What if Health Visitors modelled 'catching' in Baby Clinics?

We know that babies tend to pee and poo when the nappy is taken off, right?  It frequently happens when baby is weighed at the baby clinic.  Parent is embarrassed, mess has to be cleaned up?

Why not have a small pottry or even a yoghurt pot or ice-cream/margarine container and the health visitor could demonstrate how to catch a baby's pee and/or poo?

Want to know more about catching?  Most babies will let you 'catch' until around 6-9 months.  For most success offer the pot at specific times when your baby is likely to have a poo or pee waiting.  Your baby is an individual so watch and find out his/her pattern.  As a rule it's often after a feed and also on waking (the sensation of a poo or pee waiting may be what has woken your baby.)  If you catch a poo and/or pee the next nappy stays clean and dry for longer.  It saves you money too if you're using disposable nappies.

Some people say babies who have had pees and poos caught in the early months are more relaxed about using the potty/toilet when pottry training happens.  We need more research, but this is certainly what happens in parts of the world where nappies are not used.  What's important is to ensure parents know the difference between catching - a reflex, stimulated by fresh air from the nappy being off and being held vertically - and potty training, which is the child being given the opportunity to develop bladder and bowel control.

See Born Ready's 30 sec cartoon on You Tube about catching here.

Read more here.

Ask the expert | Baby-led potty training (BLPT)

Following our recent guest post by Amber Hatch, author of Nappy Free Baby: a practical guide to baby-led potty training from birth, we have asked Amber Hatch to run a live Q&A session.

Amber will be answering your questions on Monday 13 July from 8.30pm until 10pm ...so get asking! Please start leaving your questions here now! 

Have we made a stupid mistake?

Have you ever wondered why your baby often pees the moment the nappy is taken off?  I remember how I always held a nappy underneath my baby’s bottom at baby clinic when I carried my baby between the changing mat and the weighing scales.    I also remember how my babies/toddlers waited until they had a clean nappy on to do a number two.  I may have finally found out the answer.  No scientific proof you understand?  This evidence is purely anecdotal, but something to be aware of.

Earlier this month I attended a Natural Infant Hygiene (NIH) session at Nappy Ever After where I heard why the session leader started baby-led pottying, otherwise known as Elimination Communicaton (EC) with her daughter.   At about 3 months old, her baby hadn't done a number two for a few days.  This was followed by a massive poo explosion. 

The thought occurred to the mother that ‘elimination’ couldn’t happen or was difficult while her baby was lying down in a nappy.  She offered her baby a pot and there was no more 'constipation' after that.   Gravity and exposure to the air seemed to help stimulate ‘elimination’.

As parents, we have been told that we should just leave babies/toddlers in nappies 24/7 so the poo and pee just comes out of the child ‘naturally’.  Indeed we have been warned that giving your baby the opportunity to poo on a pot from an early age can be dangerous leading to ‘holding’ ie constipation.  See link to Huffington Post article below.  

This mother’s experience implies that babies do hold, that they are born with the instinct or if not, develop the desire quite early on to keep themselves clean and dry.  But when we don't give them the opportunity to poo (and pee) on a pot they give up.  Then when we try to ‘teach’ them to try to control their bowels at around 2 years old it’s a problem. 

And it is a problem.  We are hearing about more and more 4 year olds who are dry during the day but ask to put on a nappy to do a poo.   

Read an article on the opposite point of view in the Huffington Post.  Steve Hodges: A Doctor's Response:  Don't Potty Train Your Baby.  At Real Nappies for London we are sharing this knowledge.  It’s up to you to decide what works for you and your baby.

The New Baby Boom | Buy Shares in Disposable Nappies

Today the Financial Times Magazine published an article 'The New Baby Boom'.  It says "In 2001, the number of births in England and Wales hit a 25-year low of 595,000.  In 2012, there were 730,000, a 22 per cent increase."  And this growth is highest in parts of London: "There are more babies per person in Barking and Dagenham than in any other local authority in Britain.  One in 10 people in the area  is under five."  Working out what to do with the increasing volume of nappy waste generated by these babies is a real issue.

Recently I was told that disposable nappy waste is not a problem as we will soon have the technology to turn it into diesel.  "In our lifetime?"  I ask and "Will that be clean diesel?".  But nevermind, what that doesn't do is tackle the issue of children spending longer and longer in nappies.  The weekly spend on single-use nappies is a significant burden for families on low incomes.  Also, changing children's nappies is taking up an increasing amount of primary school teacher's time.
  
At Real Nappies for London we do not blame parents for children starting primary school in nappies.  What we (and many others) have observed is a change in cultural norms of later and later toilet training.  The norm has been to have babies in nappies 24/7 and then at the age of two and a half years suddenly introduce the potty and pants.  

Research shows that children develop bowel and bladder control through being given the opportunity to use the potty/toilet.  Just as we prepare babies for reading through showing them shapes we can introduce babies and toddlers to the potty well before they have bowel and bladder control.  Giving your baby the opportunity to poo or pee on a pot at change time, after a meal or before a bath can be good preparation for taking away nappies during the day ie potty/toilet training.

