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Diaper-Free Before 3: The Healthier Way to Toilet Train and Help Your Child Out of Diapers Sooner by Jill Lekovic, MD

Review by Shannon Jones

Written by a pediatrician and grounded in research, this book had me convinced within a few chapters that infant toilet training (also known as elimination communication) 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.  When the child is young the caregiver pays attention to the baby's patterns (for instance usually babies urinate soon after eating or waking up from sleep) and simply puts them on the toilet at those times, starting with just once or twice a day and gradually increasing.  The caregiver makes it a positive experience by reading books with the child or giving them a favorite toy to play with while sitting on the toilet and makes it a built-in, matter-of-fact part of daily life just like getting dressed and eating breakfast.  As the association builds the child will naturally wet her diaper less and less often.  

The author effectively dispels the myths and articulates the benefits of early toilet training, and then goes on to provide very practical and straightforward instructions for how to actually accomplish it.  She also provides helpful information about how children's bodies work and related medical issues such as urinary tract infections and constipation that all parents would benefit from, regardless of choice of toilet training method.  As a reader I felt motivated and eager to start as soon as I could.  

While the sections on the history of toilet training and the practical tips to get started are very good, this book has some major weaknesses as well.  The first is what the book is missing.  The author focuses on timing as the main method toilet training, namely after the baby wakes or feeds.  However, there are other important tools for success, such as paying attention to your baby's signals that they need to eliminate, and providing a cue for the baby to eliminate such as an "ssss" sound.  Second, the author offers no advice for parents who want to begin toilet training before the age of six months.  Thirdly, she doesn't provide any tools for nighttime potty training.  Her only solution to nighttime bed wetting is to not allow fluid intake in the evening, and for parents who nurse or bottle feed their children to sleep (let alone nurse/feed in the middle of the night) she offers no advice except "don't do it."  This is not only unhelpful but dismissive to parents who have a different parenting style to the author's.  

Lastly, I was put off at a few points when the author took advantage of her captive audience to dispense her personal parenting advice which was only tenuously related to the topic of the book.  A few examples are that she advocates cry-it-out sleep training, says that bottles and other comfort items should be cut off at age one, and devotes the entire epilogue to a critique of helicopter parenting.  This is not only out of place and irritating but in some ways it is detrimental to her message, as it does not acknowledge a diverse audience of parents.  For instance, she seems to assume that families bottle feed and only gives passing mention to breastfeeding.  She also does not differentiate clearly between breastmilk and cow's milk in her discussion of the role of milk in constipation.  She dismisses the use of cloth diapers as too much of an inconvenience, which not only perpetuates this cultural myth but is inconsistent with the rest of her philosophy about toilet training (as she states in many places how disposable diapers are unhelpful in toilet training because the child does not feel wet in them.)  While these views may appeal to a mainstream audience that formula feeds and uses disposable diapers, in the same breath she alienates (or at least fails to address the practical concerns of) parents who breastfeed, nurse to sleep, or use cloth diapers.  In short, while the core of this book is solid, there are important topics that are not addressed, and some parts of what she says or fails to say are too heavily influenced by her own personal parenting experiences and thus not broad enough for a diverse audience.  

Though I haven't had a chance to read it yet, from what I can glean I think the best book available on this topic, especially for parents practicing attachment parenting, is Diaper Free: The Gentle Wisdom of Natural Infant Hygiene by Ingrid Bauer.  Whatever you read, the take-home message is that infant toilet training is normal and healthy and requires only a few basic instructions and principles to get started.  I'm glad I am learning about this topic and am enjoying accompanying my baby in the process of learning to use the toilet!

"Our Babies, Ourselves" by Meredith Small

Review by Shannon Jones

Written by an anthropologist, this is an intriguing account of how humans care for infants, from a cross-cultural and evolutionary perspective. It begins by providing a fascinating summary of infant care in several diverse cultures including three hunter-gatherer societies and the modern industrial societies of Japan and the U.S. The variety of practices described, not only of caring for the young, but also related to social structure, mating, pregnancy, and birth made for some interesting reading. While I would have been interested to learn about the customs in even more cultures, these summaries served the purpose of illustrating both the great variety of the practices in existence across the world, as well as how unusual the practices that we take for granted in the US (and Western civilization) actually are.

