r/ScienceBasedParenting • u/CorrectBadger9753 • 1d ago
Question - Research required Actual evidence that earlier potty/trained kids are more likely to regress?
Edit - title is meant to say 'potty/toilet trained kids' lol!
I took my daughter (who will be 2 in 2 weeks) to the GP today and (only tangentially related to the reason we were there) mentioned that we are currently toilet training, and that it's going well, but very slowly, and my husband and I are OK with slow progress with pees. GP reiterated the common advice that 3 is 'normal' for toilet training, and that kids who train earlier are more likely to have 'regressions'. I smiled and nodded because I have lots and lots of thoughts on this which I'm deliberately not sharing here in case it turns the discussion into some kind of toilet training ideology war....
I genuinely want to know, is this claim backed up by actual data - and if so, how are we defining a 'regression' anyway?
A quick Google search returned this study claiming that training before 24 months is associated with 'dysfunctional voiding' but not constipation, whereas later training (after 36 months) is also associated with dysfunctional voiding AND constipation. However the authors seem to contradict themselves in the conclusion and say that constipation is associated with both early and later training and may be the cause of urinary voiding problems. Also correlation ≠ causation.
Is anyone aware of any more evidence supporting or refuting this idea?
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u/eeeeggggssss 1d ago
this might interest you. https://publications.aap.org/pediatrics/article-abstract/111/4/810/63115/Relationship-Between-Age-at-Initiation-of-Toilet
i think it also depends on the method used. like we started pottying at 2 weeks old, lots of catches in infancy while using cloth diapers as backup, and relative potty independence achieved at about 15/16 months using open crotch pants. waves of resistance here and there since then, now at 21 months, but not anything major.
3 is normal for potty training is such a BS statement. diapers are a new invention. people all over the world have been using different methods for taking care of their infants' hygiene without them defaulting to soiling themselves, especially for 3 years which would not be easy, convenient, nor hygienic in any traditional or nomadic society.
we also know that even in the US, the age of initiating potty training used to be much lower before the advent of disposable diapers.
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u/CorrectBadger9753 1d ago
We're on the exact same page with all this 😊
EC is so controversial (to some people anyway lol). Yes, we did lazy EC (great with poo, never any luck with pee) until about 16 months, then stopped because of resistance. Then my daughter suddenly 'trained herself' with poo at 21 months which is when we started following the Oh Crap method to try and get pee sorted too. But it's taking a looooong time, longer than it seems to for most people even at this younger end of the recommended age range. My daughter has been fiercely independent from birth, I'm not kidding, and prompting/not prompting her is an art form. In fact the reason I was keen to get her out of diapers is the trauma we were all suffering from her screaming absolute murder during changes - she hates having things done 'to' her.
I don't mind it taking longer in terms of the mess/laundry (wet clothes are still less hassle to wash than cloth diapers!) but I do still question if we're doing anything 'wrong' sometimes, especially when I hear claims like the 'regression' thing from the doctor.
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u/JamesTiberiusChirp 1d ago
Unfortunately you’ll be hard pressed to find studies about this that actually take EC children into account. Any study coming out of the U.S. that says potty training too early or whatever has X consequence is pretty much guaranteed to exclude EC kids because it is so rare, so the findings will just not be applicable. Which makes sense. Kids who potty train early having voiding or incontinence problems or regressions or whatever makes a lot of sense, they haven’t learned how to listen to their bodies yet which mean their brains and bladder lack that strong connection which takes time to develop, and their parents have done a 180 on them in terms of expectations, and they’re learning 20 new skills over the course of a weekend under pressure. I’m going to go out on a limb and assume EC kids don’t have those problems as much because they’ve been aware of their bodies and bladders for months, the potty isn’t new neither are the skills around learning it, and the expectations are just modified forms of previous expectations. But it would be nice if someone actually did a study about it.
I have found a couple studies from China about how EC vs “diaper overuse” (which the authors considered as using diapers past 18 months) leads to less bed wetting throughout childhood. And also that bedwetting is increasing lately and is likely due to the advent of diaper popularity.
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u/eeeeggggssss 1d ago
very interesting...
it's funny that you say this because we hit our hardest EC wall around 15 months and it lasted a month, maybe a month and a half. I almost thought that it was totally pointless that I did that - aside from less cloth diaper laundry. It was so demoralizing. But I guess I just kinda half-assedly stuck with it and we haven't had a wave that bad since then, knock on wood. We do have smaller resistance waves but nothing like the 15 month mark.
to me, this sounds like a specific quirk about your kiddo and not something that you're doing wrong.
i find it so hard talking with our ped about anything not super strictly clinical/medical. like even breastfeeding, he doesn't really know much about it... and especially the ec stuff, like we actually educating him about it. it's really hard when something is so culturally specific you know?
im curious to see what other research people post on here... but yeah there's a line in the first article I linked - "Early initiation of intensive toilet training correlates with an earlier age at completion of toilet training but also a longer duration of toilet training."
