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Diaper-Free Before 3: The Healthier Way to Toilet Train and Help Your Child Out of Diapers Sooner Paperback – April 25, 2006

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Product Details

  • Paperback: 224 pages
  • Publisher: Harmony (April 25, 2006)
  • Language: English
  • ISBN-10: 0307237095
  • ISBN-13: 978-0307237095
  • Product Dimensions: 5.2 x 0.5 x 8 inches
  • Shipping Weight: 5.6 ounces (View shipping rates and policies)
  • Average Customer Review: 4.2 out of 5 stars  See all reviews (68 customer reviews)
  • Amazon Best Sellers Rank: #95,452 in Books (See Top 100 in Books)

Editorial Reviews


“Using medical studies and other parenting literature, pediatrician and mother Lekovic challenges conventional potty-training wisdom and presents a plan to get you baby out of diapers as early as age two.” —From the University of Chicago Magazine, April 2006

Excerpt. © Reprinted by permission. All rights reserved.

Chapter 1

What's wrong with the idea of readiness?

The parents of a healthy one-year-old boy, Jake, bring him in for his regular checkup. His growth is normal and his parents report that he started taking a few steps on his own over the last few weeks. He says "mommy" and "daddy," shakes his head no and yes, and looks around for his shoes or favorite toys when they are mentioned. He was weaned from the breast two months ago and now only takes a bottle before bed and nap. He loves a variety of foods and does well drinking from a cup.

Jake wears disposable diapers, and his parents have noticed that his diaper is often dry after a nap and that his bowel movements are usually after breakfast and dinner. He is curious about the toilet and wants to go in with his parents. He loves to have his diaper off and even tries to take it off himself at times. Jake's paternal grandmother got him a little potty chair for his first birthday, and his parents have a lot of concerns about when to introduce it. Their friends have told them that it is "way too early to even think about it." They want to know how to tell if he is ready to be toilet trained, and how to avoid making any mistakes along the way.

Is Jake ready to be toilet trained? Most doctors and parenting books recommend that children must show signs of readiness before beginning toilet training. Different experts list various skills, but most suggest that children require some communication skills, a desire to use the potty, and the ability to walk to the potty before being trained. Before you decide when it is best to start training your child, you should know that these guidelines (and the very idea of readiness) are based on the well-publicized opinions of a few individuals (not medical research), and are by no means infallible.

When you look at the history of potty training, how it was done in the past and under different circumstances, and how we came to consider the readiness guidelines to be the standard, you will begin to question what you have been told and to seriously reconsider what is best for your child. Despite the fact that a review published in the May 1999 issue of Pediatric Annals stated that "there is little question that children can be toilet trained by 1 year of age," most parents (and doctors) are not even aware that there is a well-established alternative to toilet training based on readiness skills.

Over the last century, changes in American lifestyles have been complex and far-reaching. Many of the changes in the perception of children and the practice of child-rearing are closely linked with these more general trends in our society. The most influential development with regard to toilet training was the introduction of Dr. T. Berry Brazelton's child-centered approach to training, a concept that has led to the current American Academy of Pediatrics guidelines for toilet training. In this chapter I will explain the current guidelines and how they evolved. I will also explain how this approach is based on a false set of assumptions and theories (many of which have subsequently been established in the medical community to be mistaken). The readiness approach may actually pose multiple health risks to your child, inadvertently impeding her natural course of development.

The American Academy of Pediatrics

Guidelines for Toilet Training

The idea behind child-centered training is that children show various signs (related to their overall development) when they are ready to be trained. The AAP lists several signs of readiness, including:

*The ability to walk to the potty

*The ability to understand and follow one- and two-step commands

*Adequate language skills to express needs and wishes

*The child's desire for independent control of bowel and bladder function

The guidelines suggest that once you see these signs of readiness in your child you should gradually introduce your child to the potty. Most people see these signs begin to emerge during the second year of life, and the usual time to start training based on these guidelines is around two years of age. However, observing development is very subjective, and many children do not have much useful vocabulary in the second year of life. Many people see verbal communication skills (or a lack thereof) as an obstacle to potty training their child based on these guidelines, and they put off training because they do not know how to train a child who can't (or won't) tell them when he needs to go. Furthermore, the child's desire for control must be recognized by the caregiver and can mean anything (depending on the parent's interpretation) from pulling off the diaper to wandering into the bathroom to actually asking to use the potty. That means a child could seem ready at twelve months, or not until he is three years old, just based on how much he talks (a skill that has nothing to do with actually using the toilet), or on how curious he seems to be about the toilet. A lot of this has to do with the parent's expectations, and if she does not think a child can be trained at fifteen months of age, she will not think her child's curiosity about the potty has anything to do with toileting readiness.

