Melinda Rothstein began potty training baby Hannah when she was 4 days old. Now, at 4 months, Hannah almost never wears a diaper. (Globe Staff Photo / Bill Greene)
Some local parents are embracing a technique for potty training infants
By Ricki Morell, Globe Correspondent | July 5, 2005
DOVER -- On a sunny weekday midmorning, Hannah Rothstein,4 months old, coos in her mother's lap at the kitchen table. Her older brother, Samuel, who is almost 3, plays in the backyard with a baby sitter. It's a typical suburban scene, except for one detail. Amid the accouterments of modern parenting -- bouncy seat on the floor, cellphone on the counter -- one kind of baby care basic is conspicuously absent.
This house has no Diaper Genie, no diaper pail, and no stack of diapers next to the changing table.
That's because no one in this house regularly wears diapers.
At the kitchen table, baby Hannah sits bare-bottomed on a tiny plastic potty that her mother holds while cradling her. Hannah is happily taking care of business while Melinda Rothstein talks to a guest.
Hannah was 4 days old when Rothstein first ''caught" her before she actually went to the bathroom, and Hannah has been going in a potty ever since. Rothstein sometimes lays out cloth diapers under her to sop up any ''accidents." And she uses little cloth training pants when they go out. Once in a while, she'll put on a disposable if they go to a restaurant. But, most days, Hannah is dressed in pint-size underwear. ''I wouldn't want to wear my toilet, would you?" says Rothstein, 31.
About a year and a half ago, Rothstein and a friend, Rachel Milgroom, started DiaperFreeBaby and DiaperFreeBaby.org, a nonprofit and a website dedicated to spreading the word about a technique called ''elimination communication," or infant potty training. About 70 people in the Boston area now belong to the group.
''Discover how amazing your baby really is," encourages the DiaperFreeBaby brochure. ''Just as parents learn to read their baby's signs for sleep and hunger, they can also learn to read their baby's signs for needing to eliminate."
Elimination communication has its roots in the traditional cultures of Africa and Asia, where mothers carry their babies close to them and hold them out to let them urinate on the ground. In suburban Boston, parents observe the child closely, taking cues from the child's body language and trying to get him to a potty, a toilet, or even a sink before he eliminates. A baby may start kicking or grimacing, or even stop nursing, just before the big event. And sometimes a parent can give the baby a cue, like holding her over a potty and making a ''sss" sound. Though most people agree it's easiest to start the process before the child is 6 months old, Rothstein says she started her older son at 8 months and it worked. Usually by 18 months children ''graduate," which means they know when they have to go the bathroom and they take themselves there.
Rothstein, like many of the mothers involved in the DiaperFreeBaby group, believes in an ''attachment" parenting style. Rothstein gave birth to Hannah at home. Hannah sleeps in her parents' bed and spends part of the day being carried around in a baby sling by her mother. This close contact allows Rothstein to better pick up on her baby's cues. Others are attracted to elimination communication because they worry about the environmental effects of using disposable diapers, and of washing loads of cloth diapers. Still others are simply trying to save money or avoid diaper rash.
''The first time I heard about it, I thought it was really weird," says Milgroom, who has two sons, Isaiah, 5, and Simon, 2. ''But the more I heard about it, the more I realized they do know when they need to go. How can I ignore that if I know he's telling me?"
Emily Jean Davidson, a pediatrician at Children's Hospital Boston, started elimination communication with her daughter, Betsy Resner, when she was 8 months old. Betsy, who is now 2, started wearing underwear in the daytime at 17 months, but still wears pull-up diapers at night.
''I try to compare it to other developmental tasks, like learning how to eat," says Davidson, who works with children with developmental disabilities. With eating, she says, parents watch for hunger cues and help children slowly develop independent skills over time. Why not do the same with toilet training?
In the first half of the 20th century, early toilet training was considered the norm, but it was regimented, even abusive. Children were strapped into potty chairs, or given soap suppositories when they wouldn't go on schedule. By the 1950s, Dr. Spock's more child-friendly methods became popular. But those old-fashioned cloth diapers were so uncomfortable when wet that most parents still toilet trained their children by 18 months. By the 1960s, pediatrician T. Berry Brazelton was advocating the ''child-led" approach. He advised parents not to pressure children but to let them proceed at their own pace until they could take control of their own toileting needs. Disposable diapers, which are absorbent and not as uncomfortable on the baby's bottom, made this easier. Procter & Gamble, maker of Pampers and Luvs, estimates that 95 to 99 percent of North American parents use disposable diapers.
That means children are taking longer to be toilet trained. According to a 2001 Medical College of Wisconsin study, the average was 35 months for girls and 39 months for boys.
Brazelton, who helped Pampers develop larger diapers for older kids, understands the impulse behind infant potty training but isn't convinced. ''To me, this is parents getting themselves trained and not leaving it to the child at all," said Brazelton, founder of the Brazelton Touchpoints Center at Children's Hospital Boston and one of the authors of ''Toilet Training: The Brazelton Way." Brazelton says he witnessed mothers holding their babies out from their bodies to urinate when he worked with Mayan Indians in southern Mexico. ''It's a regression to an earlier stage in our civilization," he says. ''I don't see it as progression. It seems like an unnecessary hovering of a parent over a child. I think there are more productive ways to interact with a child -- like play."
Laurie Boucke, author of ''Infant Potty Training" and ''Infant Potty Basics," says she understands the approach is not right for every family. ''If it resonates, give it a try," she says. ''And if it doesn't, don't do it."
At a recent meeting of the DiaperFreeBaby group, about 20 mothers, all toting infants and toddlers -- and, in some cases, potties -- gather at Milgroom's Newton home to discuss the basics of infant training.
''He pees like every 20 to 25 minutes," says one mother, Krysia Welin of Brookline, whose son, Kieran Hunter, is 10 weeks old. ''How do you pick it up each time and that quickly?"
Rothstein says, ''It's not all about catching it. It's more about communicating with your baby."
Emily Gelbert, also of Brookline, is expecting twins and hopes to practice elimination communication. Even in this group, people seem taken aback that she would attempt such a task with two children at once. They reassure her that sometimes using diapers -- even disposables -- is OK. Still, for these mothers, diaper-free is the key. Little Hannah Rothstein sits like a queen in the middle of the room on her tiny potty throne. Her mother explains that in the morning she goes every five minutes for about 20 minutes, after that, perhaps once an hour. At night, she usually goes only once.
''It's not more work," says Rothstein. ''Just a different kind of work."
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