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Elimination Communication

When Maya was about six weeks old, she threw a crying fit that lasted a couple of hours. This happened two days in succession. It had not happened before and it has not happened since. Worried that something was wrong, we took her to the pediatrician. They were unable to identify anything that was upsetting her. But, they made an incidental finding, she had a fungal infection in her mouth. Called thrush, it is caused by a yeast fungus, candida albicans. It is not painful, it is not uncommon in infants, but it can spread and spread it did. The infection showed up at her other end, around her groin. The doctor suggested that we give Maya some anti-fungal tonic and keep her groin area as dry as possible to remove the potentially fertile breeding ground for the fungus. This whole episode turned out to be a blessing in disguise.

One of the big topics with infant rearing in this country is toilet training. “Have you changed your first diaper ?”, a new father is frequently asked. Parents begin to wean toddlers off the diaper and into the potty like adults somewhere around 18 months to two years of age. The popular notion here, promoted by pediatricians and other health practitioners, is that infants are simply not “ready” till they are 18 months to two years of age. Having spent their lives peeing and pooping into a diaper at will, asked to suddenly become aware of pee and poop, retain it till they get to a potty and do it there seems like too much work for them. So, you have the phenonmenon of disposable diapers for kids aged six years. And stories like the one told by a colleague of Shanthala where her kid would put on a diaper, poop in it and announce that she had pooped. And stories where using the potty became another line of control over which the kid and the parents duelled over. Starting toilet training around the time of the terrible twos seems like a decision fraught with control issues. I read a statistic that said that the average age by which a child is toilet trained is about three years now.

Like most other parents, we were considering a life with the convenience of disposable diapers, when we began to hear of the environmental costs of that convenience. Looking for alternatives, cloth diapers jumped out immediately. Where we live, there is even a diapering service, that deposits a week’s worth of clean diapers and collects a pail of the past week’s dirty diapers to clean and return the next week. You don’t even have to wash! Shanthala did some research and concluded that it’d be much better to just wash them ourselves and acquired some cloth diapers.

A couple of years ago, Shanthala had come across a book, in the new bookshelf section of the local library, called “ Diaper Free: The Gentle Wisdom of Natural Infant Hygiene” by Ingrid Bauer. Ingrid Bauer talked about toilet training done in other parts of the world where parents start the process much earlier on, as early as two months in some cultures; in India, parents start it somewhere around six months. One of the diaper free books states a New York Times report about “startled” adopted parents confronting the reality of their adopted children already toilet trained. Reading the book brought back memories of how we were raised. When we were infants, disposable diapers were unheard of. We were toilet trained at an early age. Our parents would carry us around butt naked and still mostly avoid the kind of disasters that would terrify Western parents in a similar position, pee and poop everywhere, all the time, to be cleaned constantly.

Ingrid Bauer writes that physiologically, there are two parts to toilet training, retention and release. The infant can be trained from early on to practice the latter and over time, as her muscles mature, she learns to retain till she’s taken to a potty. She says that physiological studies and looking at non-Western cultures worldwide is an indicator that infants possess the ability to release at will practically from birth. Our parents attest to this statement. Shanthala’s mother recalled how they had been training Shanthala to pee by placing her in a corner in their bathroom and saying “ssss”. Shanthala had taken the placing in the corner as the cue and on being placed in any corner would start peeing. My mother similarly mentions how she started training me to release by saying “ssss”.

Ingrid Bauer suggested a return to those practices. This technique is called elimination communication (EC). The basic idea is to train the infant to pee and poop outside the diaper, thus retaining her awareness of the elimination process so that as she gets older, she can shift gradually to asking to be taken to a toilet to finally, going there by herself. It is about not allowing the infant to learn that a diaper is the toilet.

EC consists of observing the patterns of elimination in an infant and cueing the infant to release just as she’s ready to relieve. Knowing when she’s ready to relieve comes from observing and from practice. So EC starts with the release part of the elimination and builds over time to handle the retention.

With the cloth diaper, we’d use a plastic cover as recommended. With her thrush, we stopped using the plastic cover so that we could change her diaper as soon as it got wet, thereby keeping her groin area as dry as possible. This proved beneficial to start noticing patterns about her peeing and pooping. We started saying “ssss” when we realized that she was peeing. We then started taking off the diaper a little before the time we thought that she wanted to pee, and holding her over a sink, we’d cue her release by making the sound “ssss”. Maya learned to associate the sound with peeing pretty quickly and we were off to the races.

