Sunday, December 10, 2017

How EC Works

How You Know When Baby Needs To Go

Cues: Physical signs baby needs to go

With practice, parents may see cues from baby, which are (typically involuntary) reactions to the body preparing to void.
  • Poop: For most babies poop is obvious as baby needs to bare down to push the poop out. 
    • Baby may grunt and/or strain
    • Baby may make a gassy smile or grimace
    • Baby may pass gas
    • Baby's eyes may look hollow
  • Pee: Two sphincters control urination. The interior urethral sphincter is released involuntarily when the bladder is full, creating the "urge to pee", which baby may react to or caretakers may otherwise notice. The exterior urethral sphincter is under voluntary control from birth. After the interior sphincter opens you may see cues, and you have until baby opens the exterior sphincter to get to the potty.  
    • Baby's lips or whole body may shiver
    • Baby's legs may move
    • Baby boys may have an erection
    • "Phantom pee," where baby's bottom suddenly gets hot, like fresh pee, yet the diaper dry. Extra blood flow after the internal sphincter opens may create the "phantom pee" effect.
  • Either: Baby may react to the body preparing to void unconsciously as above, or consciously because of the instinct for cleanliness or learned behavior. These cues may look like:
    • Baby may adopt a faraway look, a look of concentration, or become wide-eyed as focus shifts inside
    • A busy baby may suddenly become still
    • A still baby may suddenly become busy
    • Baby may try to escape clothing, swaddle, sling, or other containment device
    • Baby may become agitated or fussy
    • Baby may try to get your attention
    • Baby may pull away from the breast while nursing
    • Baby may ask to be picked up or put down
    • Baby may imitate your cue sounds, sign language, verbal language
    • Mobile baby may move toward the potty
  • Sometimes babies will only cue when diapered or in a sling or carrier, as if the feeling of something bound tightly around them becoming wet is particularly undesirable.
  • As babies grow, their cues tend to change, so expect to need to re-learn your baby's cues regularly. Sometimes cues are obvious and other times very subtle, so if you don't see cues now, watch for them again later.
  • Baby cues are often much more subtle than a toddler's "pee pee dance" because babies lack the motor skills to react to the urge to pee in a way broadcasts the feeling as clearly. Think of how a toddler will normally tug on an ear with an ear infection, whereas a newborn baby will fuss for apparently no reason because their hands can't find their ears. Baby potty cues can be subtle like this. 

Timing: Predicting when babies will need to go

Contrary to popular belief, EC parents aren't watching their babies every second for cues. Sometimes we are busy with other things.  Sometimes we don't even know what their cues are, because we haven't done observation recently, or we tried and their cues were just so dang subtle.  Timing helps caregivers predict when baby will next need to eliminate.  Many times are so predictable we just build them into our routines and don't wait for baby to cue at all.

