EC AT NURSERY
elimination communication/ natural infant hygiene/ baby led potty training in childcare/ daycare/ creches/ playgroups/ nannies/ childminders
This article follows on from the Baby Led Potty Training Article, which describes how we toilet trained our baby from two months old, including how to hold a baby and how to know when they need to go.
In this article I will consider how providers in childcare settings could toilet train babies. This is based on my memories of working in nurseries and reading, since my own child has not been in childcare.
There are many reasons to offer EC at your nursery. For example, infant toilet training is commonplace in much of the world. In the UK, EC is becoming more popular and has been in the media, which means offering this service makes your nursery topical. Furthermore, some parents may be waiting for a professional to raise the topic of potty training, and be pleasantly surprised to hear it is possible to start sooner. There is an increased risk of urinary tract infection for children who still wear nappies at age 3 or 4.
BABY LED POTTY AND TOILET TRAINING
What happens around the world
U.K. based Foundation Years published a document informing parents that children can communicate they need the toilet from age 16-26 months. Articles published in Nursery World and written by PACEY reference toilet training taking place at 3 days old in the past, and currently between 15 months and 3 years.
In a Chinese nursery, children from age 1 are placed on enamel spittoons after their naps. At another nursery, a 10 month old was held in the EC position over a metal bucket, from 6 months the children are trained to sit on a wooden potty, and from 2 they will go to the toilet by themselves. Another Chinese nursery has child-sized toilets and sinks, and potties; but also squat toilets for reasons of space, because these require less cleaning, and are child-sized by nature. Squatting is also an easier position to relieve yourself in. The nursery has a staff member responsible for cleaning throughout the day.
In the area previously known as the Communist German Democratic Republic, nurseries used potty benches, where everyone sat at allotted times throughout the day, and waited until everyone had finished. This may not be a practice we would imitate, but it is interesting to know what happens elsewhere!
EC suited childcare setting
The way baby led potty training is incorporated into a setting depends on: the facilities you have, the expectations of parents, the baby’s development, and what nappies or pants they wear. Nurseries tend to keep track of down nappy change times, and a note could also be made of potty trips on the same form. This could help the staff notice a pattern.
Has a potty training policy- It is good practice for a setting to have a potty-training policy, which covers: ‘when to start potty training, how to use praise and recognition effectively and a structured plan for potty training’. This can be based on a template with baby toilet training added into it. Staff should be trained in how to potty train and the importance of children drinking enough water. The potty procedure would have similar hygiene requirements to a nappy change procedure.
A clear commitment or system for partnering with parents to share information and find out parent's wishes
Key worker system- Toilet training an infant depends on adult vigilance and proximity. A keyworker could learn about the individual child and form a trusting relationship with them. A nanny or childminder may have more time to devote to an individual child.
More permanent than supply staff and low staff turn over. This means the child can build a trusting relationship with the staff, and are less likely to be taken to the toilet by an agency worker. The staff are likely to be attracted to somewhere with better working conditions and pay. A chain nursery, when focussed on shareholders may find it hard to provide this.
Higher adult to child ratio gives staff more time to attend to children's needs and leave the room to empty potties if needed. There will always be something else that needs doing at the same time.
Mixed age group- could give younger children the chance to learn from older children, and toilets are more likely to be available for younger children.
Open minded staff- people from other parts of the world or who are of an inquisitive disposition may already be aware of EC or eager to find out more.
Cloth nappies accepted or encouraged- toilet training children often wear cloth training pants. A nursery which allows this is likely to be more open to EC too.
Toilets, potties, sinks and nappy changing in an adjacent room, rather than along a corridor, or shared with another room- Makes it easier and more likely children will be taken.
Relevant UK National Standards
National Standard 3: Care Learning and Play “Required a regulated person to meet children’s individual needs and promote their welfare’. A parent could request a continuation of the home practice.
National Standard 7: Promote the good health of children. A parent could request their child does not sit in their own waste for long periods of time.
National Standard 9: Childcare providers also have a duty to provide each child with equal opportunities
Annex A: Babies and children under 2 years of age. Point A.4 Food and drink. ‘Feeding and nappy changes take place in accordance with the child’s individual needs and not as part of the childminder’s routine.’
