Saturday, January 11, 2014

EC - Elimination Communication: Taking Your Baby to the Bathroom from Birth - Updated!

Using The Newborn Hold On The Smart Potty Insert With My 7-week old Baby
(Update: You can see my blog post, 4 Reasons Why My Newborns Use the Toilet, on The Huffington Post here).

(Update: You can check out the blog post on my 2 picture books on Elimination Communication here or click on their titles to be taken to Amazon: Nikhil's New Underwear and Zuni's New Brother. They are available as paperbacks and e-books, and for a limited time, 3/17/2016 to 3/20/2016 the Kindle books are free!)

EC, or elimination communication, is the name given to the ages-old practice of taking your baby to the bathroom from birth.  It isn't a race to potty-train but rather a natural elimination technique, based on the idea that humans, like other mammals, do not want to sit in their own waste.

When you diaper a baby, you are teaching him/her to unlearn this natural instinct of not wanting to sit in one's waste, teaching him or her to get used to being comfortable going in a diaper, and then a year or two down the line, teaching him or her that this is no longer acceptable and switch to potty training.  

In our modern world, it is often difficult to remember that there was a time, not too long ago, when diapers did not exist.  But they didn't always exist and humans around the world took care of their babies' needs through one form of EC or another, and you can see it being practiced today too in more natural cultures or among  poorer communities worldwide, where people cannot always afford diapers.

Here is a guide to how my husband and I EC'd our child (I have added updates on our experience with EC and our second child throughout the post as well in purple):

1.) The Diaper Free Baby is a great resource for EC'ing.  This book lays the groundwork for how to figure out your baby's needs and they even have different tracks, depending on if you want to start EC'ing full-time or part-time, and based on the different ages before age 1 that you could start doing it.
2.) The Baby Bjorn Smart Potty
3.) The Baby Bjorn Smart Potty Chair
4.) BabyLegs, Bambino Land or another brand of leggings.  We have one pair of BabyLegs in the newborn size and several other BabyLegs and a Bambino Land pair in the larger, one size fits all, purchased on Amazon and Zulily.
5.) Leggings that go all the way up the waist, so they look like pants.  Brands like Doodle Pants are on sale all the time at Zulily.
6.) BPA/Phthalate-free spray bottles (look for the recycling codes #1, 2, 4, or 5 for safer plastics) to fill with white vinegar.
7.) Prefolded Cloth Diapers 
8.) Diapers and wipes
9.) Reusable tote bag for traveling with your Bjorn Smart Potty and spray bottle.
10.) A notebook to keep track of timings.
11.) Non-toxic Training Underwear in smaller sizes
12.) Oxo Tot Sit Right Potty Seat With Stand Right Base
13.) Babee Greens Organic Cloth Diaper in 100% organic cotton
14.) Clotheez Organic Cotton Doublers

Have a thick skin and be prepared to deal with a lot of resistance and ridicule from people who mean well but don't understand what you're doing or who tell you it isn't possible.  People may also say it isn't possible for a baby's sphincter to be strong enough to do this, or that you're expecting too much out of a newborn, or that you're forcing them to do something but none of this is true.  EC is a totally gentle way of communicating with your baby and meeting his natural needs, keeping him comfortable and happy, and it is not at all a race to potty train.  Sometimes a gentle reminder that just because you choose to parent a certain way doesn't mean you think any less of the way someone else does something, can go a long way to deflecting the criticism or negativity.

Despite all the naysayers, I was fairly confident in this method, having read a news article about it almost a decade earlier, and I knew this is how my grandparents and parents in India were taken to the bathroom as babies, but I also made sure to get support from a friend who had EC'd her three children.  If you don't personally know anyone who is EC'ing, you can find support and helpful tips from online groups such as the ones found here.