People who do EC part time often work exclusively on timing, as these are times most babies need to go without being taught anything at all and without the parents needing to learn their baby's cues.  It's also the simplest and most rewarding way to start EC for many (you can work up to learning cues).
  • During or after eating
    • Poop: there is a reflex called the gastro-colic reflex that causes babies (and adults) to feel the urge to poop when eating. Babies may delay the poop until they are done eating, or they might poop while eating. Some multi-talented mommies choose to nurse with baby's bottom held over a little potty for this reason. Others find baby pulls off the breast in time to get to a potty.  Or just use a diaper at that time, which is fine too: you don't have to catch them all.
    • Pee: some babies need to pee shortly after nursing, or a predictable few minutes after drinking. Many people observe this, and it is actually true of many adults too, but I don't know the physiological mechanism behind it.  Let me know if you think you know what it is.
  • After waking from sleep
    • Babies normally need to pee when they first wake up any time of day, and normally need to poop when they first wake in the morning as well. Most EC parents preemptively take their babies potty immediately upon waking. 
    • Babies (and adults) instinctively hold it during sleep because:
      • Sphincter control: babies (and adult) instinctively hold their sphincters when asleep, but may need to go as soon as we wake up. For babies, this can include going in the period of slight wakefulness between sleep cycles. Because elimination only happens between sleep cycles, you may hear or feel baby moving around giving cues similar to daytime cues, when they are waking up slightly to go. Some parents make use of these cues to potty baby at night, although night EC is not required for successful day EC.
      • Hormones: as babies grow, they produce a hormone that prevents them from pooping during the night, normally by around 3 months old. Later on, children produce a different hormone that slows the production urine at night. Some children are known not to make enough of this hormone to stay dry overnight until well into the grade school years, but some babies seem to make it before a year old.
  • After coming out of anything
    • If you are taking baby's diaper off for a change or any other reason (bath, weight check), offer the potty. 
    • When baby comes out of a sling or other carrier.
    • When baby comes out of the car seat, swing, high chair, etc.
  • Intervals
    • Baby will pee at semi-regular intervals throughout the day.  Most babies pee more frequently in the morning, less frequently in the afternoon, and relatively little overnight.  For example, you may find with experience that baby pees about every 20 minutes in the morning, every 90 minutes in the afternoon, and every 3 hours overnight.
    • When taking an awake baby potty on intervals (or preemptive offers), be mindful of what baby is doing. Babies are always busy with something, often exploring or examining their surroundings. Either take baby potty at a natural transition between activities, or watch baby and wait for a cue or another natural break in baby's activity.  Babies resent being interrupted (just like adults), so if you don't see signs that baby needs to pee right this second, watch and wait a few minutes for baby's attention to wander.
  • Preemptive offers
    • If baby always poops in the high chair or car seat, like they think that place is a potty, offer before putting them in it. This won't always cure the problem, but it can help a lot.  
    • If baby seems to always notice they need to pee right as you are pulling out of the driveway or 2 minutes after you get them all wrap with fancy finishes, make it a habit to offer the potty first for your sanity.
    • Before sleep
    • Before bath
    • Before major distractions for children, like play dates
    • Before major distractions for adults, like conference calls

How Baby Knows When To Go

Instincts: What baby is born knowing

Babies are obviously born instinctively knowing how to pee and poop. Whether you do EC or exclusively diapers, they will pick up on their bodies' internal urges to void, and they will void. But they are also born with a number of instincts that help us communicate to baby that it is a good time to go.
  • Cleanliness: Babies are born with an instinct for cleanliness, which means they will instinctively try to hold it when they are wearing a diaper or clothing, and they will instinctively and opportunistically go as soon as the clothing and diaper are removed. This is why exclusively diapered babies pee on the changing table. It's not luck, it's baby's instinct. One of the best ways you can tell your baby to go potty is to take their bottoms off.

    As babies grown into toddlers, they do eventually learn that a diaper is a potty you wear on your butt.  In EC, we often refer to this as "diaper training" and it generally happens sometime between 6 and 18 months.  Once a child learns they are "supposed to" go in their diapers, the child will generally hold it while naked, and go when diapered. Some ECed children avoid this phase, but many ECed families still do encounter it.  Its especially likely if baby is only ECed part time, with some of baby's caregivers exclusively diapering and ignoring cues. 
  • Mimicry: Babies always try to mimic their adult caregivers, from facial expressions to fecal expressions. Research has shown that even before that first smile at 6-8 weeks old, babies are attempting to copy our facial expressions.  There are 3 key ways we use this for EC:
    • Grunting: If you grunt and strain like you are trying to poop, baby will attempt to mimic you, and poop. This is where the traditional grunting sound for poo comes from in EC.  It takes baby 6-8 weeks on average to learn to smile, so be patient and keep trying if it doesn't work the first time.
    • Ssssssing: If you make the sound of running water, by running the faucet or using your voice, it prompts babies and adults alike to want to pee. This is where the traditional ssssss or whistling sound for pee comes from in EC.  
    • Body language: Sphincters open by relaxing and they close by contracting. Thus, peeing and pooping require your baby to relax. Baby will only relax if you relax, so it is important that your body language and demeanor show that we are relaxed, confident, and in control. This is also why babies rarely go while you rush them to the potty, they wait for you to relax.
      • Loosen your muscles
      • Sigh deeply, slowly, and audibly
      • If you feel skeptical or excited because you are new to EC, fake relaxation.
  • Position: Human bodies are designed to poop in a squat.  Holding baby in a position that imitates a deep squat will straighten the colon and help baby know it's time to eliminate. I won't say more about this, since I'm pretty sure everyone on the internet has seen the Squatty Potty videos, but if you haven't, you're welcome.

