Document 8 of 17.

 
Copyright 1999 The New York Times Company
The New York Times
 
January 12, 1999, Tuesday, Late Edition - Final

SECTION: Section A; Page 1; Column 2; National Desk

LENGTH: 1789 words

HEADLINE: Two Experts Do Battle Over Potty Training

BYLINE:  By ERICA GOODE

BODY:
   Toilet training is not rocket science, says John Rosemond, a syndicated columnist and best-selling author of parenting books. He considers it "a slap to the intelligence of a human being that one would allow him to continue soiling and wetting himself past age 2." The process, he says, should be as simple and straightforward as housebreaking a 4-month-old puppy.

The noted pediatrician T. Berry Brazelton says there is more to it than that. Parents who force toilet training, he says, can cause lasting problems. "Don't rush your toddler into toilet training or let anyone else tell you it's time -- it's got to be his choice," Dr. Brazelton advises in a television commercial for Pampers size-6 diapers, suitable for children 35 pounds and over.

What does he think about Mr. Rosemond's arguments? "They sound very logical -- for a puppy."

So goes the newest round in the toilet-training wars.

The previous round was won by parenting experts like Dr. Brazelton and Dr. Benjamin Spock, who schooled a generation of 1960's parents in a flexible toilet-training approach.

But over the last few decades, the age at which toddlers become diaper-free has been creeping upward. In 1957, 92 percent of children were toilet-trained by the age of 18 months, studies found. Today the figure for 2-year-olds is just 4 percent, according to a large-scale Philadelphia study. Only 60 percent of children have achieved mastery of the toilet by 36 months, the study found, and 2 percent remain untrained at the age of 4 years.

Moreover, though there are no hard statistics on them, pediatricians say they are seeing more children with toilet-training problems, including withholding of urine and stool, chronic constipation, and wetting and soiling by older children. Dr. Bruce Filmer, an associate professor at Thomas Jefferson University Medical School in Philadelphia, for example, says he and other pediatric urologists have noticed an increase in referrals of young patients experiencing problems with both daytime and nighttime urinary control.

These developments combined have fed a multibillion-dollar diaper industry, which last year had training-pant sales of $545 million, and have spurred the introduction of the giant-sized diaper, designed for toddlers well past the terrible 2's.

The sight of diaper-clad 3- and 4-year-olds does not amuse Mr. Rosemond, a family psychologist who advocates a return to traditional child-rearing practices, and he has decided to do public battle on the issue.

In a series of columns last month, published in more than 100 newspapers, he attributed delayed training to wishy-washy parenting inspired by "Freudian mumbo jumbo." In particular, he pointed to Dr. Brazelton, professor emeritus of pediatrics at Harvard Medical School, who in the 1960's pioneered the "child-centered" parenting approach, recommending that parents let their children decide when to become diaper-free.

The increasing tendency for parents to leave the timing of toiling training up to the child, Mr. Rosemond asserted, is largely responsible for the rise in toilet-training difficulties. Delayed training, he said in a telephone interview, can also lead to discipline problems, because mothers spend too much time being servants for their children and do not make the transition soon enough to "authority figure."

Mr. Rosemond concedes that Dr. Brazelton has been giving the same advice for decades but also criticizes him for serving as a consultant to Pampers, a product of the Procter & Gamble Company, and for appearing in the Pampers commercial.

"I think it's a fairly blatant conflict of interest," Mr. Rosemond said.

For his part, Dr. Brazelton said he believed that the rise in toilet training problems was a result of too much pressure on children, not too little. The increase can be traced to the escalating demands of modern life, he said. Day-care centers often require that children be toilet-trained in order to enroll, and working parents end up leaning on them to comply. Parents share the responsibility for training with nannies and baby sitters, a circumstance that children may find confusing.

"Parents are feeling very guilty, and people like Rosemond are making them feel more guilty, not less," Dr. Brazelton said. "And the child's only recourse is to withhold urine or stool in protest."

As for his relationship with Pampers, which provides financing for his research and health care projects, Dr. Brazelton said he was proud of the association.

"It took me a long time to decide to do it, but I'm absolutely convinced that it was a wonderful thing to do," he said. "I'm certainly not doing it to keep kids in diapers. It's just the opposite: Pampers is willing to go along with me to make it easier for mothers to let kids be open to toilet training when they are ready."