Maya pees every 15-20 minutes after she drinks milk, for about three or four times, and then it tapers off to maybe every 25-30 minutes. However this pattern varies considerably, especially if she is going through a growth spurt; the weather also seems to affect this timing. So, keeping a dry diaper through the day is impossible. Some days, we catch enough that we use only a single diaper for about five or six hours. Other days, we’re both off kilter and we end up using a diaper every 20 minutes or so. Some days, she’d look like she was signaling that she wanted to pee. Other days, she’d just pee with no prior warning.

Offering a release immediately after she woke, either in the morning or after a nap, almost always produces a pee. From when she was three months old to almost seven months or so, she even remained dry throughout the night. Somewhere around seven months, she started peeing in the night and we had to make a diaper change or two in the night. We started carrying her without a diaper for extended periods of time, sometimes getting wet in the process, but usually doing quite well. I also noticed that she was better at signaling and I was better at noticing that she wanted to pee, when I held her. If I put her down in a chair or her jumperoo, she’d pee without prior warning. Maya indicates fairly consistently that she has no pee/poop by arching her back if we start taking her to the toilet or her infant potty.

Luckily for us, Maya poops only once a day. Infants apparently learn to control their anal muscles much before their bladder. We found this to be very true. For the past six months, we have had only four incidents where she pooped in her diaper; they were all caused because I was engrossed in something and missed her signal that she wanted to poop. Otherwise, she’s been pooping very successfully in the toilet. This in itself is a very welcome change for us because it makes cleaning her diapers so much more simpler.

We were a little apprehensive whether we’d lose it all when we hired a nanny. Luckily for us, Ginez while unfamiliar with the practice, was eager to try and soon became proficient at it. She even takes the infant potty with her to the park and makes Maya use it. She says proudly how she and Maya are the star attraction at the park with the people being completely amazed at Maya’s ability to pee on command and stay dry. Ginez is also happy with the process because she has no mess to clean up as Maya poops in the toilet.

When we travel outside, we usually don’t get a chance to get Maya to pee in a toilet. So we either carry a handful of cloth diapers or we use a disposable diaper. We acquired a regular pack of disposable diapers when she was born, to tide over the initial days, and we still have a lot of them left. When we start traveling, we’re planning to carry a pack of gDiapers, an eco-friendly diaper that can be even thrown into a compost or flushed down a toilet, as we may no’t be able to wash her diapers. After some reading, it appears that gDiapers aren’t as good as I originally thought them to be.

Nothing comes for free. Toilet training an infant this way requires considerable effort from the parents, or at least it did from us. As Ingrid Bauer writes:

No book is written from a wholly objective viewpoint. This one is no exception. Though backed by extensive research, I write from my personal experience with a bias that reflects my parenting philosophy. I believe babies are happiest when they spend their first months and years in close contact with their parents, particularly their mothers. I think babies usually thrive best when they are nurtured at their mother’s breast. I assume that babies sleep most securely with loving parents in the family bed. I believe that children are simultaneously far more capable than we often give them credit for and far more dependent than we appreciate.

As a parent, I want to be my child’s ally, and I want to cultivate compassion, creativity, and a willingness to take my child’s needs seriously. I believe that a prompt response to a child’s needs helps that child maintain and develop an innately secure interdependent nature. And I believe that Natural Infant Hygiene provides a wonderful part of that picture.

Our reading of anthropological studies of infant rearing in books such as Meredith Small’s “Our Babies, Ourselves” had already won us over to this philosophy. Over time, EC has become natural and less stressful. As I was writing this entry, Maya signaled that she wanted to poop and I took her to the loo. It seems quite effortless now to be in tune with her needs this way. There are times when I’ve felt constrained from letting Maya play for a longer period of time because I had to take her to pee. Then there are times when I couldn’t catch a single pee and this only added to the frustration and exhaustion. But I learned that it’s OK to let her pee in the diaper if I was too busy or exhausted or I didn’t want to interrupt her play, I learned that interrupting her play was more an interruption in my head than in hers.

