What is elimination communication? Experts share how to go diaper-free soon after birth

Potty training often stands out as one of the most challenging developmental milestones for parents. From the inevitable messiness of accidents to the struggles that come with a toddler withholding bowel movements, it can be a frustrating and trying time for everyone involved. While many people are familiar with the potty-training weekend method, where you essentially let your child run around pantless at home for two to three days, or the Montessori method that emphasizes toilet “learning” over “training,” fewer people in Western cultures are familiar with elimination communication (EC), also known as “natural infant hygiene.”

I first read about elimination communication in Dr. Harvey Karp’s book, “The Happiest Baby on the Block”. Dr. Karp discussed how humans, like all animals, instinctively seek to distance themselves from their waste. He cited examples of women in African and Asian countries who regularly babywear. These women, acutely attuned to their babies’ needs, would not use diapers and instead, would take their babies to eliminate in a toilet or receptacle. Intrigued and inspired by this concept, I decided to attempt EC with my oldest daughter when she was four months old. Our experience was overwhelmingly positive and we’ve implemented it again with our second child, starting when she was three months old.

Beyond my own anecdotal experience, I consulted with two experts—Jeffrey Bender, MD, a pediatric physician-scientist, and Rosemary She, MD, a medical microbiologist and professor of pathology. Together, they authored an article in the journal “Pediatrics” on elimination communication. Here, they share insights on the benefits, challenges and medical implications of practicing elimination communication, and offer valuable tips for parents interested in integrating EC into their busy, modern lives. Curious about EC? Here’s what to know.

Understanding elimination communication

Elimination communication is a gentle and intuitive approach to baby hygiene that fosters early communication regarding elimination needs. Unlike contemporary diapering, EC involves tuning into a baby’s cues and natural timing to anticipate when they need to use the bathroom. Infants naturally eliminate at predictable times, Drs. Bender and She write, contrary to the notion that they relieve themselves at random times during the day. Recognizing your baby’s natural timing and signals is essential; observing patterns, like peeing upon waking or after meals, helps to establish a routine. 

Additionally, incorporating specific sounds, such as “pssss” or a gentle grunt while your baby is eliminating fosters communication. 

Over time, your baby associates these sounds with the acts of peeing or pooping, further helping them to eliminate in the toilet. 

The practice of natural infant hygiene is not new. There are many places in the world where diapers are either scarce or culturally uncommon, and in many African and Asian societies, it’s customary to practice elimination communication as early as between 1 and 3 months old. Remarkably, just a few generations ago, this practice was commonplace in American culture as well. However, a significant shift occurred in 1955 with the introduction of the first disposable diaper. The convenience of the disposable diaper quickly led to the decline of EC practices in the United States.

It’s important to note that elimination is not potty training. Developmentally, children typically do not achieve bowel and bladder control until they are around 2-3 years old, so elimination communication is more about learning your child’s cues and helping them eliminate in a toilet. While the practice requires a lot of work upfront compared to traditional diapering, the benefits make it a compelling option to consider.

Benefits of EC for parents and babies

There are numerous practical benefits of elimination communication for both parents and babies. 

Strengthened bond and increased understanding

Aligning with the principles of attachment parenting, elimination communication strengthens the emotional connection between you and your baby. By relying on the heightened awareness of your child’s needs and anticipating those needs, a unique and intimate bond is formed. Furthermore, by deciphering your baby’s cues, especially regarding bathroom needs, you gain a deeper understanding of their cries, fostering empathy and enhancing your ability to respond effectively. 

Enhanced hygiene and healthy skin

Eliminating diapers allows your baby’s skin to stay dry and breathe freely. From a medical standpoint, Dr. Bender identifies several health advantages associated with EC: “Diaper rash and associated complications, like MRSA and yeast, are largely due to the moist, irritating environment created by diapers. Get rid of diapers, and all of that goes away.” Research also indicates that steering clear of dirty diapers and encouraging more complete bladder emptying at a younger age might reduce the risk of urinary tract infections. Dr. She also points out that “blow-outs” are much more rare along with the need to clean up poopy messes.

Financial savings

According to the American Academy of Pediatrics (AAP), the average child goes through about 3,000 diapers in the first year, and nearly 8,000 throughout their diaper-wearing journey. That comes out to about $936 spent on diapers for a single child in their first year. With reduced reliance on disposables, wipes, diaper creams, pail bags and other related supplies, elimination communication proves to be an incredibly cost-effective alternative to traditional diapering. 