To start the process off, we first made sure we had read The Diaper Free Baby.
We then set up our newborn toilet stations (they get modified as baby ages).  I had one in a bathroom downstairs and one in our master bathroom upstairs.  Each station had the following:

  • The white insert of the Baby Bjorn Smart Potty or Potty Chair (they're identical).  We chose these toilets because they were free of BPA and Phthalates, were easily available in stores and online, and because their insert made it easy for the toilets to grow with your child.  (As our baby got bigger, we moved to the next stage, where we put the insert into the potty base and used the two Bjorn pieces as one unit).
  • The spray bottle with vinegar to clean the toilet without chemicals (I also would just use a less toxic handsoap like 7th Generation's Free and Clear to clean the toilets as well).
  • A box of wipes (we later also used just water or toilet paper too, depending on our sons' needs).  We used the original Seventh Generation wipes because although they are not totally natural, they are free of animal testing and phthalates and parabens and a lot of the other toxins found in most baby wipes.  They are also not overly moist.  You don't need really damp wipes with EC because most of the mess goes right into the potty.  The Honest Company also makes wipes with less chemicals but we haven't tried them.
  • The Babies R Us prefold diapers hanging on our towel rod or in a little box on the counter.
While my friend started EC'ing her kids from the day she returned home from the hospital, I wasn't physically able to do that right away post-delivery so I started when my son was three weeks old.
Because my delivery was a lot different with my second child, I was able to EC him the day we got back from the hospital, when he was 2 days old.

Newborn babies will generally go to the bathroom immediately before, after or during a feeding, (when they pop off a breast or bottle during a feed, it is almost always because they need to go).  So the very first step to EC'ing is to figure out when your baby is going.  I started taking my son immediately after nursing and found that for the most part, he would urinate and have a bowel movement in the potty insert within seconds of nursing.  There were also a couple times in that first week-and-a-half when he was going while breastfeeding, so I nursed him over the potty in the master bathroom.  He did cry but nursing helped stop the crying and within a couple days I no longer had to nurse him over the potty and we just synced up.  By around 5 weeks old he was waiting to go until I held him over the potty insert immediately after nursing.

With my second child, we synced up almost instantly, after which he only pooped in his diaper 11 times ever.

I also found that he would go to the bathroom right after waking up from the numerous newborn naps one takes in the first few months of life so I would start to undress him as soon as he began to stir from his sleep and hold him over the toilet (the urgency soon stopped as he was able to hold it in longer until he got to a bathroom with each day.  The Diaper Free Baby has a section explaining how this process happens with the sphincter).

I would quickly undress my son, leaving his Seventh Generation diaper on until we got to the bathroom.  After he went to the bathroom and I wiped him and disposed of the diaper, I would carry him back to the changing table by covering the lower part of his body in one of the prefold cloth diapers.  I had been advised to get a few to cover him with when changing him, to avoid getting urinated on but ended up getting a lot more to use for bathroom trips.  (We gradually stopped using them after a few months).

I kept a notebook for the first few months and recorded the time and whether he urinated or had a bowel movement or had both or none.  A pattern would quickly emerge for the week (unfortunately when babies are that young things are constantly changing, so as soon as I figured out what was happening it would change), and I would be able to predict how many bowel movements he would have. Within a couple weeks he rarely had a bowel movement in his diaper and peed every time he was taken to the toilet.

Probably due to experience, as I said earlier, EC'ing my second was a breeze right from the start. We synced up right away and he always had a bowel movement in the toilet, except for 11 times in his life. 

The Diaper Free Baby goes into more detail about the "newborn hold" for holding your baby over the toilet (or sink in the early days if you prefer).  Here are some pictures of how to do it.  By holding the baby's thighs in this position, it helps them go to the bathroom easier and in a more comfortable way.

Depending on how big their newborn is, some people hold their child over the sink or potty insert with the newborn hold or they do a variation of it when the baby is a little bigger and supporting the child's weight makes their wrists hurt, where instead they keep the baby in the newborn hold but rest their wrists on the edges of the potty insert so they're not holding all of the baby's weight.  So once our son got a little bigger in a few weeks, we started holding him over the insert with our hands resting on the edge of the insert.  Then when the potty insert started to get a little wobbly, we knew it was time to add the base for stability and safety.  (It is important to always put your baby's safety first.  If we felt uncomfortable with anything, we didn't do it, and just because the book or an EC website showed someone holding their baby over a counter or adult toilet, if that seemed too high or dangerous because our son was in the mood to flail his body, or if I felt weak or too tired, we always modified things for safety.  There were several times when I EC'd my newborn while sitting on the floor because I didn't feel comfortable or stable holding him over a sink or counter).