Whether EC will ease Maya’s transition to normal toilet usage is something that we’ll know, only in time.

References:
- Christine Loh’s Book Diaper Free Baby is a very easy and practical introduction to EC.
- DiaperFreeBaby.org is a very useful online resource for EC including information on local support groups.

On Parenting: The Initial Months


July 17, 2008. I feel her stirring beside me. I’m still groggy, it’s 6:15 am. It’s the second day that Maya has woken up an hour earlier than usual. Yesterday, I had protested this change, pretending to ignore her stirring, trying to fall back to sleep. But she had played with herself for a few minutes and then started pawing my face. That brought back memories of Kitty waking me up and I had gotten out of bed, grumpily. Today, I’m prepared to deal with the new reality. I pick her up with a smile and she coos happily. After taking her to pee, I put her back in bed while I prepare her milk.

A few minutes later, milk consumed, we’re downstairs. She’s playing with a spoon that I’ve given her, content to let me go prepare that wake-up elixir, coffee. I awaken the laptop from its sleep and sit down beside Maya, talking to her (more like muttering, since I’m not really awake yet). The coffee machine gurgles as the last drops of water filter down. When I return with the cup of coffee, I find that Maya has thrown away the spoon and has that “I need your attention” look. I pick her up thinking she wants to pee and find that her dress is soaked. She’s gagged herself with the narrow end of the spoon and thrown up a lot of the milk. I put the coffee down and pick her up to clean her.

An hour later, I’m rocking her to sleep. I try playing soothing sounds, slow, gentle melodies that reflect the morning mood for me. But Maya will have none of that. Since she’s discovered Sade, it’s nothing but her fast uptempo songs. So, at 7:30 in the morning, I’m playing “Paradise” and moving vigorously to the beat. Maya is asleep in a few minutes. Sade croons “Ooh, what a life !”

I’ve been meaning to write what about our approach to parenting in the initial months. I’ve written about my thoughts about watching her grow and the major (and minor) transformations of each month. But I’ve wanted to write about our perspective and our ideas. This entry is an attempt at that.

There is the famous adage, “Before I became a parent, I had three theories about parenting. Now I have three children and no theories”. Since we have only Maya, I guess I have two more theories left. In reality, our ideas about how we wanted to parent have so far largely borne out and we hope in some sense contributed to how easy and how happy Maya has been. These decisions were largely driven by our intuition, by Meredith Small’s incisive analysis and examination of parenting from an evolutionary perspective and across cultures in her book “Our Babies, Ourselves” and by having seen the results of a close friend who parented that way. The goal was single and fairly simple, to make Maya feel as secure, loved and accepted as possible. Our reading of various infant studies indicate that more than anything else, making them feel secure and loved was the bedrock to a happy and healthy individual.

Margaret Mead said that parenting was a reflection of the culture, that the general structure of any culture could be understood at a fundamental level by following the treatment of children. More recently, anthropologist Robert LeVine has said parental goals have little to do with the immediate situation of the child, and more to do with the entire social system and its institutional goals – especially in the areas of interpersonal relationships, the level of personal achievements expected, and the degree and manner of social solidarity that is favored in that particular society. For example, “independence” permeates the American child rearing lexicon. When I called the pediatrican’s office the first time because Maya was crying inconsolably for fifteen minutes (she was a month old), I was advised to put her down and walk away. “She needs to learn that you won’t be there all her life. She needs to learn to be independent”. I hung up in disgust.

LeVine says there are two kinds of cultures: agrarian and urban-industrial, and in both, parents want some things ”from” their children and some things ”for” their children. This translates to (in the words of Steven Pinker): “In contemporary middle-class American culture, parenting is seen as an awesome responsibility, an unforgiving vigil to keep the helpless infant from falling behind in the great race of life. And that race goes to the smartest, the most competitive, the most independent”. We didn’t want that. We wanted to deconstruct parenting as much as possible and choose consciously what we thought was best for Maya to feel loved and secure. We also told ourselves several times that we had no experience parenting and so we’d not assume that we know, but would be willing to learn, not hold on steadfastly to any idea save ensuring that she felt loved and secure. Dr. Spock and the associated mainstream American child rearing practices were out, ethnopediatrics was in.