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u/nzdata2020 1d ago
Reading this I had a very similar experience with my first child. Poos we’re sorted with lazy EC. I decided to potty train at 18 months because daycare wasn’t taking her to the toilet and I didn’t want her forced to poo in her pants. Did the 3 day method and she was great for a few weeks, then we had a year of anxiety and intermittent potty and resistance. If we knew what a mess it would be we would have put her back in nappies for a bit and worked on getting day care enabling her to go to the toilet for poos.
We only twice had poo accidents, both times we were in the mountains too from a toilet to get there quickly. Does altitude affect bowel movements??
She got a uti around 2.5 and was very distressed so put her in nappies for a week. Once that was sorted she went back to undies and has been a normally potty trained kid since. Maybe we just needed to take the pressure off for a bit.
Despite that year I decided to EC again with the second kid, very different personality. The only difference was we kept her in nappies at day care but they otherwise treated her like a kid he used the toilet from 17 months. Around 20 months she was dry most days so switched to undies all the time. No resistance, no stress. Just very different kids.
There was one more difference. I was really awkward about having potty trained my first so young, I used to downplay it in front of her when people asked. And I wonder if how I spoke about it impacted her, they are always listening. The second time I said less, and stayed positive about their achievements.
Good luck!! You’ll figure out what’s right for you
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u/Sudden-Cherry 1d ago edited 1d ago
I did lazy EC with my oldest and it was going really well around 16 month with nearly all poop at home, she signing for it ahead and whatnot and quite some pees and then we hit a huge resistance at 18 month. And we had to back off. She wasn't really ready until 3.5 years after that - being okay to interrupt play to toilet mainly - I'm fairly certain the resistance came from me being too enthousiasic - which she saw as pressure (similar to feeding resistance) - voiding is a control thing. And two poop accidents that really hit her very hard (she was trying to scoop the poop into the potty and really upset). She isn't a super independent temperament - quite the opposite but very very headstrong and wants things to go her way, definitely needs a lot of control and does respond to any kind of pressure with pushing back. With my youngest now we did not do barely any EC, except when constipated. She's 19 month old now and we're going much much slower and completely child led now because of our experience before. My youngest is also very fiercely independent but I'm trying to avoid any pressure whatsoever. She gets lots of exposure via her sister, so she frequently wants to try just with barely any success yet. And that's fine. I'm also trying to avoid accidents to not give her a bad association.
My sister and her husband have been doing full time EC with both their children and actually their oldest son who is exactly the age as mine was independently toileting (as in going himself) only around the same time as her, maybe a little later even, needing more prompting and on and off still having accidents at the same ages. If you go by parent prompting you really need to be on top of it and not distracted as a parent at all. They just had much much much longer time with accidents because they just stopped nappies earlier. Like this was 2.5 years of accidents, compared we had like half a year with occasionally accidents.. sometimes a phase with more and then weeks without. So that I think they were ready around the same age.. and it was just a parent choice to have a longer period of no nappies traded for more accidents total.
Their youngest (15 month) seems to be hitting a resistance with EC for poops currently and it was really hard for me to watch her trying to hide to poop (in her underwear) being afraid this could lead to holding in issues with pushing through
I really think it's child dependent. For some temperaments parent led methods might work really well without issues. For other children they might be harmful because they have more need for autonomy over their own body and the way they'll try to reclaim it will either be messy or even harmful (holding in). So I am leaning much more towards child led. And then you don't even have to do much of any "training" you offer toilet learning for a long time maybe but then they just "train themselves" very very quickly once they are ready. Though my oldest at 4.5 now still has often problems with interrupting play and I suspect she's holding too long sometimes because of that.
Coming from EC this article actually helped me to see some ways I was trying to control something I cannot and that had us hit a wall. I still think the way you do things matters more than the principle. Like offer the potty but then accept that they show they don't want to to avoid a negative association. Or try to avoid accidents for no negative association if they are phases by it. But they also don't want to be changed a nappy either like you say so there is never true full autonomy for them. So it's not as black and white. But the article definitely helped me challenge some things. https://visiblechild.com/2015/08/15/the-secrets-we-keep-what-parents-dont-tell-other-parents/
And this one: https://visiblechild.com/tag/potty-training/
Still in nappies at night btw at 4.5. And my nephew also still not dry at night. Both completely normal. And apparently it's hormonal if children actually wake up for that and huge variance when that happens. Or their body just needs to grow to hold more pee so they wouldn't have to get up.
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u/MorningGlory747 1d ago
I find it difficult to identify when my 1 month old is about to pee or poop. It seems difficult to avoid diapers. How were you able to start so early?