While holding our baby over his toilet, we would make a "ssss" sound to cue him to pee (we would also sometimes run the faucet or put a few drops of water on his penis if he wasn't going).  After a few weeks, he would urinate every time we made this noise.  We also did the ASL sign for "bathroom" every time he went.  You make your hand into the sign for the letter "t," which is the sign for toilet, and shake it left to right.  It seemed pretty useless for several months because from what I've read babies can't sign until they are a few months older but we did it every time anyway, and eventually, months later, he would do the sign to us when he needed to poop, and that was a great feeling to know he could easily communicate his needs to us.

Sometimes a newborn will cry while being EC'd because they are cold.  This is where baby leggings are a great help.  Because my son was smaller, we used the newborn size of BabyLegs for a month or so but they are tiny and some newborns will never fit into them.  BabyLegs come in a second size, which is one-size-fits-all.  These are meant to grow with your child into elementary school.

In terms of clothing, I didn't (and don't) like onesies at all because the tail of the outfit would easily dip into the baby toilet.  Clothing with lots of snaps or buttons like one-piece playsuits also were not my favorite because in the early days, before my son's sphincter was fully able to hold until I got him to the toilet, I would be in a rush to get his clothes off and take him to the bathroom.  So I preferred shirts and elastic pants (or shorts) to make the job easier.  That way, all I had to do was pull down his pants and get him on the toilet.

We chose to EC through the night as well, which not everyone will do, so in the first few months I took my baby to the bathroom immediately after nursing.  He eventually started falling asleep while I held him over the baby toilet and by 2.5 months old I realized from my notes that he was going 4-6 hours at night without a bowel movement.  Within a few more weeks he no longer had bowel movements at night and was able to wait until I took him in the morning so I no longer had to take him to the bathroom at night.

Because of the nature of newborn poop and the white Bjorn insert, sometimes the insert would retain some staining even though we washed and sprayed it immediately after every use.  In these instances we would also put a less toxic hand-soap in it to clean it, like a Free and Clear Method or Seventh Generation, which are both phthalate free, and occasionally we would need a Seventh Generation wipe to clean the insert as well at this stage.

For the first few months of EC, there were also some easy signs that let me know I should continue to hold my son over the Bjorn because he was still going to the bathroom.  My son was under six pounds when he was born and I quickly realized that I could feel a gurgling sensation along his left side as I held him, as his intestines went to work.  I always knew he was about to have a bowel movement when this happened but as he quickly got bigger, and fattened up, this sign disappeared because I could no longer feel it through the fat.  My friend had let me in on two other tips for EC'ing boys though, which her EC'ing friends had passed on to her (a good example of why an EC support person can be a big bonus).  The first tip was to watch his penis.  It would start to balloon up right before my son had to urinate, and right before he had to have a bowel movement his testicles would rise up.  Again, these signs only worked in the first few weeks or months but they were helpful enough at the time to help me figure out how long to hold him over the toilet or know when he had to go.

For traveling, we always keep a tote bag in the car with the Baby Bjorn Smart Potty, a vinegar spray bottle (which I later moved to my diaper bag so it wasn't getting exposed to the extremes of summer and winter in the car), and paper towels and plastic bags in case there is a mess to clean.  On long road trips, every time we stopped for food or gas, I would put the potty on my lap in the parking lot, remove my son's diaper so that it fell into the potty, and held him over it so that he could pee and poop.  This method allowed all the waste to go right into his diaper so I could just wrap it up and throw it out.  However, when he got older, it was no longer possible to put the diaper in the toilet because he could feel it against his bottom and wouldn't go, thinking he was going in his diaper.  So when my son got older, we would hold him over a toilet in a restroom.

This early phase can be exhausting.  My son was having 8 to 11 bowel movements a day.  But these early weeks are also extremely rewarding, when you are able to sync up with your newborn and understand their needs at such a young age.  After starting EC, my son had less than 35 bowel movements in his diaper from 4 weeks old to 8 months old.  This sounds like a lot but when they are pooping 8 times a day, it really isn't.  And almost every time he pooped in his diaper, it was because we were driving and couldn't stop for him to go, (which led to a lot of hysterical crying in the car, (from him.  Usually), or a couple times it happened when he had first started solids, which can be a big change for EC'd babies (more on that below).

As noted earlier, my second son had only 11 bowel movements in his diaper, and almost all of these bowel movements in the diaper happened for him when he started solids.

