Elimination Communication: Your Baby is Speaking to You About Poop

As parenting fads go, elimination communication (also known as EC) might be one of the most controversial. It’s almost certainly the messiest. Based on the idea that indigenous cultures and non-nationalized nations rarely use diapers and potty train babies much earlier than Westernized nations, EC involves a parent or caregiver attempting to read a child’s cues that they’re about to go to the bathroom, then take them to the nearest toilet, rather than simply diapering them and changing diapers as needed.

Proponents of EC believe it to be a natural, more hygienic and less wasteful form of potty training that responds to a child’s needs in the moment. Skeptics of EC call it a form of baby housebreaking that actually ignores a child’s needs and requires constant attention from parents. Unsurprisingly, it’s a frequent topic of heated debate in the so-called “mommy wars” and generates hundreds of comments from those both for and against the practice.

So does EC actually work? Is this something parents should be flocking to or running away from?

The actual term “elimination communication” and the concept of western babies going diaperless was first coined in the 2001 book Diaper Free! The Gentle Wisdom of Natural Infant Hygiene by Ingrid Bauer. There had been a few books on the fringes of parenting espousing the benefits of infant potty training, but Bauer’s book caught on. Unsurprisingly, EC first became popular in the US with proponents of attachment parenting in the wealthy enclaves of New York and the west coast.

The crux of EC is that almost from birth, parents attempt to read the cues and signals their newborn is giving them. According to the EC advocacy site Diaper Free Baby, these signs can include:

• squirming, "fussing," vocalizing
• tensing the face, raising the eyebrows
• frowning or having a look of "inner concentration"
• becoming still and pausing in activity
• agitation or sudden increase in activity
• stirring or waking from sleep
• looking intently or reaching for you
• reaching for the potty, or indicating towards the toilet place

Once a parent observes one or more of these cues, they take the baby either to the nearest toilet or to a bowl strategically set up wherever they happen to be. The baby then eliminates. As this process continues, babies learn to give cues when they need to go to the bathroom, then eventually associate their own cues with going and go to the toilet on their own.

Theoretically, if practiced correctly and consistently, EC would save a family thousands of dollars in the cost of either buying disposable diapers or laundering cloth diapers. It would also save that much landfill space and water, while giving a child the freedom and independence that comes from being able to not ever sit in their own waste.

EC parents regale websites and comment sections with stories of taking their bowls to parties, public parks or friends houses, simply holding their baby over it and letting nature do its work, rather than dealing with a screaming, shrieking child that needs to be cleaned up. They claim it fosters intense communication between children and parents, and is an ancient form of childcare that long predates diapers. In fact, Diaper Free Baby lists 75 benefits to EC, everything from less irritation on children’s skin to it being fun and impressing other people.

One group of people who aren’t especially impressed with EC, however, are pediatricians, particularly those with a background in urology. The general opinion among people whose opinion is actually backed up by training and clinical experience is that EC is anywhere between ineffective and dangerous.

For one thing, it seems to discourage babies from simply going to the bathroom when the urge hits them and leads to chronic holding �" which, in turn, leads to urinary tract infections, physical injuries and repeated accidents. As pediatric urologist Steve Hodges writes on the Huffington Post:

“For proper bladder development, young children need to pee and poop without inhibition. For most babies, wearing diapers facilitates unconstrained elimination. […]

In toilet-trained children, chronic holding is the root cause of virtually all toileting problems, including daytime pee and poop accidents, bedwetting, urinary frequency and urinary tract infections. Published research, including our clinic's 2012 study published in Urology, demonstrates that when you clear up clogged kids and prevent them from holding, the accidents, UTIs and bedwetting episodes almost always cease.”

Beyond that, EC opponents look at the practice as the same kind of conditioning done to dogs in order to get them to do their business outside �" reading cues and rushing them out to the great outdoors (or the pee pee pad.) While EC parents claim regular toilet training assumes babies and young children are stupid and don’t know when they need to eliminate, it’s actually counter to a baby’s natural urges. It's also counter to societal norms.

Babies that young don’t understand what the feelings in their bodies mean, only that they’re there, and sometimes they make them feel uncomfortable, ie, a wet and cold diaper that needs changing. The nerves and muscles aren’t developed enough to properly hold waste, nor are the brain connections there to signal what a full bladder entails. A child as young as two months old might not even know that their hands belong to them, yet EC supporters expect them to know the ins and outs of complicated body functions enough to know how to read and express them. Most doctors agree this is not only unrealistic, it’s harmful.

Beyond the physiological reasons EC is something to be skeptical of is the commitment it demands from parents. It requires that parents (and almost always mothers, at that) spend virtually all of their waking hours reading and anticipating cues from their babies. Most EC proponents claim they begin the process almost immediately, and infants can urinate as often as once every hour. This is a recipe for exhausted parents and frustrated, unhappy babies. And since most fathers in America go back to work soon after the baby is born, the burden of EC falls on the mother, who is already the baby’s primary food source.

There’s also the usual logical fallacies inherent to any kind of woo. Declaring that EC is the right choice because “ancient cultures and non-industrialized people do it” is the appeal to tradition: it’s old, therefore it’s good. It's also squarely in the naturalistic fallacy: it's natural, therefore it's good. But neither age or status as natural is actually a reason to do something. As Hodges writes on the HuffPo:

“[I]n much of the developing world, toilets aren't the norm; instead, people squat, a position that, research demonstrates, makes elimination much easier. And when you don't need to worry about finding a toilet (behind a bush will do), there's less reason to hold. It's all about access.”

Many parents in the developing world go diaper free for a simple, tragic reason: they don’t have access to diapers, or the funds to buy them. This is typical of so many fads in food and parenting: taking something born out of poverty and turning it into an affection for the upper class to boast about at parties.

Finally, of all of the “75 Reasons to Practice EC,” none are born out of good scientific research. There’s a reason for that: there is virtually no solid scientific research that supports EC as any more beneficial than western toilet training. Given the risks involved, not to mention the messes, it would seem the benefit to EC might not be to babies at all, but to their parents.

Obviously, every child is different, and has different elimination needs and habits. And every parent has the right to raise their children any way they want, provided it’s safe for the child and those around them. But is EC really safe for children? Is it beneficial? Is it better than the alternative?

It would seem that the only way to find out is an exhausting, difficult, messy and possibly harmful process with no scientific research backing it �" only tradition born out of necessity by people who, given the choice, would probably much rather diaper their children.