For instance, in our society we take for granted that babies should sleep in cribs and often in their own rooms, but it is startling to realize that this practice has only been around for the last 200 or so years in Western civilization, that babies still sleep with their mothers in the vast majority of cultures in the world today, and that this is what humans have done for ages over the course of our (successful) evolution. It points out the contrast between our cultural practice of infant solitary sleep and how infants have evolved biologically to sleep in close proximity to their mothers. This data leads us to question whether our modern cultural practices are actual compatible with the biological needs of infants, and what is actually best for meeting the needs of infants.

This relationship between culture and biology is the theme that guides the rest of the book. In addition to sleep, two other topics which are central to the lives of infants are covered: eating and state (crying, temperament, etc.) Each of these chapters was packed with interesting information from historical, evolutionary, cultural, and scientific perspectives. Some of the parts that stood out to me in the "eating" section were learning about weaning ages from a biological (looking at humans within the spectrum of other primates) and cross-cultural perspective (ranging from 2.5 to 7 years old), as well as the history of breastfeeding and formula in Western culture. I was also interested to learn that "insufficient milk" syndrome only has a physical cause in 5% of the reported cases and is not found anywhere other than Western industrialized nations. Rather, its cause is usually associated with separation from the mother at birth, interval feeding (rather than feeding on cue or "demand"), and artificial milk presented as a reasonable alternative. Such insights, if properly applied, could help us to prevent this frustrating problem for many mothers.

Another eye-opening topic was crying. Crying is accepted in Western culture as normal and expected for babies, but in many cultures babies hardly cry at all. Studies have shown that what helps babies to cry less is human contact- picking up a crying baby, promptly feeding a baby that is crying out of hunger, and carrying the baby for more hours of each day. This may sound like common sense, but it is not the mainstream way that babies are cared for in Western culture. Rather, babies' cries routinely receive delayed responses and "cry-it-out" is a popular and widely accepted sleep training method for infants.

It frustrates me that as many advances as have been made in Western civilization, in many ways it has failed us so miserably. I wish I lived in a culture in which I could trust the mainstream cultural practices for infant care (and everything else), but unfortunately that's not the reality we live in. By broadening our perspective on infant care to cultures across the world and our evolutionary history, this book allows us to view our own culture in a new light and begin to look more closely at what is actually best for our children.

The information and perspectives shared in this book went well beyond what you would find in a normal "Parenting" book, and it kept me interested from beginning to end. I highly recommend this book for parents and non-parents alike.

Good Nights: The Happy Parents' Guide to the Family Bed (and a Peaceful Night's Sleep!)

by Jay Gordon, M.D., and Maria Goodavage

Review by Shannon Jones

If you're interested in co-sleeping, either to practice yourself or just to learn more about it, this is the book for you.

Good Nights covers all the basics of bedsharing and co-sleeping, and addresses the hesitations that tend to come up for people, such as "What if I roll on my baby?", "Won't the baby suffocate?", "Will the baby ever leave our bed or learn to fall asleep on her own?", and even "What about sex?".  

Easy to read and balanced with practical tips, research, and real-life examples, the book provides background on the biology, culture, and history of infant sleep arrangements, effectively capsulizes co-sleeping research, addresses safety concerns, provides safe bedsharing guidelines, and illustrates the many benefits of bedsharing both through statistics and interviews with grown children who slept in the family bed.  

It also provides valuable advice on helping babies and toddlers to sleep, both at night and for daytime naps, explains the drawbacks of cry-it-out sleep training, offers a troubleshooting section for bedsharing parents, and even suggests a very gentle sleep training method, which the authors emphasize should only be used by desperate parents who would otherwise resort to cry-it-out.  The authors include interesting and insightful facts on babies and sleep, and finally give suggestions on how to respond to criticism of this choice of sleeping arrangements.  

Personally, since I have been bedsharing with my baby for almost a year now, I got the most out of the section on how to gently and respectfully help your child transition from the family bed to independent sleeping.  Armed with both insights into children's developmental capabilities and practical tips, I feel knowledgeable and prepared for when this time comes for our family.  It also served as a good reminder to cherish the precious moments I share snuggling in bed with my baby, because they won't last forever.

There is very little I can find to criticize about this book.  Though it was published nearly ten years ago and would benefit from being supplemented with more recent research that supports its claims, the current version is still completely relevant as it is.  

In summary, this book is nothing short of excellent.  I wish I had read it when I was pregnant, and would recommend it to new parents, parents of young children who have the transition to independent sleeping ahead of them, and anyone who is interested in learning more about the topic.

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