June 30, 2017

Diaper-Free Babies!

Some parents are choosing to skip diapers altogether and using elimination communication to get their babies to go.

Parents have been debating the relative merits of cloth and disposable diapers for years. Now two physicians offer a third option: don't use diapers at all.

The method, sometimes called elimination communication (EC) or natural infant hygiene, is not new, but remains unfamiliar to many people. It relies on an infant's own timing and cues to recognize when they need to go and also uses a brief whistle, hiss or other sound to help point the way.

“When we talk about EC with others, many are shocked that that early toilet training is even possible,” said pathologist and microbiologist Rosemary She. “Interestingly, it is the grandparents and great-grandparents that are most familiar with EC and are the biggest supporters of using it.”

“We happily discovered that our daughter naturally responded by relieving herself.”

The reason older people are more familiar with the idea of letting babies go diaper-free is that it once was much more common in the U.S. than it is today. In fact, bare bottoms still remain the method of choice in much of the world.

She and her husband, Jeffery Bender, an infectious disease specialist, had used disposable diapers for their first two sons. But when a third child was on the way, they wanted another option. They were unhappy about the environmental effects — disposable diapers may take more than 500 years to degrade. The U.S. produces more than three million tons of used diaper waste every year. They were also not prepared to use cloth diapers, partially because they thought washing and drying them would triple their workload. And cloth diapers do not solve the health problems that come from sitting too long in a soiled diaper.

Bender, who is a pediatric disease specialist, sees many children in the clinic where he works who are suffering from recurrent skin and soft tissue infections. According to Bender, children will often stay in soiled diapers for hours, which at a minimum irritates their skin and can also lead to infection. The best way to prevent this is to get a child out of diapers altogether.

So when their third child was born, they were ready to try something different.

“We began using EC when we first brought our daughter home from the hospital,” said She. “I went to change her cloth diaper and I noticed it was dry, so I took her over a potty as we'd read about in the books, and she urinated into the receptacle.” During the first few weeks, they repeated this after each awakening and after each feeding, using a brief whistle to cue their child that it was time.

“We happily discovered that our daughter naturally responded by relieving herself.” By the end of one month, they were having only one or two “misses” per day and at six months old, their daughter no longer required any cloth diapers as back-ups. “By the time she was 18 months old and developmentally ready, she transitioned seamlessly into using the toilet independently, ” added She.

The method is not for everybody. Bender and She were fortunate that they were able to take alternate months off from work after their daughter was born, a luxury many couples don't have. Given how sleep deprived and thoroughly frazzled new parents often are, the idea that they should also constantly watch for cues that their baby is ready to go may have little appeal. Then there are the problems with daycare and babysitters, who are likely to be thoroughly unfamiliar with diaper-less babies.

Once upon a time there were no diapers. Of course, the same could be said for cellphones and air conditioners, two items people show no signs of giving up. She and Bender, both professors at the Keck Medical Center of the University of Southern California (USC), would like people to know that raising a child without diapers is possible for those who really want to do it.

“While it requires some hard work and dedication at the outset, EC is natural, generates no landfill or ocean waste, and it's free,” they explain. “As working parents and physicians, we believe it is important that providers who care for children learn more about EC and incorporate this alternative into their discussions with young and growing families.”

Their article appears in Pediatrics.

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