Newborn baby

Elimination communication or ‘nappy free toilet training’ is an age-old technique of training a baby to use a toilet from birth, but how does it work? We asked members of our Professional Advisory Committee to tell us more about this practice. 

The history

Dr Anne Wright, the lead consultant for the Children's Bladder Clinic at the Evelina Children's Hospital, London explains the history, “There is a recognised toilet-training technique called ‘Assisted infant toilet training’ (also known as ‘elimination communication’) which is practised fairly widely and in particular in some African and Eastern cultures.

How it works

It relies on a very close physical relationship of mother and baby where the mother picks up physical cues that the child is about to wee or poo and she pre-empts this by holding them over a container and usually makes a sound during the elimination (for example a ‘sssss’ sound with weeing). The baby learns to associate this sound with eliminatory behaviour. This starts in the first six months of life.

It relies on a very close physical relationship of mother and baby

Responding to cues

With time, and somewhere towards the first birthday (in second six months), the baby is actually able to wee on request when the mother makes the sound. This, together with the mother anticipating a poo and providing enough opportunities for the infant to eliminate, allows the child to come out of nappies usually during the day. The child is not toilet-trained in the conventional sense of recognising the need to go to the toilet, removing clothes, getting on to a potty or toilet and eliminating independently, but it does mean that the child eliminates on a potty or container throughout the day and does not need nappies.

Mother carrying baby Around the world

There is a Vietnamese study that shows that children potty trained this way were able to be nappy-free at one year of age and emptied their bladders better than Swedish children trained in a more conventional western way at nursery-school age. In their first year of life, infants wee very frequently (this can be up to 20 times a day in a newborn baby) and also poo more frequently and often after a feed. 

Infant awareness levels

The previously held belief that babies are not aware of weeing/pooing is not true and infants do show signs of arousal even from sleep and other small movements etc. before weeing, for example. These are the features that the mother of a baby could be aware of particularly if the child is constantly close physically to the mother, for example on a sling on her front, allowing the mother to recognise the signs and act pre-emptively. This can be more predictable for the bowel. It is important for a mother to recognise her role in scaffolding and managing this form of toilet training as it is obvious that the child is unable to do so independently.”

It is important for a mother to recognise her role in scaffolding and managing this form of toilet training.

ERIC’s stance

Brenda Cheer, ERIC’s nurse says, “Potty training and elimination communication are completely different things. We are aware of the technique of nappy free toilet training within the first 6 months of a baby’s life, but as we have very limited experience of it we are unable to advise on it.

It is unlikely to achieve widespread uptake in the UK as very few people’s lifestyles are conducive to it.

Whilst the technique is undoubtedly very successful in the countries/cultures that have practised it for many years, it is unlikely to achieve widespread uptake in the UK as very few people’s lifestyles are conducive to it. As Anne has explained, it is a method that requires close physical contact at all times, for instance carrying the child in a sling, from birth onwards. For most families, conventional potty training will continue to be the most appropriate way to achieve continence.”

Get help with knowing when to start potty training and call our helpline to chat it through with a potty training expert. 

ERIC's guide to potty training

ERIC's guide for children with additional needs