Early Potty Learning the Montessori Way- Our Journey

Disclaimer: This is a long post!  But, do not fear, you don't have to read it all-  I really want it to be helpful for those interested, so I've presented lots of information and lots of the same information in different ways, so you can choose which version works best for you!  If you have questions or tips for other parents, please comment!

Here's what you'll find below:

• Overview
• Our Basic Action Plan
• Summary of Early Potty Learning by Month
•  What I'd Do Differently
• Our Favorite Potty Books

Overview
 As I've described in several posts, we began potty learning quite early by current Western standards.  Dr. Montessori considered the "sensitive period" for potty learning from 12-18 months.  We started at 14 months. When I started our journey, I looked for sources and stories from other families for inspiration, but, frankly, I did not find very much. Two of my favorite Montessori blogs had some information (How We Montessori (it was especially interesting to follow this mom's journey as her son and my son are the same age, so we were struggling together!) and Vibrant Wanderings).  Additionally, I used some elimination communication resources (specifically this book and this book) for tips, although we were certainly beyond the timeline for EC.
   It was a very slow road- with many pit stops along the way, but ultimately one that I'm very happy we took.  So, I wanted to share our journey- month by month- with the goal of helping or possibly inspiring other early potty learning families.

Our Basic Action Plan

1. Introduce potty, when child is interested and comfortable, encourage her to sit on potty.
2. A few hours of daytime diaperless time.  During elimination, introduce your sign and/or verbal cue.  Move child to potty during/after every elimination and explain that all elimination happens on the potty.  Encourage them to help clean up any messes, but otherwise use no reward or consequence.
3. Increase diaperless time during the day as understanding progresses.  Move to diaperless time during naps.
4. Go diaperless outside of the house (use trainers or just bring extra clothes).
5. Go diaperless at night.

***If at any point, your child is clearly uncomfortable or upset by the potty, put it away for awhile.  You don't want your child to have negative feelings toward the potty!

Short Summary by Month

13 Months
For the first time, I noticed that Q-ball indicating to me that she was "feeling" when she was peeing.  As a baby who was never bothered by dirty diapers, I felt this was a significant change that signaled readiness for potty learning.  For the next few weeks, I researched potty learning (see sources listed above).

14 Months
I finally got around to buying a potty. We just set it in front of Q-ball on day, explained what it was for and waited for her to be comfortable to sit on it.  It really didn't take long- just about a day or two.  At this point, we started going diaperless at home for a few hours a day.  When Q-ball peed on the floor, we would make the sign for "pee" and a "pssss" sound.  We then moved her to her potty and encouraged her to clean up the mess.  We went through lots and lots of towels.  We were lucky that Q-ball did not mind sitting on the potty; if anything, she loves it- we get to read lots and lots of books.  But, no "catching" this month. 

15 Months
Q-ball started to make the sign for "pee" and within the next 10 minutes would normally pee.  Still, we didn't catch every pee.  Mainly, in retrospect, because I do not think I was fully committed.  I was a little too casual about potty learning at this point, I think as a result of reading some Montessori resources over resources completely devoted to potty learning.  When Q-ball signed, I would not completely drop everything and wait on the potty for the next however long.  As a result, I think I missed a real opprotunity at this point to help Q-ball connect a her physical sensations to moving to the potty. 

16 Months
Not much changed.  Diaperless time did increase to any time at home.  One major difficulty for us was that I was never able to figure out Q-ball's elimination schedule.  I kept lots of notes and observations, but, frankly could never really figure out a schedule that was consistent.  Perhaps she started holding her pee very early in the process?

17 Months
Q-ball was obsessed with watching others go potty.  Whenever we were out and someone went into another door, she would look at me and make the sign for "pee" with the "psss" sound.  Also, I was dragged into bathrooms during every outing.  Q-ball herself, however, was not overly interested in eliminating on the potty herself.

18 Months
For the first time, Q-ball moved to the potty herself and peed!  Biggest success yet!  She was very excited and kept looking in her potty to see if it's full of pee, but, alas, we still didn't have too much success.