Teaching and Learning: What you teach baby

While elimination communication is more a matter of a waste management than it is potty training, all children need to master all the skills of independent toilet use sooner or later. Not only do they need to master these skills because we won't always be around to help, it also turns out that most children want autonomy over their bodily functions from early toddlerhood, so a successful EC practice must grow with the child, and gradually pass over more and more of the control to the child. ECed children often go through "potty pauses" when their desire for autonomy outstrips their skills for independence. Ideally, these skills would be taught as you go and before they are needed, though of course in real life many families--including my own--end up falling behind on skills and needing to follow up a long potty pause in EC with conventional potty training, to give the child the final set of skills for independence they need for the autonomy they crave. It's kind of a bummer, but really common, and the good news is that there is an awesome book available at most local libraries called "Oh Crap Potty Training" that works very well for most formerly ECed children who need that last push into independence. The author says it is a method for children aged 20-30 months, but formerly ECed children often do well with it starting at about 15-16 months old.

Associations and Conditioning

Babies and young toddlers don't understand sequences of events, cause and effect, and don't form conscious memories, so methods of teaching used in today's mainstream potty training of preschool aged children are largely ineffective with babies and young toddlers. Positive or negative reinforcement of an event that happened in the past--even just a minute ago--is generally not effective because the baby or young toddler literally does not remember the event preceding the reinforcement. Instead, babies learn associations between things that happen together, at more or less the same time.