Although these guidelines are well intentioned, they are based on some faulty assumptions and have led to some huge delays in toilet training and unforeseen consequences. The average age for completion of training has advanced from before eighteen months (in the 1970s) to thirty-six months and beyond. The AAP guidelines are completely open to interpretation and have not provided adequate guidance to help parents understand their children's development. There has been a shift in what we recognize in our children's behavior and abilities, leading to even further delays in training. There are no instructions about the use of disposable diapers or suggestions about when it might be appropriate to stop using them. There are also no comments about accidents, how many to expect or consider normal, or how to handle them. Finally, the idea that it is potentially harmful to your child to introduce the potty before he is ready is neither based on any medical facts nor supported by the many studies that have been done on this topic.

Dr. T. Berry Brazelton

The guidelines used by the AAP developed (to a large degree) from the work of Dr. T. Berry Brazelton. Dr. Brazelton's approach centers on the signs of readiness from the child, such as communication skills to express needs and motor skills to be independent with the task. He advised mothers to gradually introduce their infants to the potty after eighteen months of age, which at the time of his study was a huge delay for most people. He urged parents to avoid using pressure, in order to facilitate the infant's independent control of toileting. He argued that bowel control at age two or three was strictly a developmental task (or something that a child will "grow into"), as opposed to a skill that needed to be taught or practiced.

These recommendations evolved from Brazelton's famous 1962 article called "A Child-Oriented Approach to Toilet Training." In the introduction to this article he states: "Since the advent of streamlined diaper care has liberated mothers in our culture from the real need to 'train' their children early, this step may be viewed more honestly as a major developmental task for the child." I realize that I am looking at this from a different point of view, but who says women needed to be "liberated" from caring for their children? Furthermore, how could the invention of disposable diapers made of paper and plastic materials that were created in the last few decades (after human beings have been dealing with this issue for thousands of years) allow us to finally see the task more "honestly"? It simply does not make sense. It was the same (patriarchal) medical establishment that convinced an entire generation of women that giving their babies formula saved them from the onerous, time-consuming, and unseemly task of breast-feeding. Since then, it has become evident that there are many health benefits to breast-feeding (not to mention some mothers who think it is a wonderful, important experience to share with their babies).

Brazelton relied heavily on psychoanalytic theory to make the case that delaying toilet training was not only more convenient but also desirable from a developmental standpoint. He argued that children trained at a younger age were more prone to regression under pressure (or having accidents), and that this could be avoided by confronting this task at a more advanced stage of development. Writes Brazelton:

Parents and pediatricians are aware that the child's autonomous achievement in any developmental area frees him to progress to more advanced areas. Faulty mastery may leave him with a deficit that results in regression under stress. [Pathological symptoms such as constipation and enuresis] . . . usually reflect a fundamental psychological disturbance in the child's adjustment.

In short he felt that there was a connection between problems with potty training and the child's psychological well-being. This was not a new idea (I discuss a little history in Chapter 2), but Brazelton popularized it in a way that changed how everyone viewed toilet training. He took toilet training from being a natural part of a child's growth development and made it one with special psychological significance.

Myth #1: Toilet Training Has

Special Importance in Children's

Psychological Development

Many experts have questioned the connection between toilet training and psychological disturbance i...

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Customer Reviews

This is a well written book, it is easy to understand..
Shauna Lynch
Without the help of this book, I don't feel that I would be as succesful with potty training as I have.
Landon's Mom
You can get your kid out of diapers way sooner than I'd ever imagined.

Most Helpful Customer Reviews

100 of 103 people found the following review helpful By Auntie on December 14, 2009
Format: Paperback Verified Purchase
I started putting my 6 month old son on a Baby Bjorn little potty. He started going #2 in the potty right away. When he was about 10 months old, a friend recommended this book. That is when I knew the goal was to have him out of diapers between 15-18 months.