19 Months
At times, Q-ball catches accidents half-way and runs to her potty, but, mostly, we still go through lots of towels.  I should stress that we sit on the potty A LOT.  Like, Q-ball will ask to sit on the potty for over an hour reading but will not think about peeing.  She definitely holds her pee.  As we still wear diapers when we go out and at night, and I know that she is holding her pee until these times.

20 Months
Stomach bug strikes household for several weeks.  After a traumatizing diaperless experience for Q-ball and Daddy, we decide to take several weeks off potty learning to prevent any major setbacks.  (Q-ball clearly was really disturbed by the incident was begged not to go diaperless during this time.)

21 Months
I really start to take potty learning more seriously this month.  I keep fairly strict schedules for when we sit on the potty, although if Q-ball is clearly upset, I don't force anything. Also, we don't always do diapers when we go out- we also wear cloth trainers. Potty successes daily- mainly when we first wake up and before bed.  But, we also traveled to see family, and Q-ball was not interested or comfortable practicing anywhere other than home.  We took about a week to get back into our schedule at home.  I know that we are still dealing with some pee holding. 

22 Months
Q-ball's "I-got-it!" day finally has struck.  I think that my increased focus on potty learning had a major impact.  Where we once sat on the potty for 15-20 minutes before Q-ball eliminated, now there is success pretty much as soon as we sit on the potty.  We now do not wear diapers outside of the house, although we still have accidents- we just bring lots of extras.  We ordered an extra potty for the car and encourage Q-ball to use the potty before we go into a store, to the park, etc.  Q-ball even took rather easily to pooing on the potty.  While we did have a few instances of holding her poo and some emotional potty experiences and explanations of how it all works, we did not have complete refusal. 

23 Months
I'd been looking for the time to introduce nighttime pottying with Q-ball, nervous that it would be quite dramatic as diapering is part of our very set bedtime routine.  But, one night, Q-ball announced she only wanted to wear pants to bed. So, that answered the question.  A few nights, Q-ball has asked to put on a diaper, and we have her help us lay out her nighttime diaper and tell her it will be close by "in case she needs it." This satisfies her.  We certainly have not been accident-free, but I feel as though we have as many successes as misses.  Her potty is set up in the corner of her room, and, if she calls me into her room at night, I help her sit on the potty (which, I admit, she's not always happy about.) or I quickly lay down a new towel and change pants if necessary.

24 Months
I certainly consider Q-ball toilet-trained by two years old.  She is still hesitant about using a "big potty," but we have been looking at pictures from EC sources of babies sitting on big potties, and she has had success.

What I'd Do Differently

• I had a difficult time finding Q-ball's elimination schedule, I'd recommend starting to figure this out before going diaperless or immediately upon going diaperless.
• I was very, very relaxed at first, waiting for Q-ball to always show interest, or ask if she wanted to sit on the potty.  I'd use a bit more of a schedule next time- on the potty every 60 or 90 minutes for a few hours each day.
• In the early days, Q-ball was uncomfortable pooping on the potty, so I did not force it.  However, it is much easier for a caretaker to anticipate when a child will poop than pee.  I'd recommend continuing to try to master pooping first or along with peeing.  (Some books recommend that poop-learning come first as when a child poops, they as tend to pee.)

Our Favorite Potty Books
Many potty-learning books are for older toddlers.  These were the ones that we found were most helpful in the early days and weeks.  Q-ball really, really studied these books and clearly used them for tips and encouragement.

• A Potty For Me!  A lift-the-flap book, this was fun for Q-ball.  Also, stressed that the child was proud of her accomplishments rather than external rewards.
• Potty The most simple potty book we found.  Q-ball (and I) still say "Uh-Hmm-Ha-He! when we really have to use the potty!
• Even Firefighters Go to the Potty All kids love firefighters!  This was just a fun one to read that encouraged her to sit on the potty for a long period, when necessary.
• I Want My Potty We found this older book at the library.  While I do not think the author intended it, this became our "poo poo book."  The pictures in the book seem to show the little girl really pushing on the potty- we used these pictures to discussed different methods that can help with pooping (this was especially helpful during Q-ball's poop-holding time.)

