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The Four Stages of Toilet Learning Starts from Birth.

A gentle guided natural progression toward toilet independence.

By Rebecca Larsen


Elimination Communication is a fun and easy way to help assist your baby with their toilet needs and can be started right from the newborn stage. The benefits are supported by various medical studies and can help a child reach the underwear wearing stage much sooner. One of the big bonuses, is that poo is really easy to potty from a very young age.


Karla from Nurturing Touch teaches a holistic sleep method which in many ways shares the same philosophies as Elimination Communication. The non-coercive approach is gentle, baby-led and parent guided offering support for a more settled baby.


This excerpt is from my step-by-step book Elimination Communication Babies. I've written this book to help assist parents through their toilet learning journey with their babies, in a simple and easy to follow guide. Having fun with EC is key, so I've made sure to add some humour to my book to keep you smiling!



Stage one – The EC hold

The baby cannot sit, is on a liquid diet and is assisted in eliminating in a held squat position over a potty. The old term for this is ‘held out’. The baby does instinctively eliminate when in this hold and can show signals when they need to eliminate. The EC hold is a deep squat and a very advantageous position for passing stool. This stage is important as it reduces the risk of nappy rash/nappy dermatitis, soft tissue infections or worse, MRSA.1 It builds communication between baby and parent. Natural elimination patterns are responded to, resulting in a cleaner and healthier practice. Regular potty use maintains and develops sphincter control from a young age.2 The baby also follows their instinctual preference to eliminate outside their clothing or bedding and learns correct potty use. Nappies are worn as a back-up and not solely worn for the duty of being a toilet. The use of a nappy forms a habit that must otherwise be unlearned.


Stage two – The sitting potty

The baby can sit unsupported and is eating solid foods. Once a baby can sit without being supported, they can control and coordinate their bladder, urethral sphincter and anal sphincter muscles.3The potty is used as an accessible, safe option during this stage and encourages a squat sitting position. This stage is important for healthy stool elimination and early development in toilet independence. A baby can begin to get onto and off of the potty independently. Regular use of the potty develops the elimination routine and can be beneficial to avoid urinary tract infections.4,5According to an elimination research study by Nuria Estrada-Zambrano, the most common age for controlling stool (day and night) was 6 months.6


Stage three – Toilet independence (toilet training)

The toddler can walk and communicate. This final stage progresses the child through using the toilet assisted to non-assisted where the child can state their need to go toilet before they go. For Elimination Communication children, this final stage focuses on bladder control and recognising their need to use the toilet. The bladder can now hold more, and the frequency of urination is less. For children starting their toilet learning here, the process of stool management sometimes follows bladder control. Privacy and independence become important for a child as they become more self-aware. This stage is important as it is the final stage to toilet independence and removal of the nappy safety net. On average (EC children) reach daytime dryness around 18 months and bowel control from 6 months.7,8



Stage four – Sleep dryness

Nighttime assistance can occur during the first three stages or following. Nighttime dryness can be achieved earlier if started earlier. During sleep, a baby can stir and awaken because of their need to eliminate which can sometimes be interpreted as needing to feed. Elimination tends to happen during a wake state. You may wait until your child can walk and aid themself to the toilet. While encouraging independence, you will still need to offer assistance and provide lighting and tools for their success. Aim to wrap up nighttime before too long, so night wetting does not become a habit. Deep sleepers may need nighttime assistance. EC children are thought to have better awareness and control of the bladder, with more complete emptying. Anecdotally, they have less nocturnal enuresis (bed-wetting).9


The natural progression of toilet learning

Starting on the path to toilet learning within the first year is the optimal window to reach toilet independence within the second year or earlier. It is a choice that is healthier for babies, more economical and environmental, but it is a choice that is not often presented to families at the right time. In support of sharing this information, so more families are aware of their choices please share my work and this blog.



References:

1 HOLSENBACK H., SMITH L., STEVENSON MD. Cutaneous abscesses in children: epidemiology in the era of methicillin-resistant Staphylococcus aureus in a pediatric emergency department. Pediatr Emerg Care. 2012;28(7):684–686

2 DUONG TH., JANSSON UB., HOLMDAHL G., SILLÉN U., HELLSTROM AL. Development of bladder control in the first year of life in children who are potty trained early. J Pediatr Urol. 2010;6(5):501–505pmid:19939737

3 DUONG TH., JANSSON UB., HOLMDAHL G., SILLÉN U., HELLSTROM AL. Development of bladder control in the first year of life in children who are potty trained early. J Pediatr Urol. 2010;6(5):501–505pmid:19939737

4 DUONG TH., JANSSON UB., HOLMDAHL G., SILLÉN U., HELLSTROM AL. Development of bladder control in the first year of life in children who are potty trained early. J Pediatr Urol. 2010;6(5):501–505pmid:19939737

5 DEWAR G. (2010) The science of toilet training: what research tells us about timing. www.parentingscience.com

6 ESTRADA-ZAMBRANO N. (2020) Elimination Communication Research Study and Survey

7 ESTRADA-ZAMBRANO N. (2020) Elimination Communication Research Study and Survey

8 RUGOLOTTO S., SUN M., BOUCKE L., CALÒ DG., TATÒ L. Toilet training started during the first year of life: a report on elimination signals, stool toileting refusal and completion age. Minerva Pediatr. 2008 Feb;60(1):27-35. PMID: 18277362.

9 BENDER J., SHE R. (2017) Elimination Communication: Diaper free in America. Pediatrics. Official Journal of the American Academy of Pediatrics. www.pediatricsaappublications.org


About the Author

Rebecca Larsen lives in Tauranga, New Zealand. She had her two babies while living in Toronto, Canada. She is a best-selling children's picture book Author in New Zealand, and is passionate about sharing Elimination Communication as an option for toilet learning. She has helped coach hundreds of parents, assisting them toward toilet independence typically around 18 months – saving them loads of money, building their confidence and sharing her fun and easy to follow approach.


Book link to Amazon -

Black & White Interior: https://www.amazon.com/dp/0473554437 Link to my shop (I have some books on stock for free shipping in NZ) -



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