The four stages of toilet learning explained

This article discusses the four stages and transitions of toilet learning and why each stage is important.

Elimination communication is making a comeback in Western countries, with diaper companies more recently releasing trainer pants to support the transition toward toilet independence. Elimination communication1 may be a newer name, but the method to assist a baby with their elimination requirements has been done throughout history.

After the world wars, there was a shift away from infant potty learning. It was a time of progress for women with women entering the workforce but a move away from some instinctual, natural techniques for babies. Bottle feeding was heavily promoted to Women during this time. During the 1950s the La Leche Leche was formed to encourage and help Mothers with breastfeeding. Gerber promoted feeding solids to babies from as young as 4-6 weeks.2 However, pottying babies changed in the West and developed a more relaxed attitude. These days, it is common for toilet training to be delayed until a child is 3 to 4 years of age, sometimes older. With the delay and prolonged diaper use, a number of issues can occur such as Urinary Tract Infections3, (Diaper) Rash including Staphylococcus aureus (MRSA) skin and soft tissue infections4 and stool with-holding.

Stage 1 – Holding baby out

The baby cannot sit, is on a liquid diet and is assisted in eliminating in a held squat position over a potty. The old term for this is ‘held out’. The baby does instinctively eliminate when in this hold and can show signals when they need to eliminate. The EC hold is a deep squat and a very advantageous position for passing stool. This stage is important as it reduces the risk of diaper rash/diaper dermatitis/napkin rash, soft tissue infections or worse, MRSA2. It helps communication and trust-building between baby and parent. Natural elimination patterns are responded to, resulting in a cleaner and healthier practice. Regular potty use maintains and develops sphincter control from a young age. The baby also follows their instinctual preference to eliminate outside their clothing or bedding and learns correct potty use. Diapers are worn as a backup and not solely worn for the duty of being a toilet. The use of a diaper forms a habit that must otherwise be unlearned.

Stage 2 – The sitting potty stage

The baby can sit unsupported and is eating solid foods. Once a baby can sit without being supported, they can control and coordinate their bladder, urethral sphincter and anal sphincter muscles.4 The potty is used as an accessible, safe option during this stage and encourages a squat sitting position. This stage is important for healthy stool elimination and early development in toilet independence. A baby can begin to get onto and off of the potty independently. Some will introduce the toilet during this stage. Regular use of the potty develops the elimination routine and can be beneficial to avoid urinary tract infections.4

Stage 3 – Toilet independence (AKA Toilet Training)

The toddler can walk and communicate. This final stage progresses the child through using the toilet assisted to non-assisted where the child can state their need to go toilet before they go. For elimination communication children, this final stage focuses on bladder control and recognizing their need to use the toilet. The bladder can now hold more, and the frequency of urination is less. For children starting their toilet learning here, the process of stool management sometimes follows bladder control. Privacy and independence become important for a child as they become more self-aware. This stage is important as it is the final stage to toilet independence and removal of the diaper safety net. A study into completed toilet training for daytime dryness and bowel control were 17.4 and 15.0 months, respectively; those who initiated toilet training during the first 6 months completed training earlier than those who started later.5

Stage 4 – Nighttime Dryness

Nighttime assistance can occur during the first three stages or following. Nighttime dryness can be achieved earlier if started earlier. It’s fair enough to prioritize sleep though. You may wait until your child can walk and aid themself to the toilet. While encouraging independence, you will still need to offer assistance and provide lighting and tools for their success. Aim to wrap up nighttime before too long, so night wetting does not become a habit. Deep sleepers may need nighttime assistance. Elimination Communication trained children are thought to have better awareness and control of the bladder, with more complete emptying. Anecdotally, they have less nocturnal enuresis (nighttime bedwetting).4

1. Author Ingrid Bauer penned the term Elimination Communication in her book Diaper Free: The Gentle Wisdom of Natural Infant Hygiene (2001)

2. https://solidstarts.com/baby-led-weaning/history-of-baby-food/

3. DUONG TH, JANSSON UB, HOLMDAHL G, SILLÉN U, HELLSTROM AL. Development of bladder control in the first year of life in children who are potty trained early. J Pediatr Urol. 2010;6(5):501–505pmid:19939737

4 BENDER J, SHE R, (2017) Elimination Communication: Diaper free in America Pediatrics. Official Journal of the American Academy of Pediatrics.

5. Rugolotto S, Sun M, Boucke L, Calò DG, Tatò L. Toilet training started during the first year of life: a report on elimination signals, stool toileting refusal and completion age. Minerva Pediatr. 2008 Feb;60(1):27-35. PMID: 18277362.

And the first two important stages not to miss.

Nowadays, many parents follow a method of delayed ‘toilet training’ skipping the first two important stages of toilet learning.

Here are the four that promote healthy, instinctual and normal elimination practice.

Learn more about how to assist your baby, in our book