More Research on "Early" Toileting

Image credit: www.lilomaternity.com

  

   A few weeks ago, I published this post on some of the research on early toileting.  Truthfully, I wasn't overly happy with the post, mainly due to a mix of lack of time and lack of research that focused on age and toileting.  So, I decided that I would dedicate another Science Friday post to the topic and hopefully share a bit more of the limited information about age and also look at the research that explores the various methods of toileting.
   A quick google search of "potty training" will lead many parents to believe that young babies and toddlers are not capable of bowel or bladder control. Babycenter.com actually tells us "Before 12 months of age, children can't control their bladder or bowel movements..."  However, one study comparing bladder function in babies in Vietnam (where the babies rarely wore diapers) and Sweden (where all of the babies wore diapers) reveals that this isn't the case. How do you test for bladder control?  The researchers measured voided urine for newborn babies to those 12-months old and then used an ultrasound to determine the amount of "residual urine."  This reminded me of my first ultrasound when the technician told me that I needed to pee before I actual knew that I needed to.    Additionally, researchers looked for "interrupted voiding," the phenomenon of two urination episodes within 10 minutes of each other, with higher residual urine after the first urination.  Interrupted voiding may be caused by immature muscle control and tends to decrease with age and is typically stops when the child is potty-trained.
     The researchers discovered that the babies in Vietnam exhibited much more advanced bladder control than the babies in Sweden.  Instances of interrupted voiding stopped at 9 months for the Vietnamese babies, but continued until 27 months for some of the Swedish children. Additionally, instances of "incomplete emptying" which is measured by the residual urine ended between 9 and 12 months for the Vietnamese children (residual urine was just .7ml and .5ml, in case you are really interested).  For the Swedish children, residual urine instances were still very high at 9 to 12 months (averages were 7.4 ml to 7.1 ml).  Most Swedish children obtained complete bladder emptying at around 2 years old.  Using these data, the researchers conclude that the Vietnamese babies do exhibit bladder and bowel muscle control before 12 months and "can be considered potty trained much earlier than children in Western countries."
   Looking beyond when to potty train, the next question most caregivers ask themselves is, "how should I do this?"  Again, the research that has been conducted is not overly helpful.  While there has been substantially more research that examines potty training methods than examine the the best age for potty readiness, the research often does not compare the various methods, and instead focuses on the results of one method. However, within research circles, there are typically four accepted methods of toileting (these descriptions are meant to be very brief! Please do more research before following one!):

1. Child-oriented: Typically starting around 18 months, the child is introduced to the potty according to her timeline. Diaperless time is used as the child demonstrates they are comfortable sitting on the potty. No system of rewards or punishments are used.
2. Azrin-Foxx Method: Typically begins around 20 months of age.  Child and caregiver stay in a room with all necessary supplies and with minimal distractions (i.e. toys).  A doll that wets itself is used to demonstrate the potty method.  Child is given praise (snacks, verbal praise) for using the potty and reinforcements are removed when the child has an accident.  After an accident, the caregiver also uses the doll to demonstrate 10 "positive practice" sessions.
3. Early elimination: Starts within the first weeks of life or at less than 4-5 months.  Caregivers learn to read infants elimination cues and allow child to void in an appropriate place, providing feedback to the baby.  Through work with the caregiver, the child is expected to learn to communicate her need to use the toilet.  By the time the child can walk, she is expected take herself to the toilet.
4. Dr. Spock's Method: Typically around 2-2.5 years.  Allows the child to choose to potty train when they are ready.  Introduce potty chair and keep it insight.  Suggest to child she use it to eliminate.  When child shows interest, start to ask them to use the potty throughout the day.

   A large-scale research review of toileting methods for healthy children (it started by examining 772 studies of potential relevance!) discovered the following:

• No studies analyzing the results of elimination communication or early elimination.
• No "head-to-head comparasion" of the child-oriented method and the Azrin-Foxx method, making it impossible to truly compare the results.
• But, looking at the results of individual studies, the Azrin-Foxx method typically has faster outcomes when followed precisely, sometimes within days.
• For longer-term success (1 to 4 months of training) both Azrin-Foxx and child-led methods are successful for healthy children. 

