Do you ever wonder how most of us practice Elimination Communication (EC), what are our reasons and our difficulties, and what are our results?
Will a child be potty trained earlier if we start earlier, or does it mainly depend on his chronological age?
How common are “potty pauses” and around what age should we expect them?
How involved are partners in EC?
Are you the only one who can’t convince any of your friends with babies of the benefits of EC?
All these questions, and many more, remain unanswered...until now, that is.
Unfortunately there were hardly no studies regarding EC, and mainstream medicine seems to recommend later toilet training based on consensus that isn’t backed up by solid research.
This is the reason why Núria Estrada, a clinical psychologist and part-time researcher (in other fields) from Barcelona, decided to run a survey to find out how we are all managing with EC.
The survey was given to people who are currently practicing EC with their babies (full-time or part-time, even if they have just started) or who have finished doing it recently (less than a year ago).
I invite you to download the entire study and analysis for free, to read it and draw your own conclusions. It hasn’t been published in a journal yet, but Nuria has allowed me to publish her study on our blog for immediate sharing!
Alright so 1226 total people responded to the survey. 1176 of those started before the 1st year. Only this group of 1176 were included in the analysis. Almost all respondents (99%) were women (mothers and one grandmother!).
The average start age was just under 3 months, and the average duration of EC of the respondents of the survey was just over 9 months.
Nuria divided the sample into four groups according to starting age (0-3 months, 3-6, 7-9, 9-12) and compared the current success regarding pee and poop during the day and night, the starting age of intentional signaling, and the age of completion (pee/poop and day/night, if they claim to have reached completion).
Does starting earlier in the first year mean reaching “poop or pee trained” sooner?
Basically, there is a trend that shows that an earlier start means earlier continence regarding POOPS and intentional signaling, but not regarding PEES. (This difference and statistical significance holds if we divide the group in 2 (0-6 months, 6-12 months) as well.)
This means that people who start earlier in the first year report better success than those who start later regarding POOPS (not pee). This is very interesting because the current effectiveness is also influenced by the current age (those babies with an earlier start age are currently younger than those that started later – the difference is statistically significant, however younger babies still do better on average than their older counterparts).
So if you start EC earlier within the 0-12 months range, you’ll have an easy road to poop training - the earlier, the better! With pee, it doesn’t make much difference at what age you start within the 0-12 month range. We’ll talk about average end results in a sec.
Another way to look at this: On page 8 of the study, it says that the earlier you start (in the first year), the earlier they won't soil themselves. We all know poops are easy, right? But it also says urine will still take some time and it doesn't make a difference if you start earlier or not (again, starting earlier within the first year is all we’re looking at here).
Nuria personally thinks that this would not be true if we were doing mostly full-time EC and without diapers, as in other cultures, but this survey reflects the results of our real practice, which is more "relaxed" and adapted to modern living.
I know that I’ve experienced pee completion with both of my girls by 13-15 months of age, and I started both of them at birth, so note that this is not the be-all, end-all of everything! This is not the last word on the matter.
With both of my girls, I did EC full-time and I took them out of diapers at 13 months old, right after walking, and into undies within a month. I would guess that this helped them achieve pee control - no accidents - because I removed the diapers at that age and trusted them to stay dry.
My boys, on the other hand, were a different story! I had a similar experience to the survey respondents with them - it didn’t matter how early I started EC within the first year (all at birth) or when I took the diapers away (9, 17, and 12 months) - we still had some pee accidents until around 17 months of age.
Finishing by 6-10 months with poop and 19 months with pee? That’s HALF the current national US average of potty training 36-38 months. I’ll take it.
Start early, finish early!
Okay back to Nuria’s analysis of her study:
Did people do EC full time or part time?
Another interesting finding is that approximately half of the respondents practice EC full time and half part-time during the day, but at night 61% claim that they “usually don’t practice any form of EC.”
Among those still in training, the effectiveness of EC was greater for those who practiced full-time EC.
Which backup do folks use?
Daily bladder control was related to the type of diaper used (those using cloth diapers experienced more success than those using disposables).
Among those still in training, the effectiveness of EC was greater for those who used regular underwear or training pants.
Are people satisfied with EC?
People value EC as quite satisfying (8.5/10).
Are people tired / is EC time-consuming?
Participants stated that EC was not too tiring or time-consuming and were highly satisfied. On a scale of 1 (not tiring or time-consuming at all) to 10 (enormously tiring or time-consuming), most people rated 3, with a mean of 3.9.
So, yeah, EC is technically and legitimately not wearing people out, not time-consuming like people fear!
(EC actually takes away one of your duties as a new parent...just sayin’.)
Are partners / dads on-board?
About 80% say that their partner is just as involved as they are, or less but due to practical reasons (like they work full-time), but that their partners are not less motivated.
And now for the big reveal:
At what age were babies pee and poop trained?
The most common age for controlling stools during the day and at night was 6 months.
The most frequent age of urinary continence was 18 months during the day and 20 months at night.