To "go along," of course, is not all that difficult for Procter & Gamble, which, like its competitor Kimberly-Clark, maker of Huggies, recognizes a bonanza when it sees it.

Wendy Strong, director of corporate communications for Kimberly-Clark, said the company's own marketing research confirmed that toddlers were toilet training later than in the past: only 12 percent of children are trained at 18 months, the company found, and 85 percent by 30 months. Huggies, too, just began offering customers a size-6 diaper, but the company also makes "training pants" for toddlers of 38 pounds or more, a product category, Ms. Strong said, that Kimberly-Clark "expects to grow to more than a billion dollars by 2002."

Whichever expert's school of parenting a toddler's parents decide to follow, they run no risk of confusing the philosophies, or the methods themselves.

Mr. Rosemond offers a toilet-training technique he calls "naked and $75," which he recommends that parents embark upon with their 2-year-olds.

"You stay home from work with your child for a few days," he said, and "you let the child walk around the house naked all day long." The parent puts the potty where the child spends most of his time, and moves it when necessary to keep it nearby. Every so often, the parent reminds the child to use the potty when needed.

"Children at this age do not like urine and feces running down their legs," Mr. Rosemond said. "When they have an accident, they stop and start to howl, and the mother comes along and says, 'Well, you forgot to use the toilet.' She puts him on the toilet, wipes him off, speaks reassuringly to him. And within three days, or five days, he's doing it on his own."

The $75, he added, is for the carpet cleaning.

In contrast, Dr. Brazelton, like Mr. Rosemond the author of best-selling parenting manuals, discourages parents from expecting their child to potty-train in a few days. He recommends that parents buy a potty chair and "show children what is expected of them at 2, what we are all doing and why it is important."

But, he says, the rate at which training occurs should be left up to the child.

"If your child is afraid of the potty chair, don't put pressure on him to use it," Dr. Brazelton advises in a step-by-step guide available on the Pampers Parenting Institute's Web site (www.pampers.com). "Put toilet training aside for a month or two, and give your child time to get used to the idea of the potty and to be comfortable with it."

"Be patient and positive," the pediatrician suggests. "As with any new skill, your child will master toilet training in time."

In his experience, Dr. Brazelton said, 85 percent to 90 percent of children will embrace toilet training soon after they first show an interest.

"But the others are saying that there are other issues they're trying to deal with," he said, "like day care, like parents who are extremely busy. The child gets confused and maybe even angry, and withholds. And at this point I think you have to be able to say, 'This has got to be up to you.' "

For parents, the bottom line seems to be: Whatever works.

Melissa Saren, for example, a Manhattan lawyer, said she tried introducing her son Matthew to the potty when he was 3. "But I think looking back on it that I started when I was ready, not when he was ready," she said.

For months, nothing seemed to work, not bribes, not the books "Once Upon a Potty" or "Everyone Poops," not "big boy" underwear. Finally, she said, Matthew decided the time was right -- when he enrolled in day care at 3 1/2.

"Seeing the other boys poop in the potty" seemed to do the trick, Ms. Saren said. "I would fall into the category of thinking that you just leave them alone and they'll come to it."

Other mothers -- Mr. Rosemond said his daughter-in-law was one example -- find that the "stay at home and do it in three days" approach works just fine.

But many pediatricians say their experience has landed them much closer to the Brazelton camp than the Rosemond. Dr. Filmer, for example, said he had seen many parents become embroiled in battles with their children if they try to force toilet training within a defined period of time.

"Goodness me," Dr. Filmer said, "you talk to these parents and they will tell you that their children formed almost a fear of toilet training."

Dr. Bruce Taubman, a pediatrician in the department of gastroenterology and nutrition at Children's Hospital in Philadelphia who has a private practice in Cherry Hill, N.J., said: "To get a child trained by 2 can be done, but it is probably done at a cost. It takes a tremendous effort."

But Dr. Taubman said he had a hunch, though he did not yet have data to support it, that there was a window of opportunity, perhaps near the age of 2 or 2 1/2, "when kids really want their parents to get excited if the kids poop." If this opportunity is missed, toilet training may take much longer.

