E. Anticipatory Guidance

Discipline: Normal Toddlers

Introduction: As a pediatrician, your advice on discipline will result from a combination of your upbringing, your biases about what does or does not work, the parents’ reactions to what you say, the underlying gender and personality of each child. The approach to developmentally delayed children, children with disabilities must be different; but in general advise parents to always be consistent with children, and, whenever possible, use positive reinforcement: (charts, rewards) not negative reinforcement (See spanking).

1. Temper Tantrums: Most often seen between 18 months and 3 years of age. Use Charts.

Rx:

Do not:	-show anger and hit child - may reinforce behavior
Do:	-Walk away from the child: if child follows and persists: -Time Out: best done in child’s room for 5-7 minutes. Helps to have a kitchen-type timer that rings when time up. Always hug child after punishment.

2. Head banging: Most common in the 15 month to 2 year old. Associated with overactive males; Rx: none. Reassure parents that no harm will come to the child

3. Biting: 18 mos. - 3 years. Can be very disruptive to family, playgroup, daycare, etc.

Rx:

Do not:	- Bite back: this is ineffective and can cause possible infection - Laugh and indicate you think it funny to have child bite - Discipline after the fact or say “You were a bad boy”
Do:	- Say “No” sternly immediately and tap (do not hit) mouth. - Say “That was a bad thing to do. No biting.” Use Time Out

4. Eating Problems: Defiant children can throw food on the floor, not eat with family, constantly get out of high chair, drink too many fluids, receive too many snacks. Problems with eating when young can translate to problems eating when older. (Acta Paed.1992;81:575)

Rx:

Do not:	- tell parents to make a lot of different meals in hopes child will eat something - offer more liquids and snacks during the day - allow children to wander around when everyone else eating - bribe and offer great things if only child eats a helping
Do:	- offer children three meals a day. If child insists on getting down, that’s it: no more food until the next meal. If parent does weaken and want to give child something, offer same meal just rejected. - have children come to table with family and get down when finished - restrict fluids and snacks between meals.

5. Sleeping Problems: see handout about sleeping issues. Ferber approach. Often sleeping, eating, and behavior problems occur in the same children: oppositional defiant children. Reassure parents that this behavior can be controlled and it will be controlled.

6. Toilet Training: Major area of conflict particularly with defiant boys. Use charts.

Rx:

Do not:	- start too young: infants can be trained, but relapse rate is high get angry, punish, show impatience
Do:	- start around 2 1/2 to 3 years of age; positive rewards OK to use - have 4-5 times each day without fail that parent takes child to bathroom. - start training when dry through naps and verbally aware of needs.

Department of Pediatrics | Medical College of Georgia
Please email comments, suggestions or questions to:
John T. Benjamin M.D., jbenj@mcg.edu

February 27, 2004

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