EYFS Physical Development-30-50 months, ‘can usually manage washing and drying hands’ and ‘… can attend to toileting need most of the time themselves’. The Early Learning Goal in this area states that children should ‘… manage their own basic hygiene and personal needs successfully, including dressing and going to the toilet independently’
Working with parents
Caregivers should work with parents to make EC practice as consistent with home as is possible. Parents should help the child to learn who and how to ask.
Parents should give demonstrations themselves of how they take the child to the toilet and explain the child’s patterns and signals. Parents should take the child to the toilet themselves when they arrive and before they leave. This way parents can take some weights off the care givers, settle the child, and learn about the toilet facilities and check the child feels comfortable.
Ask parents to provide several changes of easy to change clothes, cloth training pants. Ideally, there should be enough time in a child’s day to poo at home, as they may feel more comfortable about this than at nursery.
Child centred approach with positive reinforcement
As when toilet training an older child, encourage without judgement, praise all efforts, not just success and don’t make a fuss about accidents. Disappointment and anger at accidents can impact children’s bowel health later in life. Too much praise which only relates to successful potting could infer a stress of performance or fear of failure in the child. For example, if they are always a good girl/ boy when they use the potty will this make them think they are a bad girl/ boy when they miss.
Children can get used to the toilet area by having their nappies changed there even if they are not toilet training. They can also play using the facilities at nappy changes. Children can be involved in the nappy changing process by being asked to fetch their own nappies and wipes. Have potty picture books available in the book corner to normalise the idea, and activities about hand washing.
Children can have phases where they go off being taken to the toilet, and it may be best to go along with this. The little breaks are known as ‘potty pauses’. One reason we have been told to delay toilet training is that parents can become disappointed by these pauses. Perhaps we should be told to expect pauses instead, and how to respond to them.
Key Person system
Many nurseries now have a key worker system, with key workers responsible for duties such as nappy changing. Since every child is different, it takes time to focus on how they communicate. EC works best when there is one person, the key person, with main responsibility for learning and watching for a child’s signals that they need the toilet. Where there is no key person, then a person who the child has an affinity with can take responsibility. The key person would pay special attention to learning the child’s signals for the first week or two, as well as gaining the child’s trust. It may be easier to a nanny or childminder to offer this level of care.
From the child’s angle, they need to feel comfortable about asking to go to the toilet, and being with the person who brings them. Children may not respond to multiple people. They may associate going to the toilet with a certain person, which makes them only able to go , or feel safer going with this person.
My observation of the keyworker system in my own experience has been that it works well when followed, but that it is not always adhered to. Managers should train staff in the reasons for the policy, and provide sufficient staff numbers to make the practice possible.
EC children are taken to the toilet at transitional times, such as before and after naps, meals or going outside. Mass nappy changes often happen at these times anyway, and the potty can be added into the nappy change routine of the setting. The keyworker could also offer breaks in-between every hour or 20 to 30 minutes, depending on the individual.
Scheduled and reliable potty breaks help children to remember to go to the toilet. Routine helps children feel comfortable as they know what is going to happen. The predictability of a nursery routine may even mean children are trained at day care before they are trained at home. Apparently, the peer pressure when everyone follows the same routine is a good motivator.
The signals a child gives that they need the toilet can vary with time and different adults. In a busy environment such as a nursery, children may act differently; they may be distracted and their signals harder to read.
Always name wee and poo the children go to the toilet so as they learn the language. If the nursery already uses some baby signing or makaton, then toilet signing might work. Children might take to it if signing is something everyone does. Try the 'chest slap' signal.
Privacy and safeguarding
The keyworker should carry out intimate care responsibilities, such as changing nappies, taking to the toilet, and changing clothes. They should use the correct terminology for private parts, and also for wee and poo.
As they get older, children are likely to want some privacy when going to the toilet, whereas before they would need more help. Privacy can be maintained, but safeguarding ensured by leaving the door slightly ajar. This way the staff member can be seen by other staff members, but the child less-so.