Dr. Taubman is one of the few people who have collected systematic data on toilet training. In 1997, he published the first large-scale study of children's reactions to toilet training since the 1960's, a report on 482 children in suburban Philadelphia. The study appeared in the journal Pediatrics.

In addition to assessing the ages at which most children now train, Dr. Taubman found that boys trained later than girls on average and that the average age at which parents introduced toilet training was 23 months.

There is no relationship, Dr. Taubman found, between when a child is trained and the mother's work status, the presence of siblings, the child's scores on measures of behavior, or whether the child is in day care.

About 13 percent of the children in the study had trouble with toilet training, withholding stool or refusing to use the toilet. But the vast majority of these children, Dr. Taubman said, "resolved the problem without intervention."
 

GRAPHIC: Photo: T. Berry Brazelton, advocate of flexible training, in a Pampers ad for large diapers. Rivals see a conflict. (D'arcy Masius Benton & Bowles)

LANGUAGE: ENGLISH

LOAD-DATE: January 12, 1999


Copyright 2005 The New York Times Company
The New York Times

October 9, 2005 Sunday
Late Edition - Final

SECTION: Section 1; Column 2; Metropolitan Desk; Pg. 1

LENGTH: 1411 words

HEADLINE: Toilet Training at 6 Months? Better Take a Seat

BYLINE: By TINA KELLEY

BODY:


Hannah Rothstein, 7 months old, has double thighs and a dimpled bottom, but very svelte German underwear. She can still fit into her birth-to-3-month-old clothes because she lacks her peers' familiar bulge in the rear. She can sleep all night without a diaper. And during the day, every so often, after her mother, Melinda, of Newton, Mass., places her on a plastic potty and makes a little ''pss-wss-wss'' sound like the one used to call a cat, Hannah uses the toilet.

For many parents in the United States, the idea of potty training before a baby is able to walk, or even before age 2, is not just horrifying but reprehensible -- a sure nightmare for parents and baby, not to mention a direct route from the crib to the psychiatrist's couch. But a growing number of parents are experimenting with infant potty training, seeing it as more sanitary, ecologically correct and likely to strengthen bonds between parent and child.

About 2,000 people across the country have joined Internet groups and e-mail lists to learn more about the techniques of encouraging a baby -- too young to walk or talk -- to go in a toilet, a sink or a pot. Through a nonprofit group, Diaper Free Baby (www.diaperfreebaby.org), 77 local groups have formed in 35 states to encourage the practice. One author's how-to books on the subject have sold about 50,000 copies.

''It's just so simple,'' said Lamelle Ryman, who recently attended a support meeting at an apartment on the Upper West Side. Ms. Ryman, the mother of 7-month-old Neshama, added, ''I feel like it's been such a gift in our relationship.''

To be sure, adoption of the approach in the West is in its infant stage, so to speak. Moreover, the philosophy behind it flies in the face of Spock-influenced child-rearing. Dr. Benjamin Spock, the last word in child rearing for many American families through much of the 20th century, recommended against any training in the first year, believing that it could lead to rebellion later through bedwetting.

Once, however, breastfeeding was also a rarity, until conversations among mothers, supported by medical research and encouragement from doctors, nurses and midwives, pushed it during the 1970's to the mainstream of child care practices, where it remains today.

With early toilet training, there is a broad body of knowledge and experience to draw on. Parents in at least 75 countries, including India, Kenya and Greenland, embrace the practice, with Chinese babies often wearing pants with split bottoms for easy squatting (available for $1 in Chinatown, according to savvy mothers in New York).

Some parents who adopt children from other countries say they are startled to find that their babies arrive ready to use the toilet. More than 50 percent of the world's children are toilet trained by the time they turn 1, according to Contemporary Pediatrics magazine.

From birth, the reasoning goes, infants are aware of their needs to eliminate, and although their muscles are not developed, they can soon learn to go on cue. Conversely, by relying on disposable diapers, modern parents are in effect teaching babies to ignore the signs that they have to go, making potty training at a later age more difficult.