After he had gotten over the occasional constipation from solids and the unexpected bowel movement in the diaper from prunes to help this constipation, he never again had a bowel movement in his diaper after he was 8 months old, (and was peeing every time he was put on the toilet after he was a month old).  As someone who would rather not deal with poop, this was reward enough for me but there were several other benefits as well:
  • He never had a diaper rash
  • He never peed on us while being changed after starting EC because he had learned to hold it for the toilet
  • We ended up using fewer diapers and a lot fewer wipes because of EC.  When my son started pooping in a toilet, it almost always came out clean, with no poop getting stuck in crevasses like often happens when your child is sitting in a diaper full of poop.  We ended up only needing a little bit of a wipe to do the job so I would cut them into smaller pieces and half the time use toilet paper with some water on it instead that could be flushed for bowel movements and just water or less than a square of toilet paper for urine.
  • He only had two blow-outs post EC.  One was because we didn't get him to a toilet fast enough while on the road, and the other was when he had been constipated for two days after starting solids, and had a blow-out after being fed a lot of prunes.  (Sitting on the Baby Bjorn after starting solids also helped put the proper amount of pressure on his bowels to help with constipation). 
  • My second son never had a blow out because we started EC'ing him when he was day 2.
  • We cut down on laundry because there were only a couple times when he pooped on his clothes with those two blow-outs.  
  • In addition to less diapers sitting in a landfill, we just used a Simple Human stainless steel trash can with a regular garbage bag in it.  With no poop going in the trash can, there was no need for a Diaper Genie or similar system that wastes a plastic bag per diaper.
  • With my second son, I used an organic cotton diaper and doubler for naps, (more on that later), and because he was never pooping in them, they were a breeze to wash so you probably end up using less water for washing cloth diapers with EC as well.
  • Whenever we took our son to a splash pad there was no need for a diaper under his swimwear.  He would just go the bathroom ahead of time and then go immediately after in our portable potty station and then we could dry him and put him in a diaper and clothes.
  • Here are some more benefits from the Diaper Free Baby website.

The only downside we experienced in the early days to EC is that because our son never got trained to accept going in his diaper, there were times when we were on the road, as mentioned earlier, when he would get very upset because he needed to use the bathroom and cry until we got to a bathroom or cry even harder if he ended up going in his diaper.

This second phase started for us when our son was close to seven months old, when he started eating solids.  This is when an exclusively breastfed baby's poop changes to a much smellier one, (although it always smelled to me even though many will swear it has no odor in the early days of exclusive breastfeeding), and it becomes solid.

I had stopped writing down the timings after a couple months, once my son's routine became set but when he started solids, I again started to write things down for two weeks.  Once I realized how solids were impacting his bowel movements, I stopped writing timings down again.

Since solids can bring many days of constipation with it, using the Bjorn potty helped my son because sitting in that manner allowed proper pressure to be placed on his bowels for him to go.  There were a handful of times when he was constipated for two days and we gave him prunes.  This led to him showing signs to need the bathroom but the prunes made him go so quickly he wasn't able to always hold it until we reached there and ended up going in his diaper.

Every child is different but if you have been EC'ing from birth, once eating solids becomes a routine, it is easy to quickly figure out when your baby needs to go to the bathroom.

Around when my baby was 8 months old was our last "miss" when he had a bowel movement in his diaper.  He was having a couple bowel movements in the toilet a day at this stage and would always pee in the toilet when taken there, (we probably took him to the bathroom around 8 times a day at this age, although it is hard to remember since I had stopped writing things down by this point), but he was still peeing in his diaper too.  This was also around the time when he was able to finally use the ASL sign and tell us when he wanted to go.  He usually used the sign for a bowel movement but it occasionally signaled the need for just urination too.  And once he started to talk he would say he had to go "shee-shee" the Marathi word for "poo-poo."

The Diaper Free Baby covers "potty pauses," when your baby inexplicably resists wanting to go to the bathroom.  In those times, you don't resort to rewards or bribes or nagging but just let the baby do what he or she wants and it passes.  You can try changing the location of the toilet, placing it in front of a mirror, or even changing the toilet itself.  We had never experienced one until our son turned 19 months old and it lasted a week.