50% of the children had achieved stool continence by 6 months (at night) and 10 months (during the day), and had attained bladder control (both during the day and at night) by 19 months of age.
Yes!! We ECers knew it. Babies are typically “poop trained” before 1 year old with EC.
In my mind, that means you can send a kiddo to preschool or daycare without a diaper by 12 months old. No more reasons to not try EC. ;)
If you were wondering what you can expect - there you go. Such good info.
At what age did babies consistently signal?
From the study: By 13 months of age half of the children had already started intentionally signaling their need to eliminate.
The most common age was 12 months; while 25%, 50% and 75% of babies had started signaling by the ages of 9, 13 and 17 months respectively.
So, while many babies signal regularly by 9 months of age, about 75% of babies start signaling regularly by 17 months old. That’s almost all of them.
Be patient, young grasshopper! Signals DO come back if they disappear, and this study is proof.
On page 8 of the study, it says that the earlier you start (in the first year), the earlier the baby will start signaling. If you start EC earlier in the first year of your baby’s life, signals will come more easily.
How do parents know their babies need to pee?
Most participants said that they used baby cues (fussing, pushing away...) to predict elimination and also offered the potty at certain times (after naps, after eating, when the baby wakes up...).
How many people experienced potty pauses?
50.1% of participants stated that their baby had gone through at least one “potty strike,” refusing to use the potty or experiencing a significant decline in success that could not be explained otherwise. 57.3% of them claimed to have experienced only one strike. When only children older than 14 months were selected, the percentage of those who had experienced potty strikes increased up to 74%.
So, potty pauses are normal and you can learn more about why they happen and how to get through one (tip: teach something, give more control, give privacy!) on episode 23 or in my Potty Pause Resolution Minicourse.
How many people gave up on EC?
Most parents were always consistent with EC, and very few abandoned the practice.
Only 28 participants (2.4%) claimed they had definitively abandoned EC. Their reasons were predominantly due to lack of success and potty refusal, but participants also mentioned stress and domestic or external workload, lack of support, depression, or anxiety.
This finding makes me feel so encouraged that all the support we make available in our private book owners group and other’s online groups are really making a difference in helping people stick with it! This is my unscientific assumption. :)
Why do people do EC?
The main motivation to practice EC was feeling that it was more respectful for the baby, but participants also wanted to finish potty training at an earlier age, to clean fewer diapers or save money on diapers, and to contribute to protecting the environment.
Are ECers isolated?
According to the results of the survey, EC is a very isolated practice, with most people having no acquaintances around them involved in EC and using online resources as the main source of information.
(More reason to join our coach program and bring EC to your town!)
Most common supply used?
The potty was the most common instrument for elimination.
Do people EC on outings?
While away from home about half usually continued practicing EC.
(Learn how to use EC on outings in my EC While Out and About course!)
In Nuria’s words:
Considering the results of this survey and the review of previous research, it seems highly advisable to inform parents or caregivers of the possibility, the method, and the expected results of early toilet training, so that parents can make an informed choice.
It seems clear that infants are prepared for toilet training at earlier ages than mainstream medicine advocates, that an earlier start does lead to an earlier completion, and that, despite the effort involved, there are potential health benefits for infant toilet training.
Okay! Now that I’ve given you the highlights, here is the full study for your free download. Feel free to share it far and wide.
Also for those of you who are holding a newborn or driving or pushing a stroller, I’ll also share the beginning of the study with the full literature review from Nuria. If you’re not into stats and numbers, you can go ahead and comment below an answer to my question:
Please comment below:
What was the most surprising thing you took away from Nuria’s study? What are you gonna share about?
If you’re not sticking with me, have a lovely day and I’ll see ya next time.
For the rest of you, here is the literature review from the beginning of the study. Since you’ve just been thoroughly informed of all the conclusions of this EC study, marvel in the stark contrast the rest of this info will present. Full citations are found in the linked study.
“Toilet training is usually a challenge for parents all over the world, and difficulties associated with toilet training are a great concern and can cause much stress in families. However there hasn’t been much research regarding this topic in the medical literature, and guidelines about how to achieve this milestone have changed over the years, from rigid habit training approaches that even included coercive methods to the so-called child-centered approach described by Brazelton(1)1 in 1962 that has greatly influenced the current guidelines(2). In Brazelton’s study, parents of 1170 children were instructed to start toilet training when their child was 18 months or older, introducing a potty chair, showing the child what it was for and encouraging him to use it, and of course praising his or her success. The average age for day continence was 28.5 months, and 33.3 months including night-time. Urine and bowel continence were usually achieved simultaneously.
An earlier observational study(3) followed a cohort of 992 children born in Baltimore (USA) in 1952. This study, prior to the widespread commercialization of disposable diapers in the late 50’s, aimed to determine the age of bladder control during the day and at night. It must be stressed that children were categorized as having become dry after a month of having one accident at most, therefore using a strict definition of dryness. Although the authors don’t specify the age when training was started or the method parents used, day-time dryness was reached just before 2 years of age in 50% of children and night-time dryness just over 2 years of age, showing earlier achievement of this milestone than Brazelton had observed.