Ingrid Bauer, author of ''Diaper Free! The Gentle Wisdom of Natural Infant Hygiene'' (Natural Wisdom Press, 2001), believes it is easiest to begin toilet training in the first six months. To start, parents are taught to hold the baby by the thighs in a seated position against their stomachs and to make an encouraging hiss or grunt. With practice, parents learn their child's rhythms; some parents sleep next to their children and keep a potty at arm's reach, or diaper their babies overnight.

For families who practice the technique, the advantages are many: savings in the cost of diapers, which can reach $3,000 a child; less guilt about contributing to the 22 billion disposable diapers that end up in landfills every year; no diaper rash, and a nursery that doesn't reek of diaper pail. They also note that age 2, a common age for toilet training, is a time of notorious willfulness and a terrible age to start teaching any child anything.

Most important, they say, is an increased emotional bond with the baby, forged by the need for the parent to pick up on subtle signs and act on them quickly. Proponents of the practice use the phrase ''elimination communication.''

''It is enhancing that interaction and closeness, the intimacy between baby and mother,'' said Thomas Ball, a psychologist in California who is helping develop a documentary about the technique. ''Here's another set of cues the child is giving that may be ignored or may be responded to.''

Unquestionably, in a child-rearing culture that thrives on sanitation and parental convenience, the prospect of supervising 20 deposits a day in the first busy months of infancy is daunting.

''It doesn't sound like anything I would ever even attempt to try,'' said Erinn Marchetti, who has two preschool-age children and was shopping recently at Toys ''R'' Us in Times Square. ''It's hard enough when they're 2 and 3.''

Another mother in Toys ''R'' Us, who offered her opinion but wanted to remain anonymous, was aghast at the notion. ''Have you read Freud?'' she asked, worrying about the method's long-term effects. ''I imagine it's going to come out in sexual ways.''

Dr. T. Berry Brazelton, the renowned child-rearing expert, said parents need not worry about psychologically damaging their child. Dr. Brazelton, author of ''Toilet Training: The Brazelton Way'' (Da Capo Press, 2004), has always advocated a child-centered approach to training: do it when a child is ready, without too much pushing or even encouraging.

''I'm all for it, except I don't think many people can do it,'' he said of elimination communication. ''The thing that bothers me about it is today, probably 80 percent of women don't have that kind of availability.''

He said he did wonder if children trained as infants would rebel against it later. ''Are they going to run into some withholding afterward, when the child realizes, 'Hey, this wasn't up to me, this was up to my mommy and I'm not going to put up with it.'''

As with breastfeeding, a turn toward infant potty training would represent a leap into the past. Before the 1800's, babies in Western societies were swaddled, which restrained them and contained their wastes, Laurie Boucke said in ''Infant Potty Training'' (White-Boucke Publishing, 2002), one of several books she has written that advocate the technique.

When cleanliness became a virtue in the 19th century, Ms. Boucke wrote, infants were regularly held over a chamber pot until they learned the habit of using it. The American Academy of Pediatrics, in its current ''Toilet Training'' pamphlet, says children have no control over bladder or bowel movements when they are younger than a year and little control for six months afterward.

''Even if you're getting them to go in a pot as a young infant, I don't know if it will have any long-term impact for all the effort you have to go through,'' said Dr. Mark Wolraich, author of the academy's ''Guide to Toilet Training'' (Bantam Books, 2003). ''The risk is, if it's not working and the parents are frustrated, they're creating more negative interactions with their child.''

But parents of diaper-free babies said working with a child's signals is a rewarding and worthwhile experience.

A mother in Medford, Mass., Sarabeth Matilsky, said elimination communication helped strengthen her bond with her son, Ben, who began using a potty when he was about 10 weeks old and who was colicky as an infant.

''When I started doing this, I got to start seeing him as a little person with abilities,'' she said, noting that her son had become much happier after she learned to read his cues, and that he no longer cried before every diaper change.

At two recent meetings of support groups, mothers and one father shared signals their babies gave: kicking, nose-rubbing, getting loud, getting quiet, hiccupping, feeling warm to the touch, shivering.

Ms. Boucke, the author, noted that many fathers really enjoy infant potty training. ''They can't breast-feed, but they can work on the other end,'' she said. ''Some dads get really good results.''

She knows it can be challenging, she said. ''I tell people, you cannot be a perfectionist with this,'' Ms. Boucke said. ''No one is going to be there all the time. They won't have a life.''