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Thursday, April 3, 2008 

Much to her nanny's surprise and chagrin, Betsy Davidson, now slightly more

Much to her nanny's surprise and chagrin, Betsy Davidson, now slightly more than 2 years old, was fully potty trained by her first birthday.

And Betsy is not the only toddler who is giving up her diapers for a turn on the toilet. A growing group of parents are fast-tracking the toilet training process and teaching their children to use the potty before they can walk, talk or even turn 2.

"I started potty training Betsy at eight months because she had very regular bowel movements. I would feed her, put her down and take a shower and when I got out of the shower, she would have a poop in her diaper," Betsy's mom, Emily Jean Davidson, MD, MPH, an attending physician at Children's Hospital Boston, tells WebMD. When Davidson began to sense that early toilet training was possible for her daughter, she did research and contacted a nonprofit group called Diaper-Free Baby, which comprises 77 local groups in 35 states that promote and teach the elimination communication method to interested parents such as Davidson.

"My nanny thought we were crazy for trying this," she says. "But after a few months when Betsy was around 1 year old, the nanny said, 'she was crying and turning red and scooting, so I put her on the potty, she pooped and then she was happy.'"

Davidson explained to her nanny that Betsy was really signaling that she had to go. It is this signal/response process that is the key to early potty training. Moms like Davidson merely respond differently to cues and take their baby to the toilet -- instead of the changing table.

For the Davidson's, the method worked. "We had a very positive experience," she says. "Once we started, there were maybe 10 to 20 times that we had to change a poop diaper. She became pretty consistently dry by around 16 months."

Recognizing the Cues

Known as elimination communication, such early potty training relies on a parent's ability to read and recognize the signs that their infant needs to eliminate -- much as they would if their child was tired or hungry. Signs of impending bowel movement or urination can include facial expression, grunting, and bearing down. Advocates suggest that such early toilet training enhances interaction and communication between parents and babies, prevents diaper rash, avoids the struggles associated with diaper changing, saves money on diapers, and is better for the environment -- as 22 billion disposable diapers end up clogging landfills in the U.S. each year. Detractors, however, have their own reservations about this practice -- namely that an infant's muscles are simply not developed enough for toilet training before they turn 2.

But "in terms of communication, elimination communication is better because the child learns to understand what's going on with their body and realizes if they let you know, you can do something about it," Davidson says. "There's also less diaper rash because they are not sitting in their poop."

Davidson likens elimination communication to how parents teach children to eat. "How do we know when a child needs to feed? We just have a sense and we feed them," she says.

"There's a nice logic to the elimination communication method," agrees Leslie Rubin, MD, a pediatrician at the Morehouse School of Medicine and Emory University School of Medicine, both in Atlanta. "If you become aware and sensitive to what the little ones are doing, you can respond accordingly. It may not be absolute because just like with feeding, sometimes you can't feed an infant when it's time to feed because for whatever reason, you might be distracted."

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