For several years Real Nappies for London has been pointing out the need for a public health intervention to help parents prepare their child for this important milestone - taking themselves to the potty or toilet.  John McDermott's report indicates the urgency to start this task.

This post may also be of interest:  Are Potty Training Methods in the West ....

For a more detailed account of changes in potty training habits in the UK since the 1950s see Rachel Richardson's Factfile (pdf).  Find  link from www.realnappiesforlondon.org.uk/elimination

We're talking about potty training again

When we talk about nappies all sorts of other topics come up, like Mooncups and Cloth Sanitary Products (CSP), even recycling and composting. Washing nappies in an eco-friendly way comes up a lot as you'd imagine.  And also stuff to do with health like breastfeeding, baby-led weaning, nappy rash and potty training - that comes up a lot. We're asked questions and then we do some research and talk to health professionals.

Something we've come across lately is a worrying increase in urinary tract infections (UTIs) and constipation amongst children. Some health professionals are attributing this trend to infrequent nappy changes, others to current toilet training methods. Our refined diet plays a part too.

At the moment the findings are anecdotal and there is no hard research published on which to base health policy interventions. At Real Nappies for London we believe in sharing knowledge so that parents are aware of the risks and can make up their own mind about what to do.

In the French nappy documentary, Couchorama a toileting anthropologist (yes, really - he's very interesting) describes western style nappy habits as 'hospitalisation'. We wrap the child in a nappy and just change the baby/patient as a routine. This is in contrast to what happens in most parts of the world where the parent/carer looks for cues from the baby that s/he wants to pee or poo and the child is held over a pot or in a convenient position and place for the baby to 'eliminate'.

A study by a Swedish paediatrician of toileting habits in Vietnam found babies were releasing the bladder 'on demand' at 9 months, starting independence at 12 months and in control of the bladder by 18 months. We are meeting more and more parents who are doing this with their babies or at least giving their child the opportunity to 'eliminate' on a pot/toilet at changing time.

This is in direct contrast to mainstream Western style toilet training where we often delay offering the potty or toilet until the child is two or perhaps even older. But there is a growing body of research indicating that chldren develop the ability to control their bladders and bowels through the process of toilet training. This suggests the earlier the child has the opportunity to do this the better.

However there are also continence experts who believe children are at more risk of constipation and UTIs if potty training starts early. The influential article By Dr Steve Hodges in the Huffington Post says that children have a greater tendancy to 'hold' if they've been potty trained early. So what should a parent do?

Any baby/toddler is at risk of 'holding' on to urine or poo. It's important therefore to be observant about how regularly your child eliminates. You should notice the colour of the pee. It should be pale yellow. If it is dark yellow ensure your child drinks more water.

It's also important to be aware of how quickly food moves through the bowels. This will enable you to look out for constipation. It's true that a child may poo regularly but still be constipated. However there are certain highly coloured foods and foods that are only partially digested by young intestines that help you see how quickly food passes through your child's gut eg beetroot, spinach, prunes, peas.

Anecdotally it looks like parents are putting off potty/toilet training until later and later. It also seems to be perceived as something really quite stressful for the parent and child. Fitted carpets don't help!

Our advice is gather the information and decide what's right for you and your child.

For further reading see Are Potty Training Methods in the West

If you're looking for toilet training advice see New thoughts on Potty Training

Check out EC simplified.

Invest in a potty

Are you one of those parents that doesn't want to use washable nappies? Don't worry, you can still make a difference and save money. This European Week for Waste Reduction (16-24 November) let's talk about toilet training.

Did you know that since disposables became the norm children come out of nappies about one to two years later than they used to?

Before disposables became the norm most children were out of nappies by two during the day and three years old during the night. That's a lot more waste going to landfill and incineration - and a lot more resources in the manufacture and transportation of single-use nappies that are actually not necessary!

So if you want to make life easier (for yourself and child), save money and reduce waste, invest in a potty. According to child continence experts your child should be sitting on a potty from one year at the latest - just to get used to it. It's through toilet training that children develop bowel and bladder control so the earlier the better. For more information on how to potty training see this post: New thoughts on Potty Training.

This post may also be of interest: Are potty training methods in the West ...

New thoughts on potty training

More and more children every year start school wearing nappies.  The advice of when and how to potty train is being debated.  Parents are getting conflicting advice: you must start potty training before two; children do it themselves when they are ready. Growing evidence, currently anecdotal but significant is suggesting two things:

1 Children need to be prepared for potty training; suddenly introducing a potty and pants at 2-3 years doesn't seem to be working

2 There is no evidence that potty training early does damage.

Children in real nappies tend to potty train earlier but it's not automatic. Some intervention as described below is necessary, especially for first-borns.

There is no set age for your child to potty/toilet train. Every child is different. The most important thing is to prepare your child. Then they can develop an interest and you can read the signs to see when they are ready for you to take away daytime nappies.