He still would poop in the toilet and pee about four times a day in the toilet but had no desire to pee the rest of the times in the toilet.  We tried some tricks that didn't involve pressuring him to use the bathroom, including setting a timer in the kitchen and telling him every time it beeped he could use the bathroom if he liked.  This tactic only worked occasionally so we changed things up and got a new red potty chair for downstairs and brought out our green potty chair for upstairs.  I was pregnant and we decided to reserve the smart potties for the newborn who was due in a few months.  The new red toilet helped but he was still resisting peeing in there as often as he used to.

So it was time to once again turn to my friend who had EC'd her three children.  She and her friends had gotten their kids out of diapers between the ages of 15-18 months but for her it involved taking her kids to the bathroom every hour to pee (since, like my son, they had stopped pooping in their diapers before age one).  I had known that and really wanted to try taking my son that often at fifteen months but I've been throwing up throughout my pregnancy, well into my third trimester.  I happened to be at my worst when my son was 15-18 months and didn't have the energy to take him that often.  She assured me it wasn't an issue and that I had to feel better before I could attempt this next stage.  So when I told her what was happening at 19 months, she said that every one of her kids went through their potty pause right before they were ready to go diaper free and make the move to underwear.

That made the frustrating week go by quicker.  I had thought that feeling wetness in underwear would help my son want to stop urinating unless he was in the bathroom and I was right.  So I purchased training underwear.  My son is smaller than the average American size so the only cotton training underwear I could find that could fit him was from Hanna Andersson and I still have to fold the waist for it to fit him better.  The Hanna Andersson Training Unders are made from 4-ply organic cotton and the XS size is for 12 months-3.5 years.  They are high quality training pants that will last through siblings as well, (and since by this stage an EC baby will not be pooping in the underwear the "unders" will only have had urine in them), so although they seemed pricey at the time, I can say they are definitely worth it.  (And Hanna Andersson has a big sale twice a year.  One of those times just happens to be now so if you want to stock up for the future, it is a great time to buy them).  I bought twelve pairs of their "unders" to begin the transition.  And because the unders are the same cut for boys and girls we were able to get all their solid colors to make underwear even more exciting, (pink, pastel blue, lavendar, gray, red and navy blue).  You know I love a company that doesn't restrict color options based on how society thinks genders should dress.

You can also find these Unders on sale on Zulily, and what I like most about them is there is no waterproof coating, so no chemicals to worry about touching your baby's skin.

My second son went through the strike at 13 months. I switched him to the Hanna Unders then but he was peeing every 20 minutes to an hour in them at that point and it was just too often to constantly take him to the bathroom. So I waited a few more weeks and switched him to underwear at 15 months.

The first week of my son wearing underwear was exhausting.  We had him wearing his baby leggings to cover his legs, a shirt and the unders.  He was peeing every 18 minutes and he was definitely not using the toilet every 18 minutes so we went through about 5 pairs of training underwear a day.

Instead of traditional potty training methods like stickers, on the advice of my friend, we talked to our son about the difference between wet and dry and how nice it felt to be dry.  I took two washcloths and soaked one with water and let my son feel the difference between the two several times a day.

By the middle of the second week he suddenly began to hold his pee for an hour and we only had one wet underwear that week.  He was now just in one diaper at his nap and one at night.

By the third week he was able to hold it for 1-3 hours and for the most part, woke up from his 2-hr nap in a dry diaper.  We switched him from leggings to the Doodle Pants under a pair of pants as an extra precaution, so he had the protection of the 4-ply organic cotton Hanna Andersson unders, the doodle pants and then regular pants over that in case he urinated in his underwear but he didn't end up needing all those measures.  When at someone's house in a diaper, he ended up telling me three times that he needed to go "shu-shu," (Marathi for "pee pee"), and went to the bathroom in the toilet every time.

With my second child, when we switched to underwear at 15 months, he peed in his underwear 4 to 5 times for the first three days. Then, he suddenly became more aware of when he was peeing and started telling me every time, including at night. So we heard a lot of, "I peed." In a couple more days, he started telling us before he was peeing, and would run to the bathroom and go. By this point, my 3 year old had switched from the Bjorn Potties to the Oxo Tot seats that go over an adult toilet. So my 1 year old knew that when he had to poop he would tell us so we would put him up on the adult toilet with the Oxo seat, and when he had to pee, he could just run to the Bjorn potties, which sat on the floor.