   So, how to choose your method?  We looked at the goals we have for our daughter and selected the child-led method.  We largely practice unconditional parenting, so a method that employs rewards and punishments is not in-line with our parenting practices.  Additionally, we strive for Q-ball to be in control of her own exploration to the greatest extent possible.  Again, this leads to the child-led method as we follow her signs of readiness and acceptance of the potty.  Along these same lines, I started observing Q-ball indicating self-knowledge of bladder functions around 13 months, so we decided to initiate potty-learning at this time.  At 15 months when she is not in a diaper, she typically indicates with sign language that she needs to eliminate.  Does this mean that we always make it to the potty?  No, but we are letting her take the led!

What method of potty training did you use, or do you plan to use?  What is your reasoning?

Sources:
Duong, T.H., Jansson, U., Holmdahl, G., Sille, U., & Hellstrom, A. (2010). Development of bladder control in the first year of life in children who are potty trained early. Journal of Pediatric Urology, 6, 501e505
Kiddoo D, Klassen TP, Lang ME, Friesen C, Russell K, Spooner C, Vandermeer B. The Effectiveness of Different Methods of Toilet Training for Bowel and Bladder Control. EvidenceReport/Technology Assessment No. 147. (Prepared by the University of Alberta Evidence-based Practice Center, under contract number 290-02-0023). AHRQ Publication No. 07-E003 Rockville, MD: Agency for Healthcare Research and Quality. December 2006.  Retrieved from http://www.ahrq.gov/downloads/pub/evidence/pdf/toilettraining/toilettr.pdf

The Science Behind "Early" Toliet Learning

   We recently bought a potty for our 14-month-old.  For many in our culture, this may seem futile or even crazy.  However, many non-Western cultures begin the process of pottying at birth, raising children who never wear diapers.  Even within Western cultures, however, the average age that children achieve potty training has increased in the last 50 years.  In the 1980, the mean age was 26 months, while in 2003, the average age was 36.8 months.  The most recent numbers I can find seem to indicate that currently the average age of toilet training  is 35 months for girls and 39 month for boys.  As for the current advice from the medical community, the AAP states the following: "most children start to show an interest between the ages of 18 months and 24 months...Some children are not ready until they are 2 1/2 years old."

    We made our decision to initiate potty learning (I use this phrase in lieu of potty training in that we are not using any system of rewards or punishments, and we are using a very-child led method.) as Q-ball was signaling when she urinating, a clear readiness indicator. Following Dr. Montessori's idea of a sensitive period in which to master skills, I wanted to take advantage of this opprotunity. At least two Montessori resources (Montessori From the Start: A Child at Home from Birth to Age Three and How to Raise an Amazing Child the Montessori Way) list 12 to 18 months as the sensitive period of toileting.  However, given the mean ages of toileting for children in the Western world, this seems to challenge conventional wisdom.  So, for this Science Friday, I wanted to explore any research on the effects of "early" toileting. (A note- some parents practice infant potty training or elimination communication. While we are using some of the methods used in this practice, I would not say that we are practicing elimination communication with Q-ball as the optimal time frame for this method is between 4-5 months of age.  However, the research I found can be used when considering elimination communication.)

     I must say that I honestly had no idea what I would find in the research.  If anything, I thought that research would lead to be believe that we were starting too early, given that I've always heard that the "perfect time" to potty train is around age two because of muscle control.  However, little research has been conducted on the effect of age in toilet training, and the studies that have been conducted seem to focus on the effect of late starters (usually defined as after 32 months), not the effectiveness of infant potty training.   

Our new morning routine!

   One clear finding concerning age and potty training is that late starters typically take longer to achieve bladder and bowel control.  Beyond this, late training, even when controlling all other characteristics, is typically associated with increased in stool refusal, hiding while having bowel movements, constipation, and even delayed language development.   As I've stated, children in Western cultures are achieving toilet training later and later.  With this, constipation and stool refusal are also on the rise (Visits to the pediatrician for constipation doubled between 1958 and 1986.)  The research I read was not sure of the direction of causality as there are so many factors involved.

