(random riffs on topics medical)
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JUNE 30, 2008 10:52AM

How Potty Training Can Help Win the War On Terror

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We in America are proud of our uniqueness.  Whether it's shunning the metric system, calling football (or is it futbol?) soccer, or converting really good British TV shows into mediocre domestic ones (ok, not the Office, but remember Coupling?), we have no problem telling the world:  "No thank you.  Piss off, we'll do it our way."  And we swagger like cowboys off into our sunset. 

That difference extends to when we potty train our kids.  Whereas most parents in the U.S wait to train children somewhere between age 2 and 4 years, around the world, children are generally toilet trained at a much earlier age--often under a year of age, as my cousin's son, the child of first-generation immigrants from India, was.

What's up with that?  Well, like so many things related to out youth, our childrens' delayed toilet training rates have more to do with their parents.  We busybody middle class moms and dads,  who both work, with our nanny/daycare dependence syndrome and microwave dinners, are just too busy to put junior on the potty.  Also, disposable nappies are cheap, convenient to store, use, and toss away. 

But has anybody ever asked themselves how diapers get made?  Well, these are plastic diapers, right?  Now, for your organic chemistry afficiandos--plastic is a hydrocarbon, just like today's public enemy #1...gasoline. 

Which means...you guessed it...the same OIL we fill our gas tanks with is the same OIL that makes Junior's Pampers.

Thus, it turns out the collective butt of America's children are as dependent on the same Middle Eastern oil as our SUVs.    

Sorry.  Just when you thought buying that Prius would clear your conscience 

I have no idea how much oil it takes to make a box of diapers (according to one website, it's over 3 billion gallons a year in the U.S., which comes out go 82 million barrels of oil/year)

And according to Vitaliy Katsenelson,  manager at Investment Management Associates, it's not just the diaper that's made of oil.  Making the diapers requires energy, and, of course, those diapers need to be transported to your local store for consumption. 

So what to do?  Well here are some options:

1) Stop making babies

2) get a cloth diaper service (don't really know that this is a better environmental solution given the transport and cleaning needs.  But since my wife convinced me to do this for our daughter, I do know that our I'm not contributing to my local landfill--it takes between 1 and 2 centuries for a plastic diaper to degrade.  Plus, my little girl doesn't get as many diaper rashes as all of her friends in disposables)

3) Toilet train early

Ok, so 1 probably isn't an option (just ask those 17 Massachusetts teens), but 2 and 3 seem feasible.  Infact, toilet training a kid earlier may be easier because they're less likely to be in that "Terrible Two" phase where their favorite word is "No" and they fight back by witholding their poops and getting constipated.  

 For a most excellent history of the disposable diaper, and it's environmental impact, visit Mother Jones

 For a more cheerful view of this topic, please visit the American Petroleum's brochure--"There's a Lot of Life In A Barrel of Oil"





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My grandmother insisted she trained both her boys at seven months. I always thought it was she who was trained but perhaps I am wrong.

We used cloth diapers with our daughter (biobottoms and a diaper service helped) but when the twins were babies and I had no service, I became a disposable user and hated myself for it. In our constant search for convenience, we kick ourselves, our children, and our environment in the butt
Please explain how to potty train the immigrant Indian way. I am ready for anything that works.
Priddy, have you tried M&Ms and a reward chart? That and a showdown did it for the toddler.
I asked him how he felt about pottying for M&M's and he has agreed. As for any toddler bargain, his compliance may be iffy. But the deal is, no more m&m's except in exchange for pottying. So here we go. I already have him changing his pull-ups by himself, so we'll see. Thanks for the advice.
Priddy, at one point Anthony was so excited about getting candy, he rushed to the potty constantly throughout the day to try and squeeze a few drops out. Then I would hear, "I peed potty, Gramma, candy." I was happy to oblige though it got old early.
My father's a proctologist. My mother's an abstract artist. That's how I view the world. - Sandra Bernhard
the bare bottom weekend is a popular way to get kids trained, espeically during the warmer months. I suggest it a lot to my patients
The Indian Immigrant method is to sit the child on the pot frequently even when they don't have to go. Then, as you're able to read their body language, to take them as they go as fast as possible. With my cousin's son, his grandparents did it because they were home and could tend to it strictly. It took about 10 days, but it really requires time and consistency. I'm hoping my mother in law will come up to take care of training our when the time comes (she says she will).
funny thing, M Chariot,
That's the first thing I tell parents in my practice when I meet them. If they get it, then they can stay!
My mom claims I was potty trained at nine months. She said she could just look at my face and know that I was ready. I have been told I have no poker face -- guess it started a long time ago. Also, have to give my mom credit for planning ahead, as at nine months after I was born, came my brother. It couldn''t have been easy to wash all the cloth diapers for both of us...Poor Mom.