We felt that the basic attitudes that we needed as parents was captured best by Myla and Jon Kabat-Zinn in “Everyday Blessings”: sovereignty, empathy and acceptance. Sovereignty implies that the child has a perspective, and that it maybe different from mine. Empathy implies that I can commiserate with her perspective. Acceptance means that I accept the conditions for what they are even if they’re not what I want them to be. For example, if I want her to sleep because I’m sleepy, I have to consider that she may not want to sleep because she’s not sleepy, and knowing how difficult it is to sleep when you’re not sleepy, that I accept her not being sleepy and play with her even though I fervently wish that she would sleep and allow me to. An alternate way of being, which we rejected, is to think that she’s deliberately manipulating us, or that she’s a “difficult child” or “hyperactive child”.

An infant’s needs are fairly primal: food, sleep and poop. Initially, an infant uses her cry to communicate everything, be it hunger, sleep or attachment. Studies that I’ve come across indicate that an infant doesn’t have the machinery to manipulate parents until they’re much older, six months at least, much later according to one of our close friends. So our first decision was to to respond to her cry immediately and do what was necessary to soothe her. I’d like to think that this is a reason why Maya never cries much. In the initial weeks she cried a little more as we struggled to figure out what she was trying to say. She probably also cried because the whole thing was so alien to her, she who was comfortably ensconced in Shanthala’s womb, her every need automatically taken care of, not needing to breathe, eat or poop. Past her sixth week, when we began to read each other better, she became a very easy and happy child. Everyone who sees her remarks on how happy she seems. That and what beautiful eyes and long eyelashes she has.


Research by James McKenna, a medical anthropologist and sleep researcher, has shown that when infant and mother sleep together, the two function as a dyad, their sleep, arousal, breathing and heart rate synchronizing with each other. There is a significant push by pediatricians in this country to have the baby sleep separately. The American Association of Pediatrics strongly recommends against sleeping with the baby because of increased risk of SIDS (sudden infant death syndrome), of suffocating the child by rolling over it and because of possible psychosexual problems. There aren’t studies that back these claims. The psychosexual babble is a holdover from an 18th century church edict. Among African and Asian societies where cosleeping is common, there are hardly any reports of these problems. James McKenna postulates that a possible cause for SIDS is that infants with their immature nervous system have not yet learnt how to breathe and go into deep sleep at the same time. He says that cosleeping helps them learn how to breathe and go into deep sleep. In the US, Dr. Richard Ferber’s method of putting infants to sleep is the most common practice. The method involves leaving the infant alone in their crib and letting them go to sleep on their own and not responding to their cries. When Shanthala and I first heard about it, we cringed. There is an interesting article in the New Yorker from 1999 about one person’s attempt to put his son to sleep the American way that includes an interview with Dr. Ferber in which the doctor recants his method, somewhat. So another decision that we made was to have Maya sleep with us, in our bed.

An infant also loves being held, being enveloped in the warmth of our body. Reading books about the real life experiences of parents, I found that so many speak of difficult sleep times, of crying insistently on being put down, of suffering from that fearful word, colic. Meredith Small says that studies have found that incidences of colic are very small in Asian and African countries where traditionally infants tend to be carried more compared to the Western societies. So we decided that we’d hold her as much as possible, even carrying her in a sling as a new born while she slept. I found that she slept longer when she either slept in the sling or when she slept on me.


No disposable diapers was another major decision. We have both tried to keep as small a footprint as possible given the current environmental conditions on Earth. It’s been a modest attempt compared to some others I’ve known, but we try. Disposable diapers are the third largest item in this country’s landfill and we didn’t want to add to it. There were other positive consequences of this decision, but more on that later. Shanthala researched a lot and stocked cloth diapers before Maya was born, buying good quality, some used and some unused diapers, from eBay and other outlets for throwaway prices. She also decided that we’d wash our own diapers rather than use a diaper service. The whole thing has turned out to be fairly easy.

