And now modern research supports what many have known all along: babies can control elimination long before they are agile enough to visit the potty. They just need assistance.

“I’ve heard that sixty percent of the world’s population uses some form of elimination communication,” says Elizabeth Martin, a doula and registered massage therapist who offers consultations in natural infant hygiene in British Columbia, Canada. Up until recently this statistic would have excluded the West, but times are changing. “More and more people have at least heard of it or someone who has attempted it.” Martin says.

But what is elimination communication?

In its simplest form, elimination communication involves watching your baby for signals indicating he or she wants to void the bladder or bowel. Parents give consistent verbal cues when this occurs, so that babies come to associate a particular noise with the act of elimination. Graduation to independent toileting happens at a much younger age, on average, following this method.

Likening the process to “puppy training,” Martin describes elimination communication as “another language” that parents learn by tuning in to their babies signals. Like puppies, babies don’t necessarily need diapers, but they may need absorbent pads the way puppies need newspapers—to catch mishaps in the early days and when their parents are busy, nursing, or otherwise preoccupied.

In cultures where elimination communication is the norm, babies are often held by a caregiver and clothed to make elimination quick and easy. That means no diapers, and often no clothes. Some countries, like China, have become well known for producing infant pants with a split seam—pants which are now widely available and trendy in the west— enabling babies and toddlers to void quickly and without obstruction when the urge hits.

And the urge hits often. In newborn babies, urination takes place approximately every twenty minutes. In boys, this is often more frequent. The role of parents is to listen for babies’ cues and get them into an appropriate position and location for elimination.

But do babies really have control over their bladders that young? In one article published in Parenting Science, Dr. Gwen Dewar summarizes recent findings, noting that they “contradict the idea that infant bladders are totally uninhibited.” In other words, babies can control aspects of their own elimination much younger than previously believed. These findings help explain why a diaper free existence is possible.

Dewar goes on to point out that elimination communication works because a child doesn’t need to fully control their urges—just delay them. Moreover, cultures where elimination communication is common practice tend to be less worried about accidents. They are a regular part of life. Diapers, on the other hand, may be viewed as unnecessary or even disgusting.

Martin likens elimination communication to “caregiver training,” saying that “babies are born with the instinct not to soil themselves or their habitat.” In this way, elimination communication is really about parents learning to understand their baby’s needs and building trust by meeting those needs.

“…babies are born with the instinct not to soil themselves or their habitat.”

For those who might find elimination communication time consuming in the beginning, it’s important to consider the long-term benefits. These include an increased connection with your baby, fewer diaper rashes, and savings of more than $3000 if disposable diapers are the alternative. Washing fewer or no cloth diapers for two years or more is another possibility for families considering cloth, and for parents who don’t want to add to the estimated 10,000 tons of disposable diapers put into US landfills every day.

Another option for busy caregivers is part-time elimination communication. Says Martin, “It is doable for working parents, for people with challenges or single parents. There’s always a way to incorporate some aspect, even if your baby is in daycare eight hours a day. There’s still a way that you can do it.”

Martin’s advice to new parents overwhelmed by the prospect of elimination communication is this: “What if you could wash one less diaper per day? That is a great starting place.”

She also shares her ideas for four things leading to successful elimination communication:

1. Baby’s cues: If you watch a newborn baby, you will begin to notice subtle (and not so subtle) cues indicating they are ready to eliminate. These cues include squirming, grimacing, vocalizing and a change in breathing patterns. Tuning in to your baby’s cues is often easiest if you observe them without diapers, on an absorbent pad.
2. Parent’s cues: While your baby is eliminating, make a sound that you’d like the baby to associate with elimination. A simple “psssssss” or “sssshhhh” sound is common.
3. Timing: Observe the timing of your baby’s elimination, including how frequently your baby eliminates, and how long after feedings. Some people find making a chart helpful for observing patterns. Once a pattern is established, this may provide you with some clues about your baby’s elimination practices. Don’t expect this pattern to stay the same, however. As your baby grows, elimination needs will change.
4. Intuition: As you tune into your baby’s needs, there will be times when you “just know” she has to pee. More often than not, your intuition about elimination needs will turn out to be correct.

Advocates for elimination communication find the benefits far outweigh the challenges. In her article, Natural Infant Hygiene: The Gentle Alternative to Long-term Diapering, Ingrid Bauer states, “I think the real work of Natural Infant Hygiene is that of being in the present moment. There are days when it can seem like the most difficult thing in the world to do. And there are days when you have glimpses of enlightenment.”