By baby three, my only surviving sibling of the four of us, my mom had enough of diapers. I was in charge of washing and folding all of baby four's...I loved her so much, I didn't mind. (Well, at least that is how I remember it -- she was a beautiful baby.) Poor mom, she always had food on the table so someone had to do the rest! She was a good mom, she had it hard -- I should cut her a break! But yuck, cloth diapers are nasty!!!

On recycling: An Aussie that I knew recycled everything in her home, which was handmade of mud/clay bricks. She told me that she pulled the nappies apart and used the insides of them to enhance her soil. Nappies have those little water absorbing crystals in them. Apparently, the same thing we buy with no previous usage for $10 a jar, can be obtained for the price of a few diapers, or free from a garbage can...I cannot remember what she said she did with the plastic parts, I think she just threw that portion out -- maybe she used it as landscape fabric...who knows, but she was resourceful!
We're still working on the potty training thing. We're having to take it in stages because John doesn't care if he's wet or not, and food isn't much of a motivator to a child with a feeding disorder. (Stickers on a sticker chart, however, are proving to be quite popular).

There will be a potty-training post in the near future from me, just as soon as we have this all worked out. The mishaps have been amusing.
can't wait to read your post!
My dear Monsieur Docteur Parikh ~

Nice to know we share an appreciation for Mlle Bernhard's material!

An interesting examination of child-rearing from some unexpected angles. Not having any children, I have difficulty commenting intelligently on the child-oriented essays.
My dear M. Chariot
Like all things, children are available at Wal-Mart 3 for $1, or at costco in bulk!
The freqquent pot sitting method, we tried that. It became a game of how long could he hold it until the diaper was re-applied. It ended in constipation for two days and we stopped with it. he is a very very stubborn boy.

I tried the mother in law method. She gave advice and such and did not understand just how stubborn the boy is about his bowels. I told her to have at it and I would do whatever she said. So her son and she went to it. They gave up after three days straight.

I understand the idea that I am just not trying hard enough, but at what point of potential serious constipation do you stop?
Not to quibble here. Okay, maybe I'll quibble anyway...

But training a child at that early age isn't potty training. That's conditioning them like Pavlov's dog. Most kids, and I'm not sure what kind of doc you are but some ped will likely back me up on this, but most kids, lack the prerequisite muscle control to be trained to withhold until they can make it to the toilet when they are under the age of 1.

There are a few precocious ones, to be sure, but they aren't the norm.

What they can be trained to do is release over the toilet when prompted to do so. There are quite a few people here in the US that engage in what they call "elimination communication" which is, I'll bet dollars to donuts, what happened with your cousin's son. Although I'll bet that your relatives didn't call it that and weren't nearly as self-righteous and annoying as the EC folks tend to be.

It is a method that requires constant vigilance and someone able to devote themselves to the process. And let's face it, without an extended family household, which most American families do not have, that's going to be well nigh impossible. Indian families are fortunate that way in that the culture tends to favor extended households. It makes all kinds of things easier when you live in groups that aren't just mom, dad and kids.

Also, while the elimination communication works...it still isn't potty training. Because a child isn't "trained" until they can initiate the whole thing independently. And even the kids that are conditioned like Pavlov's dog don't tend to get to that point any quicker than your average, didn't start until they were 2, toddler.

I think cloth diapers are a more feasible option for beating the terrorists if you must go there. Either that or letting the kid run around sans pants, installing linoleum floors and a drain and hosing your house down every day.

Course, you do either of the above and you run the risk of annoying the folks who are all about water conservation.
I would even try the Chinese method, which is to have the child wear pants with a avent that unflaps when the child squats. The parent then picks up after them like a pet until they learn to aim at the right hole in the floor. I am not being rude, this is how the toilets were in traditional homes up until at least 9 years ago when I visited.

i could even get the weird pants, but I think it would be illegal here.
Oh, I just looked you up. You are a ped. Hmmmm. So you know the bit about muscle control.

My creds are merely having potty trained 6 kids. 5 boys and a girl. With varying degrees of ease or difficulty.
Elizabeth, it isn't illegal so far as I know since people do it here in crunchy-earthy-groovy land. I think it tends to disturb your more white-bread suburban folk, though.

You might want to look into the elimination communication literature. Try to ignore the smug aren't we enlightened tone of most of it. It could help, ya never know.
So, Dr. Parikh, am I to gather that this child you are in the throes of training is the first actual inhome training experience you are having and that you are fending the child off on your mom?

How I wish I had that option!

My ped, who has trained 5 actual in-home children of his own, said to wait him out. That eventually he would become uncomfortable enough to want to do it.

I am unconvinced. He has two months til he is 4 and begins pre-school. the preschool teacher said that if he hasn't got it by then, not to worry, that one week of peer pressure from the other kids and he will be going just like them.

It feels like copping out. But I am only having one and so if I skate on this...I will just keep my mouth shut with the advice when it comes to my son's kids'training.