The classic teaching method employed in infant EC is conditioning. You may recall learning about how Pavlov played a metronome sound when he fed his dogs, and then when the dogs hear the metronome, they begin to salivate. Conditioning in EC is similar.
  • Clothing: the first association many babies learn is the feeling of soaking a diaper or clothing when the release their pee.  This association doesn't require any particular action on the part of the parent, but parents can reinforce it in a few ways:
    • Choose diapers (or clothing) that feel dry before a pee and wet after.  Natural fiber (especially cotton) cloth diapers are best for this.  
    • Change diapers (or clothing) as soon as they are wet so baby learns that dry is normal, and each pee reinforces the dry to wet association.
    • Nakedness: Your ECed baby shouldn't be naked all the time.  Your ECed baby should only be naked when you are giving them your full and undivided attention (which is NOT supposed to be all the time, even with EC).  Why?  There is no in-born human instinct to use a toilet.  After all, modern flush toilets are only a few hundred years old.  No time at all on the scale of human evolution, not to mention that they aren't used by all human cultures even now.  Babies are generally pretty happy to eliminate anywhere that we present them with, so long as it's not on themselves.  To a naked baby or toddler, the potty you are presenting them is the floor (or, if you are especially lucky, your shoes).  I don't care how breezy you are about cleaning your floor, you don't want to teach your child to pee on the floor without telling you any more than you want to teach them to pee in a diaper without telling you.  Unless you are so wildly and abnormally successful that you pretty much never miss anyway, in which case, you do you.
    • Diapers vs Pants  
      • Young babies: Wearing pants feels a lot like being naked.  Wearing underpants is somewhere in between.  A young baby who has learned to request the diaper be removed before voiding may confuse the feeling of underpants or pants with being naked, and think they can just pee away without alerting you.  Then when they do, they are usually mad, and you come change the diaper.  Used in this way, diapers help EC, and they don't make you a "part timer."
      • Toddlers and older babies: Conversely, at some point older babies and toddlers learn that diapers are potties you wear on your butt.  Once a child has reached this stage, the diaper will mess up your EC because baby will treat it as a potty.  At this point it's normally time to take the leap to diaper free.  Start out completely bare butt for a while doing transportation (see below), then add pants with no underpants, because pants with no underpants give baby the feedback if they pee on themselves, but feel the least like a diaper.  
  • Cue Sounds: For a little baby, the caregiver makes a cue sound just as they see the baby pee or poop, forming an association. Later when the parent presents the baby with an appropriate place to eliminate, the sound is made again, and baby knows to eliminate.  Additionally, the sounds are simpler than regular words, potentially allowing baby to learn to say them sooner.  The sounds that are used are typically grunting for poop and ssssing or whistling for pee.  As discussed above, these sounds also tap into baby's instinct to mimic, so the conditioning also reinforces a natural association.  
  • Sign Language: Because babies typically have the fine motor skills for sign language younger than spoken language, many families sign to baby for potty in addition to making cue sounds.  The ASL sign for toilet is the letter T (fist with the thumb between the index and middle fingers) shaken beside the head in an urgent matter, as if to say, "I need to go pee right now."  Some people feel this sign is too abstract, complex, or similar to other common baby signs, and many families choose to make up their own signs, such as grabbing the crotch or slapping the chest.  Bare in mind that most babies will not sign back until 6 to 12 months old, so be patient.  They may also describe what they are doing for a while before describing what they need or want.  For example, a baby will likely first sign "milk" while nursing, and only some time later learn to sign "milk" as a request to be fed.  You can start signing with baby whenever you like, but many experts on the subject recommend starting around 4 months to avoid parents getting burned out before babies can sign back. Incidently 4 months is also around when most babies can sit well enough with assistance for the adult to have a hand free with which to sign.
  • Spoken Language: Don't forget to use spoken language in combination with your cue sounds and sign language.  You can, for example, say, "Go pee.  Sssss."  As baby goes, if you see/hear it, "Sssss" again.  And then after baby peed, "You peed."  Speaking to your baby is good practice at any age, but especially for babies beyond 12 months, they are really ready to be learning true words.
  • Transportation: For babies who have good mobility, especially babies who are walking, you also want to start to associate movement with elimination, or ideally, with the need to eliminate.  For this, when you are observing your bare bottomed baby/toddler and you see either one of their clear natural cues or see them start to pee, you immediately pick them up and move them to the closest potty, while saying something like "pee pee goes in the potty."  Remember this isn't about a positive or a negative reinforcement (even if they did just pee on your rug), this is about forming the association between peeing/needing to pee, and what to do about it.  

Balancing EC Teaching and Learning Time with The Rest of Your Life

A common reason that people give for not wanting to try EC is that they don't want to spend their entire lives watching baby for cues. The good news is that you really don't need to, even to be doing EC "full time." While people often refer to EC as "parent training" (as opposed to potty training), you can see by now that even though parents need to take an active part and know what to do, there's an ongoing exchange with baby that makes it actually much different than simply learning the correct times to put a potty under baby's butt, and always being ready to drop everything to do so.

You'll notice that some of the associations in the previous section are passive (clothing), and some are active (sounds, language, transportation). A common recommendation to keep your EC practice strong is that you set aside some time regularly (say, a couple hours per week) when you just observe your bare bottomed child. This is a time when you focus on your learning your child's natural cues (see first section), and also forming active associations through sounds, language, and transportation (see previous section).

The rest of the time, you watch baby more passively for cues, while getting along with all the other things you need to do as a busy parent and adult human being. A lot of those "other things" you do will have you in close proximity to baby, while you feed baby, wear baby, and so forth, which make noticing cues pretty easy. Even so, some cues will be missed because we are distracted, have our hands full with other things, because baby needed to go sooner than normal, or just because sometimes the signals are terribly subtle, which is typical and expected. Everyone has misses with little babies, no matter how dedicated, and the misses are part of the learning experience. The diaper (or clothing) give baby the immediate association of wetness when the adult misses the opportunity to give an active association while bringing baby potty. A baby who is used to a dry diaper will most likely alert you right away when the diaper feels wet. As babies grow into toddlers, they become less likely to tell you about a miss, along with being more likely to treat their diapers as potties, making the use of diaper backup for EC less practical.

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