Are there risks to ec / baby-led / early potty training?

This blog post is a response to the many articles by Dr Steve Hodges that pop up all over the internet. I’m going to be quoting this one from The Huffington Post as an example: A doctor responds “Don’t potty train your baby!”

[Summary: Babies who use a potty really are at risk of chronic constipation. But so are nappy wearing toddlers who have their own ritual for poos and all fully potty trained children… Once you accept that, you can manage the risk while still pottying / ec-ing your baby. These are the signs to look out for in your baby or toddler: 10 signs of constipation every potty training parent should know.]

Dr Hodges is an American paediatric urologist. He works at a medical centre attached to a children’s hospital in North Carolina in the USA where he sees children with urinary conditions, many of which should never have happened. These conditions are upsetting, debilitating and stressful for entire families, so it must be incredibly frustrating for him to know that they’re largely unnecessary; i.e. they could have been prevented by different toileting habits. By and large, they’re not brought about by bad luck, but by lack of awareness of a developing problem.

I agree with everything he’s trying to prevent. I think he has integrity and the best interests of our children at heart. (I particularly like the treatment program he recommends for chronic constipation, which causes far less family stress than anything prescribed over here in the UK – more on that later.)

Yet, it’s clear his preventative strategies (don’t potty train before age three) are aimed at the lowest common denominator rather than your average ec-er. In seeking to clarify his position (and silence the vocal commenters on his early blogs) he shows his ignorance of how ec works in other cultures.

Take this quote, in which he compares Western culture with his vision of native ec: “What’s more, in much of the developing world, toilets aren’t the norm; instead, people squat, a position that, research demonstrates, makes elimination much easier. And when you don’t need to worry about finding a toilet (behind a bush will do), there’s less reason to hold. It’s all about access.”

A baby pottier responded “I lived in the woods with no running water for years, and believe me when you have more than a few people pooping in the same area there are systems, and rules, and locations, with serious comeback if they are not followed! This man knows nothing of pooping in the great outdoors.”

It’s tempting to pick up on his lack of knowledge around ec and dismiss him as not knowing what he’s talking about, when in fact, I agree with everything else he says in this paragraph. Squatting is accepted as the natural position to poo. And it is all about access.

So even if he’s put your back up, give him the benefit of the doubt. He’s trying to prevent your child from ending up in his clinic. Keep an open mind and don’t let your own set of beliefs and prejudices prevent you from seeing the consequences of pottying-gone-wrong.

Our lifestyles often make the version of ec/baby-led pottying we practice a far cry from the natural process we’re hoping to emulate.

What’s So Wrong With Starting Early?

The problem for ec-ers, is that Dr Hodges says you should wait until age three to toilet train and that any potty training before age two is a recipe for disaster.

And yet, even his own published research suggests this isn’t really the case. The title suggests that early potty training is responsible for the kind of problems he sees in his clinic (daytime wetting, urgency, night wetting, recurring UTIs, overactive bladder) but he concludes that constipation is the cause, rather than the age at which a child potty trains.

“Our results linking constipation with both early and late [training children] with increased incidence of dysfunctional voiding perhaps imply that constipation, and not the age of training per se, is most important to the development of voiding dysfunction in children.”

So it’s constipation, rather than age of toilet training that causes ‘voiding dysfunction’.

However, it’s much easier to give a blanket message “Don’t take your kids out of nappies before they’re three!” than to educate parents on how to avoid chronic constipation in toddlers. Partly because preventing constipation requires parental effort and awareness – and not everyone is into that… (But I’m sure you are So learn what to look out for.)

By the way, if you’re feeling relieved because your family has a great diet and constipation won’t be a problem for your baby – please keep reading! It’s not that kind of constipation that we’re worried about.

So Is Early Potty Training Risky, Or Not?

As a prospective or current baby-pottier, what are you supposed to make of this?

Everything about baby-led potty training / elimination communication makes sense to you. You know that super-absorbent nappies are a very recent invention. You know that in Western countries, babies were out of nappies by the time they were 12-24 months old only one generation ago. You know that in the majority of the world, where nappies aren’t used, everyone manages just fine…

And yet, the figures are frightening. You’re warned against early potty training on every mainstream website you’ve ever visited.

“Children who train early are likely to regress.”
“Don’t push them into potty training before they’re ‘ready’.”

And, Dr Hodges again, in his previously mentioned paper, says: “Children who potty train before age 2 are 3.3 times more likely to be constipated and 3.7 x more likely to experience daytime wetting.”.

Wait… That last figure.. Surely Dr Hodges means children who were ‘coerced’ (bribed/punished/shamed) into early potty training are the ones who are at risk?

No he doesn’t.

He says parents of his patients report that their toddlers virtually ‘trained themselves’ at around 18 months old.

It’s not the method of early training that causes the problems, it’s the responsibility those kids have and the environment they live in – and that’s the same environment that we all live in, to a greater or lesser degree.

Dr Hodges does explain this, but you need to mine his articles for information rather than skimming the headlines and highlights.

Here he’s talking about starting pre-school:

“Think about it: You’re placing a little one in an unfamiliar environment where, for possibly the first time in her life, she has no family members around for half the day, and you’re expecting her to interrupt her teacher during the story circle and announce that she needs to use the toilet or to climb out of the fort she’s just built with her friends and make her way over to the potty. Whoever thought that was a good idea has surely never set foot in a pediatric urology clinic.”

And it’s not just educational or childcare settings. There are social constraints at home too.