Like I said somewhere else, this becomes obsessive and I am not quite sure why.
Our first attempts have been interesting to say the least. Elizabeth, I'm by no means the authority on this issue, but was he introduced to the potty really abruptly? Our son is a little scared of new things generally, so we're giving him some time to get used to the potty before we push him to poop in it. We figure that he'll eventually get comfortable enough to sit on it nekkid and ultimately poop in it.

He might be feeling a little vulnerable being naked and pushed to do something really personal on cue. If you can figure out a way to help him develop a comfort level, you might beat the constipation. Sometimes "stubborn" in a toddler is code for "scared."
He pops down on it, reads a book, sits there as happy as you please as long as you like.

We gave him the pot when he was 3 and it is covered with "Good try sitting on the pot" Thomas stickers. he's not afraid of it.

The first sign I have seen of progress is with having him take his own pull-ups off and wiping himself. He doesn't like the mess. He needs a little help cleaning up after poop, but can go in and change and clean up fine for pee.

This is way more than any of you want to know. I am sorry.

It becomes obsessive because cleaning up human feces every day for years gets oooold. Plus you just start yearning for when you don't have to worry about it any longer.

I'm with your preschool teacher. He's a little late but if he doesn't have it by then, unless he is a gold-medal champion stubborn child, the peer pressure and simply the desire to be at the same level as the other kids will likely do the trick.
Meh. We're moms. Talking about poop is second nature for us....

Take the progress as it comes in increments. If he's peeing in it successfully, eventually he'll poop too.
actually elizabeth,
we're not anywhere near our parents--we're just hoping that grandmother can provide some guidance about how to do it. Our is only 4 months old (we're still working on the sleep thing at this point).
Well, then...good luck.

Sleep when the child sleeps. A good catnap can work wonders. And please see my post regarding "the Deal" for your wife.

I remember when he was 4 months...each time of his life made fond memories.

You are in a peaceful, restful phase when your child is not on the move.

I hope you can get your mothers in for long visits. There is nothing like the comforts of your own mother when you are tired.

And congratulations to you both on your new life!
Rahul, get Weissbluth's "Healthy Sleep Habits, Happy Child" -- seriously, every parent in my circle of friends who has used this swears by it. My kid has issues with eating, and he isn't potty-trained, but dagnabit, he sleeps like a champ.
One piece of advice for the sleeping.

I am a big advocate of a bassinet next to the parents bed. I think that sleeping in the bed with the parents makes for bad sleeep for everybody. My husband was constantly afraid he would squish the baby, I was touched out by bedtime and needed some actual sleep, and the baby didn't really care as long as he could sense we were nearby.

The bassinet was perfect. He had a regular crib in his room, a cradle in the living room, a playpen in the den, and a bassinet in the bedroom. Always a safe place to roll around and play that wasn't too "open". Babies really do not like wide open spaces. I think that is a universal from being safe and couped up for the first leg of life.

The bassinet next to the bed and a proper swaddle as he was put in to sleep made everybody feel safe and happy. And he was right there for feeding. By 6 months, he slept through the night til morning after a midnight feeding. Swaddling nice and tight made him very happy all the way throughabout 9 months whenever it came time to sleep. just remember that he liked it all cooped up inside. That was hard for me to understand as I like to sleep loose and spread eagle.

So, a place for the baby in all the rooms and a good swaddle after a midnight bottle and I think you will all sleep well.

Playpens are your friend. It gives the mother some peace of mind that he is safe for the 10 minutes it takes to shower or heat up some soup. It is not cruel or prisonlike if the baby can see you and you can see him. They even like to try and pull up with the bars.

I say all that because playpens get a lot of unnecessary heat. The people who stash the kid for hours on end are not using them right. They are a good place to stash a few favorite toys, too. Our boy thought of it as his little acre in the living room and was kind of territorial about it. Which I think was good because it gave him a little control of a very big world. I am projecting big time, but they do get bossed around a lot.

I am feeling all warm and fuzzy for you because I remember how precious that time was. And how quickly it passed.

And a PS. A wipes warmer is not frivolous. I changed him with cold wipes and with warm cozy wipes and saw the huge difference it meant in changing time. he cried and fussed every time one of those icy wipes hit his bottom. I tried the difference on myself and agreed with him.

The best things for the first 6 months: wipes warmer, cradle for rocking sleep, a Bjorn to carry him around without backpain, a bassinet next to mom for sleeping at night, a tight swaddle, a hard patsy that he won't really like that much, and a boppie for snugglesits/feeding.

And a Deal for the wife to get out and get you in.

If I could have any more, I would be pregnant right now! I am envious.
I'm opting in for option number 1 (no babies for me, blech). But, I was a cloth diaper baby and potty trained rather early- all it took was this. Rewards are wonderful.
One question I have in this discussion is how much oil is involved in "adult" diapers like "Depend." I'm guessing there's not much in the way of medical options, and the like, for incontinent adults.
Good point designator--
especially with the aging population--I hope some inventors in the crowd see an opportunity...
elizabeth and bagheera

thanks for the advice on sleep training--I have weisbluth's book and have read it in the past--now I just need to dig it up....