Environmental impact

Diapers do more than collect waste; they generate a substantial amount of waste themselves. About 20 billion used diapers end up in landfills annually, contributing to more than 3.5 million tons of waste. Even cloth diapers, while reusable, require significant water and energy for production and washing. Embracing either full-time or part-time EC translates to using fewer diapers, making it an attractive and environmentally friendly practice.

Smooth transition to toilet training

Engaging in elimination communication establishes a smoother path for the eventual transition to full potty training as your child gains control over their bladder and bowels. While the initial effort may be more, the subsequent potty-training years become less chaotic and messy, eliminating the need to teach your child an entirely new skill. Essentially, this approach minimizes the necessity for your child to “unlearn” the habit of diaper elimination, making the progression to independent toileting more seamless.

Potential challenges

While there are numerous benefits to elimination communication, there are also some drawbacks that should be considered.

Social stigma

Elimination communication is not commonplace in the US, and it can feel isolating to embark on a practice that your friends and family don’t understand. “All of our friends and most of our family all told us we were crazy and making things more difficult than needed,” Dr. Bender said, “Don’t listen to people who think you are crazy. Figure out how crazy you are for yourself. You might be surprised at how rewarding and easy it actually is.” There are also many EC advocacy groups and internet resources these days that offer a community for those interested, such as Go Diaper Free, Diaper Free Baby, and Diaper Stork.

Time investment

A major hurdle for American parents interested in practicing elimination communication is the challenge of being consistently present with their infants. Devoting the necessary time to pay attention to the baby’s cues requires a significant investment compared to the convenience of allowing them to use diapers. Caregivers, such as nannies or daycare providers, may find it challenging or uncomfortable to provide the personalized attention needed for full-time elimination communication. 

How to get started with elimination communication

For parents keen on exploring elimination communication, start by paying close attention to your baby’s natural cues and patterns. Designate specific moments, such as after waking or meals, to introduce the toilet routine, and commit to using consistent sounds during elimination to enhance effective communication. 

It doesn’t have to be an all-or-nothing thing: Embrace a non-judgmental and low-stress approach by allowing flexibility. You can do EC on the weekend and diapers during the week, or diapers at night and EC during the day. It’s less about getting all the poops and pees in the toilet and more about emphasizing communication.

Advice from the experts

Dr. Bender shares invaluable guidance for parents interested in adopting elimination communication. (His advice is so noteworthy that paraphrasing wouldn’t do it justice!)

Try to enjoy it as a way to further bond with your infant. Don’t make it about you versus them. Don’t do it for the environment. Don’t do it to save money. Don’t do it to keep up with your peers or because someone told you to. Don’t do it for health reasons. Those are all good reasons, but you should focus on having quality time with your infant. If EC does not allow for that, if it adds more stress, or if it just doesn’t work for your family, then you shouldn’t do it. That being said, [if you’re interested] I think you should try it and give it an honest attempt. You might be surprised.

In the end, the best way to introduce the toilet to your child is whatever aligns with your family dynamics. Some families prefer a more traditional route, relying on diapers without delving into potty training until later. On the other hand, elimination communication can present an intriguing option for those who wish to explore an alternative approach. While EC offers various benefits, such as enhanced communication and potential cost savings, it’s not without challenges. If you do decide to embrace EC, have fun with it—it may not work every time, but there’s no downside to trying!

Sources

Bender J, She R. Elimination communication: Diaper-free in America. Pediatrics. 2017;140(1). doi: 10.1542/peds.2017-0398

Duong T., Jansson U., Holmdahl, G., Sillén, U., & Hellstrom A. Development of bladder control in the first year of life in children who are potty trained early. Journal of Pediatric Urology. 2010;6(5):501-505. doi: 10.1016/j.jpurol.2009.11.002

Hoo, SC, Phang XY, Ng CM, et al. Recent technologies for treatment and recycling of used disposable baby diapers. Process Safety and Environmental Protection. 2019;123:116-129. doi: 10.1016/j.psep.2018.12.016

Morin GV, inventor; Chicopee Manufacturing Corporation, assignee. Waterproof disposable diaper. United States Patent US 2699170 A. January 11,1955

Muñoz C. The diaper divide. Obama White House Archives. March 10, 2016. 

Sugimura T, Tananari Y, Ozaki Y, et al. Association between the frequency of disposable diaper changing and urinary tract infection in infants. Clinical Pediatrics. 2009;48(1):18-20. doi: 10.1177/0009922808320696

A version of this story was originally published on Dec. 29, 2023. It has been updated.