After 2 weeks, I decided to switch him to the Babee Greens Organic Cotton one-size cloth diapers for his naps. I didn't bother with a cover. I didn't want to deal with lanolizing a wool cover and I couldn't figure out what the waterproofing material was in many of the other brands' covers. Because the texture of the organic cotton diaper is very similar to the organic underwear he was wearing, I thought it would encourage him to not pee during naps. And sure enough after 2 days of accidents while napping, he didn't have one again and was able to hold it throughout his naps.  At 16.5 months we switched him to the organic underwear for naps too. Months later, at 19 months, he did have 2 or 3 accidents while napping but that was because he went through a couple weeks of napping for 3 hrs after not sleeping well at night. But those occasional incidents of peeing in his underwear during his nap also stopped and if he ever does take an extra-long nap he is dry during it.

When my second child turned 2 years old, we switched him to underwear for the night. The first two nights he peed in his underwear after 8 hours and then a couple hours after. But on the 3rd night, he suddenly stopped having accidents at night and was able to hold his pee for the entire night.

Every child is different and pauses can occur any time from changes or just a toddler's mood so I know there may be days after my baby is born when my older son resists going and has an accident.  But as of this writing, he is in his fifth week of underwear.  I still put a diaper on him for naps and he wears one at night but it is usually the same diaper, becaise he is generally not peeing in it during his naps, so we are down to one a day for the most part.  Although there were some setbacks during week four, (I was sick for a few days and he refused to go to the bathroom about half the time someone else took him and would then tell the caretaker immediately after that he peed in his underwear), I can now confidently put him in underwear for going out and he tells me when he needs to go so he doesn't urinate in his underwear anymore, even when out.

(Update: When we put our son in underwear for his nap, he once again started peeing during his nap for a couple days in a row but within a week it stopped and he was able to tell us every time he needed to pee so we no longer had to take him every hour or two, and all bathroom trips became "on demand.").

The early days of EC can be tiring, especially if you are doing it full-time and are trying to catch every pee and poop, but they are incredibly rewarding as well and within a couple weeks the urgent phase is over and it just becomes part of the routine.  While every baby will go through stages and phases in his or her own manner, EC is a great, natural, easy way to keep your baby happy and comfortable while meeting his/her needs and I cannot wait to start the process all over again when my next baby is born.

Diaper Free Baby's website has several resources, as does the EC Store.

And just for fun, here is Stephen Colbert's take on EC, because it is pretty darn cool when something you do gets ripped apart on the Colbert Report.

EC'ing my youngest, at 4 months, on my lap in a parked car into a diaper in the toilet


  1. Thank you for this post. I tried to EC my first two kids simply by reading "Diaper Free Baby" and also the EC book by Laurie Boucke. The wealth of information was overwhelming for me. I appreciate reading your abbreviated success me something to work with for my third and fourth babies? Thank you for sharing your story!

    1. Thanks! I hope it can be of some help. I will be updating it later this year to include my experiences with EC'ing my second child as well.

  2. I have been using EC since my son was 3 months old. He is now 13 months and has begun completely resisting the toilet after having been 66% toilet trained just 2 months ago. (I know because I tallied 100 eliminations). It is so frustrating! He knows very well and used to even be pretty good with cues but is now totally rebelling. What can I do?!!?

    1. Both my kids went through a phase for a few days, where they suddenly didn't want to use the toilet. They would both still poop in the toilet and pee a couple times in it but the rest of the time they did not want to pee in the toilet. My friend who had EC'd her children before me told me the strikes are common and to not get frustrated. She advised me to just ignore it for a few days and that with all 3 of her kids, when they went through that phase, it meant they were ready to switch to underwear. Her children all transitioned to underwear between 12 and 15 months. My youngest went through this phase at 13 months. My oldest at 15 months. When my oldest was 15 months old though, I was throwing up all day from my 2nd pregnancy so I couldn't handle transitioning to underwear. I did it a few months later when I felt better, when he was 18 months old. With my youngest, when I transitioned him to underwear at 13 months he was peeing very frequently still so he wasn't ready. So he went back to his diaper and then at 15 months he transitioned to underwear. I will be updating this post in a few weeks with my experience with EC and my 2nd son. Every kid is different and every situation is different. I'm sure your son will get over this phase soon!

    2. A couple more things that helped my kids during potty pauses were switching the location of the potties, or switching the colors of the Bjorns or switching from a low-back Bjorn to a high-back Bjorn.