   One topic that is currently hot within pediatric urology is the possible relationship between later toileting and urinary track infections and other bowel problems.  I was very surprised to  read about this research.  One of the studies I found did find that late initiation of toileting is significantly related to urge incontinence later in life, but other studies are not as conclusive.  That being said, I did not see any studies that stated there is not a relationship between the two.

   I certainly did not find the amount of research that I would have liked.  However, given what I did find, I am happy with our decision to initiate potty learning now. Studies do agree that readiness indicators are important for initiating potty learning or training.  So, while we have yet to get any pee in our potty, I'm sure that Q-ball will get it one day soon!

Sources:

Barone, J.G., Jasutkar, N., Schneider, D. (2009). Later toilet training is associated with urge incontinence in children. Journal of Pediatric Urology  5, 458e461
Blum, N., Taubman, B., & Nemeth, N. (2004). Why is toilet training occurring at older ages? A study of factors associated  with later training. Journal of  Pediatrics (145) 107–11.

Bouke, L. (2002). Infant potty training. White Bouke Publishing: Lafayette, CO.

Duong, T.H., Jansson, U., Holmdahl, G., Sille, U., & Hellstrom, A. (2010). Development of bladder control in the first year of life in children who are potty trained early. Journal of Pediatric Urology, 6, 501e505

It's Potty Time! (5 June 2012). HealthyChildren.org

Kiddoo D, Klassen TP, Lang ME, Friesen C, Russell K, Spooner C, Vandermeer B. The Effectiveness of Different Methods of Toilet Training for Bowel and Bladder Control. EvidenceReport/Technology Assessment No. 147. (Prepared by the University of Alberta Evidence-based Practice Center, under contract number 290-02-0023). AHRQ Publication No. 07-E003 Rockville, MD: Agency for Healthcare Research and Quality. December 2006.  Retrieved from http://www.ahrq.gov/downloads/pub/evidence/pdf/toilettraining/toilettr.pdf

Watch Her Grow

This Week's Foci: Language and Practical Life


Interactions with Materials

• It seemed Q-ball's favorite reading materials this week were the catalogs that came in the mail.  She especially like the REI catalog as it had a picture of a car and a family with bicycles.
• Like many children this age, she really is enjoying taking the tops on and off of anything. I haven't established a formal basket to allow her to practice, but it seems unnecessary at times as she is finding the objects throughout the house and practicing with them.
• We also have a large cup full of pens and markers, and she spends a great deal of time taking the pens out and putting them back in.

Interactions with Others

• She seems to be trying to interact with other children her age more than before.  We'll see if this happens.
• She's getting closer and closer to catching Bailey- our not as friendly with baby cat!  She's trying as hard as she can.  
• And, her friendship with our nice, fat cat is continuing to blossom, bless his heart....she runs up to him yelling, "ba, ba, ba!" and then slaps him or pulls his tail.  She also knows that he will chase after string, so she shows him a piece of string and then runs away, hoping he'll follow her.

Interactions with Space

• She keeps practicing her dancing.  Her favorite move is one in which she seems to be running in place. 
• She is getting in lots of practice opening and closing doors and drawers.  She now recognizes these verbs and loves to have me give the command and then act.

Interactions with Life 

• Yesterday Q-ball met her potty!  We are taking a slow approach to potty learning, and I'm sure that I will share our experiences as we go.  So far, however, it's an awesome chair for reading.
• We have finally succeeded in a regular snack time.  I've been working to get Q-ball to eat more solids so that we are not nursing every hour.  She eats tons of solids now...but, I can't say that we are nursing that much less!
• The floor bed is still working well.  She certainly no longer has a desire to put herself to sleep, but she is clearly comfortable on it, and on some mornings, she'll just hop out of bed and come into our room for the day.

To see the rational and purpose for the Watch Her Grow series, please check out this post!