emotional bond with the baby, forged by the need for the parent to pick up on subtle signs and act on them quickly. Proponents of the practice use the phrase "elimination communication."

"It is enhancing that interaction and closeness, the intimacy between baby and mother," said Thomas Ball, a psychologist in California who is helping develop a documentary about the technique. Unquestionably, in a child-rearing culture that thrives on sanitation and parental convenience, the prospect of supervising 20 deposits a day in the first busy months of infancy is daunting.

"It doesn't sound like anything I would ever even attempt to try," said Erinn Marchetti, who has two preschool-age children and was shopping recently at Toys "R" Us in Times Square. "It's hard enough when they're 2 and 3."

Another mother in Toys "R" Us, who offered her opinion but wanted to remain anonymous, was aghast at the notion. "Have you read Freud?" she asked, worrying about the method's long-term effects. "I imagine it's going to come out in sexual ways."

Dr. T. Berry Brazelton, the renowned child-rearing expert, said parents need not worry about psychologically damaging their child. Dr. Brazelton, author of "Toilet Training: The Brazelton Way" (Da Capo Press, 2004), has always advocated a child-centered approach to training: do it when a child is ready, without too much pushing or even encouraging.

"I'm all for it, except I don't think many people can do it," he said of elimination communication. "The thing that bothers me about it is today, probably 80 percent of women don't have that kind of availability."

As with breastfeeding, a turn toward infant potty training would represent a leap into the past. Before the 1800's, babies in Western societies were swaddled, which restrained them and contained their wastes, Laurie Boucke said in "Infant Potty Training" (White-Boucke Publishing, 2002), one of several books she has written that advocate the technique. When cleanliness became a virtue in the 19th century, Ms. Boucke wrote, infants were regularly held over a chamber pot until they learned the habit of using it.

The American Academy of Pediatrics, in its current "Toilet Training" pamphlet, says children have no control over bladder or bowel movements when they are younger than a year and little control for six months afterwards.

"Even if you're getting them to go in a pot as a young infant, I don't know if it will have any long-term impact for all the effort you have to go through," said Dr. Mark Wolraich, author of the academy's "Guide to Toilet Training" (Bantam Books, 2003). "The risk is, if it's not working and the parents are frustrated, they're creating more negative interactions with their child."

But parents of diaper-free babies said working with a child's signals is a rewarding experience.

A mother in Medford, Mass., Sarabeth Matilsky, said elimination communication helped strengthen her bond with her son, Ben, who began using a potty when he was about 10 weeks old and who was colicky as an infant.

"When I started doing this, I got to start seeing him as a little person with abilities," she said.

At two recent meetings of support groups, mothers and one father shared signals their babies gave: kicking, nose-rubbing, getting loud, getting quiet, hiccupping, feeling warm to the touch, shivering.

Ms. Boucke, the author, noted that many fathers enjoy infant potty training. "They can't breast-feed, but they can work on the other end," she said.

She knows it can be challenging, she said. "I tell people, you cannot be a perfectionist with this," Ms. Boucke said. "No one is going to be there all the time. They won't have a life."