There are also descriptions in the literature of cultures in which mothers learn to identify their baby’s need to void or defecate, provide an appropriate position in a certain location and cue the baby with a certain sound so that the child doesn’t wet or soil him or herself. Dryness is achieved as early as 6 months old(4)(5).
It has been shown that toilet training changes the physiological functions involved in bladder response (increasing the bladder capacity, improving the coordination between the bladder and its sphincter and emptying the bladder completely), and that from birth bladder emptying is not an automatic function without the influence of the brain. In a study comparing healthy Vietnamese (where toilet training is started in infancy and diapers are infrequently used) and Swedish children(6), the authors observed that early potty training of Vietnamese children led to complete bladder emptying by 9 months of age, while Swedish children did not show complete emptying until the age of 36 months (when they were toilet trained). By the age of 24 months, 98% of Vietnamese children had achieved bladder control independent of support from an adult, while by the age of 36 months, only 55% of Swedish children had reached this milestone.
In 2000, a survey in Belgium(7) was conducted to assess the differences in toilet training practices in the previous 60 years. Parents who responded to the questionnaire were grouped according to their generation (those born in 1920-40, those born in 1940-1960, and those born in 1960-1980). In the eldest generation group, toilet training was usually started before 18 months of age (and 50% claimed to have started during the first year), disposable diapers were infrequent and most parents used prompting as a training method. Among the youngest generation, only 22% had started before 18 months, 98% used disposable diapers and only 8% used prompting as a training method. The duration of training was not different in the three groups, with an average duration of 6 months. 71% and 61% of children in the eldest generation group were dry and clean by 18 months of age during the day and at night, respectively, while these percentages dropped to 17% and 8% in the youngest generation of parents.
As shown in this last study, a gradual delay in the age of toilet training worldwide has consistently been observed over the past century, with recent data indicating that the current average start age is 25.5 months for girls and 30.5 months for boys(8), while there is no reason to assume that children’s abilities, capacities or physiological development have changed over the last hundred years. It has been suggested that later initiation of training is related to the belief that early training does not lead to earlier completion of training and the availability of disposable diapers(9).
Unfortunately, this delay in training has been linked to higher rates of stool toileting refusal, defined as the refusal to defecate in the toilet or potty for at least one month while voiding urine consistently on the potty, with 50% of children trained between 42 and 48 months being considered stool toileting refusers and rising up to 73% in those being trained after 4 years of age, while only 11% of children exhibited stool toileting refusal before 2 years(10). It is noteworthy that stool toileting refusal can lead to stool withholding, severe constipation and, if not resolved, primary encopresis(11). Moreover, a review of urinary continence has shown that a later age of training is consistently associated with a higher risk of urinary incontinence, and it has therefore been suggested that the modern trend for late toilet training may have caused an increase in enuresis(12), but no controlled studies on early versus late toilet training exist to evaluate this hypothesis. A large anonymous survey with over 4000 respondents evaluated factors associated with voiding problems such as incontinence, urinary tract infections, and urgency, and found a strong association between these problems and the age of onset of toilet training(13). They concluded that bladder-sphincter coordination is not purely a maturational process and can be influenced by toilet training, and suggested that the best time to start this training should be before 18 months of age.
Prior to the present survey and of great relevance is a study conducted by the team of Dr. Rugolotto(14) aimed at examining the practice of toilet training started during the first year of life. An anonymous questionnaire comprising of 44 questions was developed in English and translated into Chinese, Dutch, German and Italian. It was distributed in several countries and 286 responses were obtained. The demographic characteristics of the participants were similar to those found in the present survey. The mean age of daytime dryness (with a maximum of 2 accidents per week) and bowel control (excluding episodes of diarrhea) was 17.4 and 15 months respectively. At night, the mean age for dryness (with a maximum of one accident per week) was 13.5 months (with self-awakening for voiding) and 17.7 months while sleeping through the night. Disposable diaper use and a later start (first vs. second semester of life) were found to significantly delay completion age for both bladder and bowel control.”
Have I left you speechless?
A giant thank you for Nuria’s extensive commitment to distributing and compiling information from this study. Many of the participants came from our Go Diaper Free community, and I am so proud of the results y’all are seeing!
Again, please comment below:
What was the most surprising thing you took away from Nuria’s study?
And SHARE THIS STUDY, and parts of it, FAR AND WIDE. Call your TV station, radio show, message all the social media influencers you know. Let’s get this printed everywhere!
And share with your mom and dad friends on social and email...but most importantly, share with pediatricians, midwives, and doulas. We need more people talking about this amazing practice of elimination communication, this EC study, and all the benefits for our babies, parents, and our planet.
P.S. here's the video version of this episode in case you prefer to Youtube it. ;)