Unswaddled toddlers stir the diaper-free debate

SUTTON, Mass. — Thirteen-month-old Dominic Klatt stopped banging the furniture in the veranda, looked at his mother and clasped his right hand around his left wrist to signal that he needed to go to the bathroom.

His mother took the diaperless tot to a tree in the yard, held him in a squatting position and made a gentle hissing sound — prompting the infant to relieve himself on cue before he rushed back to play.

Dominic is a product of a growing "diaper-free" movement founded on the belief that babies are born with an instinctive ability to signal when they have to answer nature's call. Parents who practice the so-called "elimination communication" learn to read their children's body language to help them recognize the need, and they mimic the sounds that a child associates with the bathroom.

Erinn Klatt began toilet-training her son at birth and said he has not wet his bed since he was 6 months old.

"The nice part is ... really getting the majority of poops in the toilet versus having to clean that," Klatt said. "I don't have to wake up at night and change diapers or have wet sheets anywhere. That's really nice."

The practice is common in many parts of rural Africa and Asia where parents cannot afford diapers.

Still, some parents and toilet-training experts are skeptical.

Experts at the Child Study Center at the University of Oklahoma Health Sciences Center say children younger than 12 months have no control over bladder or bowel movements and little control for 6 months after that.

But some parents begin going diaper-free at birth, and the infants can initiate bowel movements on cue as young as 3 to 4 months, said Elizabeth Parise, spokeswoman of DiaperFreeBaby.org, a network of free support groups promoting the practice.

And unlike some methods of toilet training, there are no rewards or punishment associated with it.

Dr. Mark Wolraich, professor of pediatrics and director of the Child Study Center, said the practice essentially conditions young children to go to the bathroom at predictable times or show clear signs when they must go.

"To be truly toilet-trained, the child has to be able to have the sensation that they need to go, be able to interpret that sensation and be able to then tell the parent and take some action," said Wolraich, who is also editor of the American Academy of Pediatrics' book on toilet training.

"And that's different from reading the subtle signs that the child is making when they have to go to the bathroom."