We don't delay cleaning our child's teeth until they can do it themselves. We start to clean their teeth as soon as the teeth come through, right? It's the same for toilet training. Teaching your child about pee and poo from an early age is important preparation. (This tends to be most important for the first-born who don't have older siblings as role models.) It means that when the time for potty training arrives (ie removing nappies during the day and using cotton pants - all day, every day) the process will be quicker and easier.

It's also important to note that control of bowels, control of bladder and staying dry at night are 3 different things. They tend to happen at different times. Children can be clean by one, dry by 18 months and dry at night around three. But it depends on the child - and possibly more importantly, you giving your child the stimulation and awareness to show you s/he is ready.

How do we prepare for toilet/potty training?

Always talk about poo and pee in a positive way - "Lovely poo, well done"

Talk about poo and pee. If your child wears cotton nappies talk about when the nappy is wet and when it is dry.

Get a potty. Your child can sit on a potty from an early age. Encourage your child to sit on the potty ONCE a day (if possible when you expect a poo) for a short time (a couple of minutes as a guide). It should be a relaxing time. Nothing needs to happen but if a poo or pee comes give praise to show this is what the potty is for. Warning: don't go overboard with the praise or it will be overwhelming for the child - although the prospect of you child coming out of nappies may be incredibly thrilling to you!

Open door policy: let your child see you on the toilet.

Visit the library and borrow different books about using the potty.

Create a game with your child about helping a teddy or doll to use the potty, praising teddy or dolly when they do a pee or poo on the pot and keep their pants dry. Get your child to role play being the teddy or doll and repeat the steps to you.

Visit a home where there are children of a similar age who use the loo and encourage your child to take an interest.

When to potty train ie when to help your child stop wearing nappies during the day?

If you do this preparation your child is highly likely to show an interest - letting you know a nappy is wet or poo is coming.

The act of toilet training has been found to help the bladder develop so current thinking is that we do not wait until the child can stay dry for 2 hours

Your child may already be using the potty/toilet for poos


How to start Potty/Toilet Training?

Choose a time when your child is showing an interest in the potty and you can spend some time together. Set aside a few days to spend mostly at home and devote the time to helping your child develop this skill. Prepare your child for what is going to happen - that s/he is going to stop wearing nappies during the day.

Tell your child that s/he is only going to wear pants from now on during the day and will only wear a nappy at night.

Make it exciting. Go on a special shopping trip with your child to buy some cotton pants. If your child is going to use the toilet straight away get a step and a special seat too.

For the first few days encourage her/him to sit on the potty/toilet every few hours - about half an hour after a drink. But make sure s/he knows that s/he can also tell you if s/he needs to go, and that you'll accompany her/him whenever s/he wants you to.

Some toddlers won't sit on the potty long enough to relax and let anything come out. Calmly encourage her/him to sit there for at least a minute or so. Stay with her/him and talk calmly, or read a story. It's best to start boys off with sitting too. Peeing standing up can be learned later.

When your toddler uses the potty successfully, give her/him lots of praise, though don't go too overboard, as s/he may find too much fuss overwhelming. Even if s/he continues to have accidents, s/he'll then start to grasp that getting something in the potty is an accomplishment.

When you think your child is ready stop reminding her/him to use the potty/toilet. There may be a few accidents but your child does need to get the feeling of when s/he needs to go to the toilet him/herself. 

What do we do when we go out?
Once this process has started be consistent. Stick with it and don't go back to nappies. When you go out you may need a portable toilet so s/he can use it. Choose to spend time at a park with toddler toilets (such as Coram's Fields) or a drop-in with small toilets so that your child will see 'big' boys and 'big' girls going to the loo.


What if there is no progress?
If you feel that your child is not ready after all go back to nappies and try again when your child shows an interest. This process takes co-operation. Your child should be an active participant. Be consistent in whatever seems right for your child.

What about night training?
Most children become dry at night within 6 months or so of becoming dry in the day but up to 20% will still wet at age 5 years. If so parents need to speak with their school nurse or GP re appropriate treatment to help their child become dry.

What about children with special needs?
Having special needs does not mean that your child cannot become toilet trained. Get expert advice
PromoCon
Disabled Living
Tel: 0161 607 8219
Email: promocon@disabledliving.co.uk
Website: www.promocon.co.uk
PromoCon, working as part of Disabled Living Manchester,
provides impartial advice and information regarding a whole
range of products, such as musical potties and other toilet
training equipment and swimwear and washable trainer pants
for children who have delayed toilet training.
Information is also available regarding which services and
resources are available for both children and adults with bowel
and/or bladder problems



If you're interested in your child developing bowel and bladder control from an early age have a look at this post on Elimination Communication. In particular see comments from parents who have experience of this method.


Help needed
This advice is based on listening to parents, health visitors and paediatric continence professionals over the last 15 years.  Comments on this draft welcome!







http://www.realnappiesforlondon.blogspot.co.uk/2012/10/are-potty-training-methods-in-west.html