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A new/old way to toilet-train baby

Can babies be toilet-trained in the first year? Of course!

This approach, now dubbed "elimination communication," revives an ancient practice.

In my cross-cultural studies — for example, in southern Mexico, Africa and Japanese islands — mothers follow age-old traditions, carrying their babies in a sling or serape. When they feel their babies' internal cues that indicate a production is coming, they rush them to the right place and hold them out. They are taking advantage of the first critical window for toilet training that relies on this kind of close contact. Before the baby has learned to walk, he has been conditioned to signal when he needs to "go" by his parents' responses.

Parents who have used this approach describe carrying their baby through much of his first year, holding him over a potty whenever he seems to signal that the moment is opportune. After a period they can put him down, but go to him every 1-2 hours to hold him on the potty. The baby cooperates by urinating or having a bowel movement.

Parents I've spoken with sound so enthusiastic about how much this early closeness means to them and to the baby. They seem satisfied to have learned their baby's cues and their baby seems proud, too.

For now, though, the demands of "elimination communication" may keep it beyond the grasp of many families.

In industrialized countries like ours, most mothers and fathers cannot be free to carry their babies all day at home or work. The Family Work Institute reports that well over half of mothers are in the out-of-home workforce from necessity, while 90 percent of fathers are similarly unavailable for this kind of toilet training in the first year.

Since we can't hold our children close all day long in the first year, we have had to "wait" until they are ready to undertake toilet training more actively as a major step in their development — typically sometime after the age of two. If parents wait for that new kind of readiness, another opportunity will arise. Two or three-year-olds' new cognitive abilities, and their desire to be in control, and to be like the grown-ups they admire, will take the place of the infant's compliant readiness for physiological conditioning.

Such readiness includes (1) imitation of adult behavior, (2) willingness to stop running around and sit down, (3) interest in putting things in their proper places, (4) ability to say "No," so that toilet training can be his own achievement, and not his parents. (See our book, Brazelton and Sparrow: "Toilet Training, The Brazelton Way," Da Capo Press 2004.)

We're asking a lot of a small child — to feel "it" coming on, to go where we demand him to go, to do it there and then watch it disappear for the rest of his life. What an achievement it is for him to learn to value becoming a toilet-trained member of society!

While "elimination communication" is effective in cultural settings that it is adapted to, there are two major pitfalls for ours.

First, if it is proclaimed as the "new" and "better" way to toilet train, "elimination communication" will make parents who must work feel even worse than they do already about missing out on caring for their children.

This will make them feel guiltier but will hardly help them feel closer.

Second, "elimination communication" must not be misunderstood to mean that this form of physiological conditioning can be used at any age.

Once an infant becomes a toddler and starts to walk, he'll insist on doing everything himself — feeding himself, dressing himself, pressing the button on the elevator himself. The last thing in the world that he'll go along with now is to be hauled off to the toilet whenever an adult thinks he needs to go.

Do I think that the new/old, hold-me-close approach is a way for parents to communicate with their infants? Absolutely. But for parents who must work, and are unable to share this process with those who care for their babies when they cannot, there are many others — talking, singing, rocking, exchanging smiles, playing and even making diaperings a time for communication. I used to sing and laugh with mine each diapering. They'd pull at their pants just to get my attention to come and play. Diapering was not a chore for me or for them.

This present trend in "elimination communication" is a beautiful one. But I would hate for parents who cannot use this form of communication to feel guilty or that this is another loss. There are so many other ways of getting to know babies and of letting them know you are passionately in love with them.

Questions or comments should be addressed to Dr. T. Berry Brazelton and Dr. Joshua Sparrow, care of The New York Times Syndication Sales Corp., 609 Greenwich St., 6th Floor, New York, N.Y. 10014-3610. Questions may also be sent by e-mail to: Questions of general interest will be answered in this column. Drs. Brazelton and Sparrow regret that unpublished letters cannot be answered individually. Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child's health or well-being, consult your child's health-care provider. © T. Berry Brazelton, M.D., and Joshua Sparrow, M.D. Distributed by New York Times Special Features