Assisted infant toilet training: A pathway to planetary health?

Problem: Current infant care norms in Minority World settings promote prolonged reliance on nappies, underpinned by toilet training guidelines recommending initiation after 18 months, despite the absence of supporting empirical evidence. This approach extends material and energy use associated with infant hygiene and remains largely unexamined within maternity care and midwifery education. Background: Assisted infant toilet training (AITT) is a responsive infant toileting practice in which infant physiological cues guide timing, while caregivers facilitate elimination through hygienic support and positioning over a receptacle. Distinct from independence-focused toilet training, AITT can commence from birth and aligns with the preventive, relational, and educational scope of midwifery practice. While widely practised across Majority World contexts, it is rarely addressed within contemporary midwifery education in Minority World settings. Aim: To explore AITT as an alternative option to independence-focused toilet training and examine its relevance within the midwifery scope of practice and planetary health frameworks. Methods: This discussion paper synthesises evidence from infant health research, midwifery philosophy, and planetary health literature. Findings: AITT may reduce the duration and intensity of nappy dependence, with associated reductions in material and energy use across disposable and reusable hygiene systems. Available evidence indicates no increased health risks compared with independence-focused toilet training, while supporting cue-responsive caregiving consistent with core midwifery values. Conclusion: Integrating AITT into antenatal and postnatal education offers midwives a practical, evidence-informed opportunity to respond to gaps in current guidance while aligning early infant care with planetary health goals.