He is 16 months old and we have not changed a #2 diaper in over a month. My parents take care of him two days a week and love not having to change messy diapers - that is not the case with my niece who is exactly one year older than him. My son was a very strong-willed infant so I knew the power struggle was going to be crazy if I waited for the readiness approach. He still screams and twists and turns when we change his wet diapers so we are VERY motivated to stick with this program.

Last week, I had him in his training pants and he ran out of the room. I found him trying to sit on the potty. I pulled off the pants and he sat down and peed. He felt good and I felt good. It was a win-win.

People will be negative and judgmental just like a lot of these posts - especially your own family. Surround yourself with positive people and this can be a great experience. I love to sit and read books to my son while he does his business. He puts bowls on his head and calls it a hat or plays with foam bath letters. We have a great time.

I am going to work with him when I am off work over the holiday (he will just have turned 17 months). I will update this post on our progress.

Update: I did work with my son over the holidays and now at 17 months he has gone eight nights in a row dry. We now do not have him in diapers at all even at night. We have an occasional "miss" during the day, but it is usually a little pee in his training pants, he pulls at them and says "wet".
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96 of 104 people found the following review helpful By Allison Collins on June 9, 2006
Format: Paperback
Let me say first, if I'd come across this book when my daughter was a newborn, I'd probably rate it five stars. I'm rating from the perspective of a parent starting later.

As a parent who has a toddler-aged child, I found this book to be very long (extremely long!) on research and "why-to," but lacking in "how-to." I didn't particularly need the "why-to" sections -- that's why I bought the book in the first place! The "how-to" portions of this book are geared almost exclusively toward those starting training at a very (six to nine months) young age, and the rest of us have to figure out on our own how to apply Dr. Lekovic's methods with an older child (my daughter is 20 months old).

I wish I'd found this book when my daughter was younger. Since I didn't, I would love to see Dr. Lekovic write a book (or supplement/article even) about how to work with an child who's already past 18 months.
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115 of 126 people found the following review helpful By L'lee on September 23, 2008
Format: Paperback
I have read several books about early toilet learning, and I have to say that this was definitely not my favorite. The author does give a lot of evidence that supports early potty training, but does not give a lot of practical advice for implementation.

I would give Chapter 2 a 5 star rating, and without this chapter the whole book probably would have gotten only 1-2 stars from me. In Chapter 2, she gives a really great, detailed history of how traditional potty training progressed to "readiness training" in the US, and how nobody has ever given sufficient evidence that there are any benefits to waiting until the child shows interest in learning to use the toilet. This section is a great resource for anyone who is scared that by exposing a child to the potty early you are psychologically damaging him or her.

I liked that the author recommended taking the leap to underwear fairly early. I think that this is important and it is a hard step for parents to take because it can be messy, but it really is the best way to help your child to be more aware of his or her body, and super-absorbent disposable diapers just don't do that.

The advice that the author gives regarding the potty training process implies that there is only one way to do it - starting at 6-12 mos, which actually is actually LATE when you compare cross-culturally. There are positions that you can use to hold a tiny infant to help cue them before they are able to sit unsupported. Some people believe that babies lose some of their awareness of their elimination by 6 mos.
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32 of 35 people found the following review helpful By Shannon on January 8, 2011
Format: Paperback
I would give this book five stars for its ability to normalize infant potty training and to empower the parent or caregiver to put it into practice. However because of the author's tendency at times to use the book as her personal parenting soapbox and her failure to address an audience with diverse parenting styles, I lowered my rating to three stars.

Written by a pediatrician and grounded in research, this book had me convinced within a few chapters that infant toilet training was the most normal thing in the world. Though I read the book for practical reasons, my interest was piqued by the history and social context of toilet training and diaper use in the US. I was fascinated to learn that the age of initiation of toilet training gradually changed from one month in the early 20th century, to six months in the 1950s, to 18 months in the 1970s, to 24-30 months today. In non-Western cultures, the process for infants often begins within the first few weeks of life. Though the author recommends starting at six months, it is because she sees it at more practical in our modern society and not because younger infants are not capable. But the clear message is that beginning toilet training at age two or three, which is the norm in Western countries today, is actually only a very recent societal trend and it's possible to start at a much younger age.

It's important to clarify that the "training" referred to is not accomplished through any type of coercion or rewards system. In a nutshell, it is more of developing an association for the child between voiding and actually sitting on the toilet.
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