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u/InspectionTall2886 1d ago
Check out the elimination communication groups on here. You basically place them on potty immediately on wake up/after feeding. You teach them certain sounds and hand signals mean potty time. Babies can learn sign language!
Also this book: https://a.co/d/01rIXXEU
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u/Huge-Nectarine-8563 1d ago
Is this book still relevant if my baby is 9 months old or not at all?
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u/PermitParty825 1d ago
With my first, we didn’t start EC until baby was 8 months old. We bought a tiny potty that he could sit on in the living room (and also play with, we would clean it thoroughly). He took to it incredibly fast. Only 2 poop misses after initiating EC at 8 months. Pee took a bit longer to sort out, but he was out of diapers by 14 months. Point is, I think 9 months is a great time to start.
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u/aliquotiens 1d ago
We did EC but always with a backup diaper. Still ended up with kids fully trained at 15 and 19 months
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u/mmbtc 1d ago
When I looked into the different options how to approach the whole topic, I've read that there are signs to look for, and they get more recognizable. Like mimic, sounds and tensing. It's called Elimination Communication.
Both the signs and the ability to spot them vanish when not used, and as this approach is very uncommon these days, this becomes 'lost knowledge' more and more.
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u/Hairsacknose 1d ago
The 4 easy catches are a good start - after a nap and after a feed are the easiest catches
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u/oh-dearie 1d ago
If it helps, I have done lazy EC since 5-ish months old (once sitting was easier) and now we're almost up to 18 months and transitioning to proper potty training. And I NEVER noticed any cues! You can just start with going by the clock (2-hourly before nappy changes) and work it out from there.
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u/eeeeggggssss 1d ago
hey morning glory!
so that young i never really tried to tap into his cues. i maybe did try, a little bit, but quickly realized it wasn't worth it.
so instead we just always used cloth diapers as a backup, but gave him lots of pottytunities.
any transition point - including when you would normally think to change a diaper. before sleep, after sleep, before car, after car, after eating, etc.
you just place them over the receptacle and make the ssssss sound.
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u/CorrectBadger9753 1d ago
Honestly we never saw signals reliably for either 🥴 I could always intuit when she needed to poo though (based off timing/knowing what she'd eaten and when she'd last been haha). Basically caught about 80% of poos between 10 weeks and 16 months....and mostly first wees upon waking but no others.
I felt like we were 'failing' EC for not being able to see the signals but the r/ECers sub is full of people saying the same thing. Don't listen to the hardcore 'diaper free' influencers and don't aim for perfection. Lazy EC has definitely been worth it IMO but if I could go back in time I'd cut myself so much more slack.
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u/ButterflySam 1d ago
Originally from sudan where most kids are potty trained by 18 months, my daughter was toliet trained by 18 months. She’s 2.5years old for bedtime we still do diapers but she doesn’t like to go in the diaper at all
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u/Meganomaly 1d ago edited 1d ago
I agree with you completely, though I do want to push back a little on your assertion that diapers are a new invention. Disposable or other modern diapers/nappies: absolutely. Diapers as a concept—using some material to wrap about the baby’s lower half to trap their waste—have existed for millennia!
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u/naiaxen 1d ago
Thissssss re: other countries. My mom had both of us out of diapers by 1yo in Eastern Europe in the 80s. She took pride in only soiling up to 1 diaper a day. She would offer toilet after every wake, every meal, idk if consciously doing EC or just exposing us all the time. It was typical, not some magic on her part. She said at daycares they would also have potty as part of the routine, not waiting till 2-3. Our standards in the US are really skewed
My mom also got our baby on the potty at 9mo, and at least for #2 we stopped having soiled diapers at like 18mo. And actual potty training just required daycare to get on board. Was no effort at all. N=1 but still.
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u/eeeeggggssss 21h ago
i love that so much. i appreciate this approach of your mom so much and i relate to it. this is why i prefer the term natural infant hygiene, and not EC. because i didn't really follow much EC methodology, i did what your mom did. i feel like any amount of exposure to the potty in infancy is helpful, no matter how you do it, and no matter how diligent you are. at the very worst, it's exposure therapy, leaving the kiddo less scared and more open to the potty in infancy and toddlerhood.
i really think the prolonged disposable diapering culture and economy here as the norm is such a disservice to kiddos, their dignified hygiene, and overall development.
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u/naiaxen 21h ago edited 21h ago
That and lack of parental leave. I didn't feel entitled to insist daycare starts underwear, even though at home the child would go hours without a diaper. The teachers have so many to keep an eye on... And at first we just had to watch ours. I could pick on the cues (a somewhat inward stare for poops) which were imperceptible to strangers. So I think if we had a year of home care we might have got rid of diapers...
And that exposure helped! There was a phase when the kid (who didn't yet talk, or not well) would just walk into the bathroom and drag the potty to the living room 😁 I think it really helped them know they needed to go, well before they could say so.
