Posts Tagged ‘Marc Weissbluth’

[Not so] early start to potty learning…

Saturday, April 6th, 2013

We’re kind of late, or really early, depending on where and when you are.

Last May (2012), I went to Half Price Books to get a copy of What to Expect the First Year, which Cindy and Rob both recommended. (Looking at Amazon, I realized that I paid too much for the previous edition. sigh.)

Anyway, while perusing the parenting/baby section, I noticed a book called, Early Start Potty Training. Curious, I read that before the availability of washing machines or disposable diapers, US parents began potty conditioning babies at 2-3 months. Back then, babies generally finished potty training by 18 months, as babies still do in much of the rest of the world.

But in 1961, Procter & Gamble introduced the first disposable diapers, and recruited then-unknown pediatrician T. Berry Brazelton to extoll the virtues of waiting to begin potty training until your baby was “ready” and to use P&G’s new product in the meantime. Fifty years later, U. Michigan Med School says that on average, US toddler girls finish potty training around 29 months, and boys finish a bit later at 31 months. They go through tons and tons of diapers in the interim.

The Early Start Potty Training book goes on to say that baby humans have the muscle control to delay peeing by about 5 months. They add that behaviorally, infants and young toddlers are much more open to learning new skills than 2- and 3-year-olds. When I read this, Sam and Cate were already six months past their due date and I decided we could start working on potty learning.

First, we would need potties. Baby Bjorn made a Little Potty that’s only 4.5″ tall. It was marketed for travel, but a bunch of Amazon reviewers observed that it’s the perfect size for 6-month-olds. It has been discontinued, at least in the US market, but Auntie Em found two of them for us on eBay. (Thanks, Em!) We were set!

* * *
Fortunately, although I was eager, my sleep-deprived follow-through was minimal, which left time for more information to percolate. I mentioned my potty teaching intent to Rebecca and Cindy, who each remembered and forwarded me a cautionary article by a pediatric urologist. (Thanks, ladies!)

In “The dangers of potty training too early,” Dr. Steve Hodges makes a fairly compelling case that potty training before age 3 is perilous for children. In particular, he cites research linking early potty training to chronic constipation, “accidents,” and bed wetting. He asserts:

  • Potty accidents are not normal
  • Virtually all bedwetting is caused by undiagnosed constipation
  • Chronically holding poop or pee makes a child’s bladder go haywire
  • 25 percent of 5-year-olds have wetting problems
  • Kids who potty trained earliest and most easily tend to develop the worst problems
  • Children can poop daily and still be constipated

At the time I read all this, both of our girls were having lots of trouble moving their bowels regularly. I promptly shelved our pink Little Potties and put potty learning on hold.

* * *
In the meantime, we’ve simply worked on labeling. We started by talking about “pooing” when a girl strained to poo. When a girl peed mid-diaper change, we said “you’re peeing!”

Recently, we started taking diapers off 5-10 minutes before bath time and letting girls play naked in the bathroom. I wait and watch for them to pee, and when they do, they are able to associate the warm wet sensation on their leg with my language, “you’re peeing!”

I knew Sam was getting the idea when, during a diaper change, she pointed to her crotch and asked, “pee?”

In addition, the girls’ bowel function improved markedly and dramatically when they started sleeping longer at night. In retrospect, we should have expected that after reading the Healthy Sleep Habits, Happy Child book. But I initially missed his point when Weissbluth asserted obliquely that children who don’t get enough sleep are “less regular in their biological processes.”

* * *
Last weekend, while reviewing what the Sleep Lady had to say about 18-month-olds, I came across her comments on potty training:

Potty Training
I don’t see any problem doing sleep training and daytime potty training simultaneously, as long as the child is ready, able, and reasonably enthusiastic. Indeed, children often have a “window” between eighteen and thirty months (later is not abnormal, so don’t worry) when they are quite interested in at least starting toileting, and you should seize that moment or you might have to wait months for another chance.

On Tuesday, we saw Dr. W for a check up, and I asked her about potty training. (She’s retiring in May… boo.) Dr. W said that in her career she’s only seen perhaps a dozen girls potty trained as early as 15-16 months, but went on to say it was fine for us to begin if the girls were interested (which they are).

I also asked her about the concerns of urologist, Steve Hodges, regarding early potty training, holding pee/poop, and urinary tract dysfunction. She nodded knowingly and said that pediatricians have long been aware of the connection between constipation and urinary health. She observed that the mistake many Americans make is asking their child if they want to go potty, of if they’re “ready,” which busy active toddlers rarely are. She said instead that we need to adopt a regular schedule, declare, “it’s time to go potty now,” and go. Potty activity has to be a non-negotiable part of the daily routine.

I went back and downloaded the Kindle edition of Dr. Hodge’s 2012 book, It’s No Accident, to learn a little more. I was struck by his assertion that one of the main culprits for toddlers holding poo and pee is parents who disengage as soon as their kids are potty trained. He goes on:

My best advice to Mom and Dad: Stay involved. I know most parents dream of the day when they can be completely removed from their children’s goings-on in the bathroom. Heck, I look forward to that day myself. But don’t get too fixated on your own potty liberation. You need to pay attention to your kids’ pooping habits until it becomes uncomfortable for both of you, which may well be puberty.

In short, safe potty training has to include ensuring that your kids both pee and poo early and often. Got it.

