Elimination communication

Overview
Elimination communication (EC) is a process by which a caregiver uses timing, signals, cues, and intuition to address an infant's excretive needs, partially or completely avoiding the use of diapers. Diapers can be used but usually tend to become extraneous and unnecessary after a point. The emphasis of EC is placed on communication. When one practices EC, they are in essence trying to communicate as much as possible with their child about the elimination process, helping the child to become aware of their own body. The term "elimination communication" was inspired by traditional practices of diaper-less baby care in less industrialized countries and hunter-gatherer cultures. EC can begin at birth and is usually started before six months of age, although it can be practiced at any age. If started in the later months or after age one, babies are more likely to be "diaper trained," and may be less aware of and/or able to communicate their elimination needs. The term "late starter" refers to a baby who starts EC after six months or after age one.

Origins
The terms elimination communication and natural infant hygiene were coined by Ingrid Bauer and are used interchangeably in her book, ''Diaper Free! The Gentle Wisdom of Natural Infant Hygiene'' (2001). Bauer had traveled to India and Africa, where she noticed that most mothers would carry their diaperless babies constantly, yet she saw no elimination "accidents" as would be expected in industrialized countries where babies wear diapers almost continuously from birth. Subsequently, she raised her own children with minimal use of diapers, and eventually began to share her approach with other mothers and caregivers &mdash; initially through Internet-based parenting support groups and eventually through her book and website.

Prior publications introducing Western parents to this ancient practice include the book Trickle Treat, by Laurie Boucke (1991), and a pamphlet entitled Elimination Timing, by Natec (1994). Boucke was influenced by an Indian friend who taught her how mothers in India care for babies without diapers, and she adapted it to fit her Western lifestyle. Boucke later authored the more extensive Infant Potty Training (2000).

While the terms elimination communication and infant potty training have become somewhat synonymous, many caregivers who practice EC do not consider it to be a form of "training," per se. EC is viewed primarily as a way to meet the baby's present needs and to enhance attachment and communication in general. In that sense, EC is often likened to breastfeeding. "Toilet mastery is, of course, an inevitable consequence," writes Bauer, "Yet it's no more the goal of Natural Infant Hygiene than weaning is the goal of breastfeeding." (2001, p. 217)

Today, one often hears the terms natural infant hygiene, elimination timing, and infant potty training used synonymously, although they are not exactly the same. EC is a bit more specifically referring to the communication aspect of the elimination process.

Components
The main components of EC are timing, signals, cueing, and intuition.

Timing
Timing refers to identifying the infant's natural timing of elimination. Newborns tend to urinate every 10-20 minutes, sometimes very regularly, which makes timing extremely useful. Older babies may still be very regular, or may vary in timing based on when they have last eaten or slept. As infants get older, the time between eliminations will increase. By six months, it is not uncommon for babies to go as much as an hour without urinating while awake (babies, like adults, rarely urinate during a deep sleep). Timing varies radically for defecation, as some infants may have several bowel movements a day, while others may only have one every few days.

Signals
Signals are the baby's way of informing a caregiver of an elimination need. Some babies signal very clearly from the beginning, while others may have very subtle signals, or no signal at all. These signals vary widely from one infant to another, and include a certain facial expression, a particular cry, squirming, a sudden unexplained fussiness, as well as others. Babies who are nursing will often start delatching and relatching repeatedly when they need to eliminate. For defecation, many babies will grunt or pass gas as a signal. Older babies can learn a gesture or baby sign for "potty."

Cueing
Cueing consists of the caregiver making a particular sound or other cue when the baby is in an appropriate place to urinate or defecate, in order to develop two-way communication. At first, the caregiver can make the cueing sound when the baby is eliminating, to develop an association. Once the association is established, the cue can be used to indicate to the baby that he or she is in an appropriate potty place. This is especially useful for infants who may not recognize public toilets or unfamiliar receptacles as a "potty." Common sound cues include "psss psss" for urination, and "hmm hmm" (grunting) for defecation. Older babies (late starters) may respond better to more word-like cues. Cues do not have to be auditory.

Intuition
Intuition refers to a caregiver's unprompted thought that the baby may need to eliminate. Although much intuition may simply be subconscious awareness of timing or signals, many parents who practice EC find it an extremely reliable component.