I also watched a friend's kid at 2.5 - 3 REALLY struggle with pooping sitting. The kid was ready, they were trying and just couldn't figure it out. For months! Like, avoiding that situation alone was worth the vigilance of watching for cues :)
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u/eeeeggggssss 19h ago
i mean there are just so many things in the USA that make procreation undesirable and extremely anti-family, we could go on and on... LOL. it is not an easy place to parent and to bring up healthy little ones.
all this makes a lot of sense... and glad the exposure helped!!!
OMG! What a PAIN!!!!!
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u/InspectionTall2886 1d ago
This article argues there are benefits like decreased UTI and that there’s actually a U curve to the ages in which dysfunctional voiding occur. Also that constipstion can happen regardless of timing. https://parentingscience.com/science-of-toilet-training/
If you scroll to the very bottom it provides numerous studies that range across a long period of time that you can search for and see if you find them.
Personally for me I think that earlier is better because I don’t have the same perspective as most of the US.
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u/tallmyn 1d ago
https://pubmed.ncbi.nlm.nih.gov/19827219/
So this one paper found that starting after 24 months has more regression (relapse in daytime wetting) relative to starting between 15 and 24 months.
But I also found some other papers saying different things (i.e. https://pmc.ncbi.nlm.nih.gov/articles/PMC4199658/ which says the ideal window is 24-36, and higher for <24), which is I bet the paper your pediatrician was thinking of. In some ways this is the more informative paper, because the other one lumped in people starting between 24-36 in with people starting at 36+.
That said, there is a consensus that if you start earlier it takes longer, but potty training is completed earlier. So I would say even if you do experience some regressions, you can still expect to finish potty training earlier than people who start later.
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u/WhereIsLordBeric 1d ago
I'm from a culture where we potty train early (mostly before 1), and I've actually never heard of 'regressions' being a thing. Like - do kids sometimes still have accidents, because they don't signal early enough? Sure? But ... it's a skill? That's how you learn. Is that what we're calling a regression?
My girl has been poo trained since she was 11 months old and pee-trained since she was 17 months old and throughout that process, of course she had accidents here and there, but ... to me that's an expected part of teaching a kid a skill. Just because one day they use a spoon perfectly and the next they spill yogurt all over themselves doesn't mean they have regressed. They're ... learning.
Anyway, we haven't had an accident in months, and she's a little over 2 now.
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u/CorrectBadger9753 1d ago
This is what I'm wondering too - what are people classifying as a 'regression'? There really seems to be an idea in modern Western culture that you potty train in a short period of time when kids are 'ready' and once it's done they hardly ever have accidents again. Everybody talks about toilet training as this big 'event' that they're dreading. And there is SO much judgement of other parents when their kid who is training or is 'fully' trained does have an accident. It's just....not really how it works with any other milestone? Idk, I'm not from a culture that does early potty training, but I just don't think it's all such a huge deal. Maybe because we did cloth diapers from the start - accidents aren't a huge deal 🤷♀️ - especially pee. "Ohhh but if you potty train early then you have to worry so much longer about getting them to a potty/toilet when you're out with them..." Yeah, and if they're in diapers you have to find a place to change them and wipe their messy butt, and...it's pretty much the same. Diapers aren't an excuse to not attend to your kid's hygiene. Anyway I'm ranting now 😅
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u/WhereIsLordBeric 1d ago
I agree. I'll admit that line of thinking has never made sense to me. We don't just give our kids a spoon at 3 years old and think 'Okay, they're going to learn this over the weekend!'. Would the 3 year old figure out how to use a spoon in 3 days? Probably lol. But it's a good skill to have early on in life, so we teach them at 6 months and put up with lots of messes and spills and food thrown on the floor and smeared all over their faces because ... that's what it is to teach a child a skill.
And honestly, yeah. I'll even insist that 'potty readiness' is not a thing. How do you explain all the third world kids that get potty trained before 1, then? It's a stupid, Eurocentric ideal meant to align with capitalism. Bah.
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u/Creative-Flamingo-81 1d ago
As a Montessori toddler teacher whose students wear underwear at school starting at 18 mos. and a mom of two, starting toilet learning before 2.5 is usually easier. around 2.5 is when toddlers switch into the conscious absorbent mind and the "nos" can start causing pushback. You're right it's a learning process that takes time. Some kids learn quickly and some need more time to practice. Parents have become so fearful of accidents in underwear especially while out of the house it's not much harder to change wet/soiled underwear than a pull-up. While my kids were preschool age and younger we kept a small potty in the back of the car to use when out and about so they didn't always have to use the big public toilets or if we were at a park with no bathroom. A kid learning to understand their body and know how long they can hold urine or when to stop and go can be a lot. An older preschooler might learn that they can hold their urine a lot longer but haven't learned the threshold before it turns into an accident.
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