I’ve overheard a conventional nappy-using parent say to her nappy wearing son: “Hey! Stop that! You can’t poo here there aren’t any changing facilities!”.

I’ve seen ec-ers guiltily lament: “She signed to poop, but there wasn’t time because we were running late, and when we got there she wouldn’t go. When she next signed I couldn’t take her because we were on a train and then she fell asleep on the way home and went straight to bed.”

And I’ve lived: “No poo this morning, nothing at nursery, and now all she wants to do is tuck up in bed…”

We lead very very busy lives.

And any child who leads a busy life is susceptible to voluntary holding which can lead to this kind of constipation. Learn to look out for signs of trouble.

But On The Whole, Parents who Potty Escape Unscathed, Right?

Unfortunately not.

I’ve read about regressions, post graduation ‘potty pauses’, night wetting and pooping problems many times on pottying and ec forums during my 8 years in this game.

Every time I respond to a post and explain something about chronic constipation I get questions via private message.

Often people who would never have posted themselves – they don’t want to discuss their long term struggles in a group where everyone is reporting their early successes.

If you’re not aware that ec-ers can and do come unstuck in the toddler/preschooler/reception class years, then you’ve only heard one half of the story.

For these parents, their early success has turned into an unfathomable battle.

Their child, who didn’t soil a nappy for 15 months straight, has started to poop in their pants just as their peer group are potty training ‘properly’.

Or maybe they’ve started wetting the bed having been dry forever.

Or they’re obviously holding (either wee or poo or both). They resolutely refuse to be ushered to the potty or toilet. The child’s personality changes during holding and to their horror, the parents find their personalities have changed too. Patience is running short. There seems to be no common ground. They’re battling over bodily functions in a way that baby-led potty training was absolutely supposed to prevent!

And their gentle/attachment/child-led parenting approach leaves them with very few options to get back on track.

Some Posts Just Scream ‘Chronic Constipation’ At Me

What makes me answer an innocent Facebook enquiry with information about holding, encopresis (leaking stool) and constipation? I mean, it’s a pretty grim subject to introduce. It can easily be seen as scaremongering, interfering or ‘making a medical diagnosis’ and lots of people take offense.

The sad fact is, I recognise the danger signs because I’ve seen them first hand.

I lived through chronic constipation with one of my kids and I know we should never have ended up in that situation. I learned an awful lot about a condition I didn’t even know existed before we were in the thick of it.

And importantly, I learned what to look for to stay one step ahead of a relapse. What to look for in my other children to make sure that they never had to go through what that poor child went through. And I instinctively use those skills every day.

So now, I can see constipation coming a mile off – and you need to know how to spot it too.

Everyone who practices baby-led potty training or ec should take on board the underlying message that Dr Hodges is trying to publicise. Make sure you know what to do to prevent your own personal disaster.

You can read about the triggers I watch out for here: Ten Signs of Constipation Every Potty Training Parent Should Know.

Some Facts About Constipation and Holding

It’s estimated that every year in the UK, 28% of kids suffer from some sort of constipation – mostly while they’re young, but if they’ve had chronic constipation once it’s likely to resurface again and again – even into teenage years. Especially if it’s not treated properly.

Constipation causes bedwetting and your child won’t grow out of it. Chronic constipation is the number one cause of secondary bedwetting (bedwetting that occurs after a period of night time dryness). If you thought you’d cracked nights and then suddenly you haven’t – make sure you rule out constipation as a cause. (Dr Hodges’ website will help: www.bedwettingandaccidents.com)

Chronic constipation causes soft stool soiling / leaking and skid marks. Constipation. Not laziness and not a failure to wipe properly (though failure to wipe will cause skidmarks, if your kid has been wiping successfully for 3 years, they haven’t suddenly forgotten how to do it.) If your child is ‘leaking’ poo and they seem unaware of it, that’s chronic constipation. If your child is ‘dropping’ chunks of poo as they walk across the room, seemingly oblivious, that’s chronic constipation too.

A child can be chronically constipated and comfortably pass a normal looking stool every day. It can be an invisible condition for many months before the onset of characteristic symptoms. The gut can hold three months worth of stool without overflowing!

Then there’s problems with holding wee… Many children will go through phases of holding their bladders longer than is healthy. Increased holding causes the bladder to spasm, which causes the child to hold to fight it, which causes the muscles to thicken, which causes the bladder to spasm, which sets up a vicious circle. Holding urine leads to recurring UTIs, overactive bladders (bladders that spasm), urgency and night wetting. This is exacerbated when a large mass in the rectum puts pressure on the bladder or squashes it, decreasing its capacity.

Our lives, schools, preschools, nurseries, diets and even the position in which we poo (sitting rather than squatting), all stand against us having healthy bladders and bowels. It pays for everyone to know what to look out for so that they can step in as early as possible to reverse the damage.

An All-Parenting-Styles Problem

The problems of chronic constipation in young children reach far beyond parents who ec or potty train ‘early’. But those of us who have used a potty from the baby days stand a much better chance of recognising it when we see it and catching it before it becomes a family trauma.

If you have a friend who is struggling with potty training conventionally – make sure they’re aware of how constipation might be hampering their efforts.

Read the Ten Signs of Constipation Every Potty Training Parent Should Know.

Signing Off…

Not the jolliest of blogs this one, but something I’ve been meaning to cover for a very long time!

I hope you’ve found it useful. I’ll answer questions in the comments sections below (scroll down a bit)

The next blog in this series gives tips on preventing chronic constipation that might otherwise be caused by busy lives.

Happy Pottying!

– Born Ready Jenn.