In an essay titled “Negotiating Violence”, the author, Meri Nana-Ama Danquah writes: “A native of Ghana, I have lived in the US since I was six years old.. My family strongly believed in traditional African values and principles such as prerequisite respect of elders, the unspoken second class citizenship of children, and the collective endorsement of corporal punishment.” The traditional African values don’t sound very different from traditional Indian values or at least different from the way I was raised. Even in America today, spanking a child is a divisive subject, with quite a few considering it acceptable, even though it is illegal. That is not how we want to raise Maya. Corporal punishment is out. As Danquah writes: “.. to understand that love and violence do not go together and should not be accepted when given hand-in-hand by the same person – be that person a lover, a friend or a parent.” I still remember vividly the terror of being beaten by my father, the indignity and humiliation from feeling violated, being subject to what seemed to me as a child, the mood of my caregiver. Just as we reject an abusive husband’s excuse “she made me do it”, we must reject a parent’s twin excuses of “the child’s actions made me do it” and “it’s only for his good”. If we use violence to teach something, the evidence indicates that the lesson will not be learnt. We don’t even want to threaten her. No “or else”.


Despite all this, it has been surprisingly easy for me to get frustrated and angry. Between Shanthala and I, I’m more patient except when it comes to Maya. Shanthala wins hands down in that category. Many times, I’d put Maya down and go to the next room to scream my anger or frustration, I’ve picked her up a little less gently sometimes. Eventually, I figured out that most of my anger came from lacking control, control as I know it. Once I realized that my anger or frustration was a consequence of counter-factual thinking, of wanting things to be what they’re not, I calmed down considerably. I realized that with an infant, you don’t set the agenda. She does. It’s still hard to accept on days I’m tired or sleep deprived, when I’m upset with something at work or I feel overwhelmed.

Food turned out to have been decided for us. Shanthala couldn’t produce enough breast milk to satisfy Maya’s needs right from the start. At best, she gave her fifty percent. At the end of her second month, we gave up and continued to feed her only formula. The decision was not easy, but we had little choice after trying everything possible from finger feeding her and using the breast pump to Shanthala taking pills and herbal supplements to produce more milk. The positive benefit of this has been that I’ve been involved intimately in feeding Maya which delighted me (the flip side was that I had to share the load of waking up in the middle of the night to feed her).

We hardly watch TV, using the set only to watch movies. Just before she was born, we gave away the TV and DVD player. We didn’t want her to grow up watching TV. We now watch movies on our laptops, maybe once a week at most. We also consciously avoid having Maya see us in front of the computer, though not always successfully. I attend to work email in the morning as I sip my coffee while she’s next to me, babbling away happily.

I came across a study the other day with the headline: “Sociologists are discovering that children may not make parents happier and that childless adults, contrary to popular stereotypes, may often be more contented than people with kids. Parents ‘definitely experienced more depression,’ says Robin Simon, a sociologist at Florida State University who has studied data on parenting.” What is interesting is that Robin Simon also states: “People ought to understand where this unhappiness comes from. I would say it’s not from their kids per se, I would say that it comes from the social conditions in which contemporary parents parent.” The headline could’ve been: “Parenting needs stronger support from society”, but that’s not as catchy. One of the earliest decisions of our marriage was that we’d have a child when we could devote all the time that was needed to raise her/him. I didn’t want having a child to be just a milepost that we cross in this journey we call life. Or even a tourist spot where we checked out the highlights. We wanted it to be a place where we stopped. For a long time. Where we checked out the terrain intimately, got to know the locals, understood what it meant to be a native of that place.


It’s 6:30 PM. Maya has woken up again. We head out for our evening walk with Maya comfortably ensconced in a sling. As we walk by a house with people sitting out, enjoying the chilly summer evening, we greet each other. They notice the baby and ask the usual questions. An older man comes out of the house and seeing Maya asks “How old is she ?”. “Five months”, we reply. “She’s so alert. She looks ready to do calculus”, he says.

It’s 10:30 by the time Maya falls asleep. I was so sleepy at 8′o clock and now I’m wide awake. My brain is too exhausted to do anything much.

What has caught me unprepared and still struggling with has been the lack of solitude, of time for myself and in my control. I want to run, to write more, to read, to reflect. When I switched to working part time, one of the things that I enjoyed most was the expanded time I had. I didn’t do anything different, but just having it and knowing that there was the potential to do anything I wanted was liberating. I had come to dislike the schedules set by the alarm clocks and daily grind at work, even though it was work that I enjoyed and was good at. I yearned to march to a different drummer. And now I am, to Maya’s.