* * *
With all of that in mind, we pulled out our pink Little Potties and introduced them as another place girls can pee/poo. We talk about peeing in the potty “like Mama and Daddy” do. We’ve started working on “sitting on our potties” for about 5 minutes at a stretch, which really means spending 5 minutes directing toddlers who’ve hopped up to go back and sit on their potty again. So far, we go visit our potties 3-5 times a day, e.g. when we first wake up, after breakfast and lunch, before nap time, etc.

Both girls have experienced incidentally peeing in their potties, which they find very exciting. They spent more time sitting on their potties before they succeeded. Now they repeatedly hop up to peer inside their pots and see whether there’s anything there yet. At least once a day, there is. Cate even pood a bit once, and seemed very surprised to find something in her potty. I hope that with practice, I’ll get the timing right and they’ll get the hang of going more readily.

We expect to be in diapers for a long time yet. We’ll continue to encourage girls to pee/poo in their diapers, and there will be no talk of holding or waiting. But I’m interested to see what they can learn.

Gotta stick to the schedule

Sunday, January 29th, 2012

The most-useful parenting book we’re reading so far is still Healthy Sleep Habits, Happy Child. Author Marc Weissbluth is a professor of pediatrics at Northwestern and founded the original Sleep Disorders Center at Chicago’s Children’s Memorial Hospital. He imparts essential ideas:

  • No newborn can comfortably stay awake for more than 1-2 hours at a time
  • Falling asleep is a learned skill and you can teach babies how to do it without crying
  • Tired babies are fussy babies and vice versa
  • Tired babies are less alert and learn less effectively
  • Babies who miss daytime naps do NOT make it up at night. In fact, the opposite is true: babies who miss naps crank out cortisol and other stress hormones to stay awake (but overtired) and subsequently have trouble falling or staying asleep
  • 4 out of 5 babies demonstrate drowsy cues so that you can get them to bed within their window (before they melt down), but 1 in 5 don’t. For these others, you have to watch the clock and start winding them down to sleep before they run out of go juice
  • Sleep cycles and durations are a function of brain maturity (age)

At almost 11 weeks past their due date, our babies are still in the process of firming up a daily sleep schedule. While the timing is a little fuzzy, and will be for several more weeks, they’ve settled into two nighttime sleep blocks and three daytime naps. As long as we keep this routine going, there’s almost no crying at our house.


Total Baby app: Sam’s timeline for the last week

On Saturday, Bill’s Mom invited us to visit and we made a valiant attempt. The upsides are that we saw Nancy, her sister, and brother-in-law; celebrated a belated Christmas; and enjoyed a yummy dinner. The downside is that we blew the girls’ nascent schedule.

We packed up the girls right after the late-morning meal and hoped they would sleep in the car… but they didn’t. Once we arrived, we set up their rockin’ new bouncy chairs in a dark, quiet bedroom and tried to get them to sleep there… but Sam didn’t. We scarfed dinner quickly, hurried home again, nursed, and bundled them for bedtime two hours later than usual and hoped they’d sleep, but for some time they didn’t. We limped along, managing to nap for an hour before midnight, pushed the middle-of-the-night feeding to 2 am, and hoped we’d get a long sleep block afterward. The girls each managed 4-1/2 hours… but not at the same time. As a result, our (parent) sleep since midnight looks like this:


Total Baby app: Bob’s sleep since midnight

Ugh.

I’m sure that we will venture out again, maybe even soon. But we need time to recover from last night first, and we’ll schedule it really carefully.

It’s about to get harder: they’re awake!

Friday, December 2nd, 2011

A few of you have come over to help us feed and care for Sam and Cate (thank you!!!) and observed that they seemed “really mellow.” Not knowing any better, we counted our blessings and felt grateful that in the baby temperament lottery, we had scored two mellow babies. What a relief!

But apparently, any conclusions about the temperament of our preemie babies were also premature. According to Dr. Marc Weissbluth in his (incredibly useful) book Healthy Sleep Habits, Happy Twins:

“Newborns are sleepy for a few days after they are born (premature infants will remain consistently sleepy for longer). Because they are so sleepy, they appear to be very portable. For a few days or a few weeks, you can take them anywhere at any time and they will sleep through loud noises and bright lights. Nothing seems to disturb them.

But after a few days or weeks of age, counting from their due date, all babies become more alert and awake. They become more curious about and aware of their surroundings. They are more easily startled by the flash of a camera or a thunderclap. If they are in a situation where there is a lot of stimulation (people talking loudly, traffic noise, kids squealing on a playgorund, loud city noises, being jostled in a jogging stroller, or bright sunshine or city lights), they might have difficulty falling asleep easily and might not sleep well with all the noise. If the duration of this excess stimulation is too long, the babies stay awake too long and get overtired. Once overtired, they have trouble falling asleep and staying asleep.”

Huh. They’re going to spend more time awake and need more attention. Right.

(They’re also becoming more vocal regarding their needs and desires, but more on that some other time.)

Keeping both of them clean, fed and happy was already a full-time job and we are right at our limits. But with November 16 only two weeks behind us, it turns out our girls are only just getting started. We of course want them to look and learn and experience the world and grow. I just think we’re going to need more help to help them manage it. So if you’re in Houston, healthy, and have an hour or two you’d like to spend with a cute girl, please let us know.