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Chapter 1 Index
A. General Information
about the well child examination B. Nutrition Issues
C. Sleep Issues
D. Dental Issues
E. Anticipatory Guidance
--Discipline: Normal
Toddlers |
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Discipline: To Spank or Not to Spank
Talk given by Drs. Flowers, Boudreaux, McLeod, Stallworth,
Hebert
Introduction: Parents often ask about how they should
discipline and/or punish their children. Discipline refers to systems of
teaching, learning, and nurturing that are used in child rearing. 90% of
pediatricians report that they include advice about discipline during
anticipatory guidance visits. The Academy of Pediatrics has come out (April
1998) with the following statement: “Parents should be encouraged and
assisted in developing methods other than spanking in response to undesired
behavior.” This statement appears at a time when over 90% of parents admit
to spanking, and over 50% of parents that spank state they do so in anger.
Each pediatrician will have to determine whether he or she agrees with this
statement, and what approach to take when asked questions about this in
practice.
Advocates of Spanking: State that there is little objective
evidence that spanking leads to aggression and later abuse. They state that
it should always be done when calm, only one or two spanks to the buttocks,
should never cause physical injury and should always be followed by a hug.
They also state that it is inappropriate before 15 months of age, and after
6 years of age.
Alternative Strategies to Spanking: The AAP give parents
three major alternative strategies
- Encourage families to develop positive, supportive, loving
relationships between parents and child. The way to bring this about is
by showing attentiveness and interest in activities, being consistent,
show respect for the child, allowing the child more freedom of choice as
gets older.
- Instruct parents in giving more positive reinforcement than negative.
Parents need to praise children often and put less emphasis on trivial
misdeeds.
- Attempt to reduce or eliminate undesirable behaviors by giving clear
explanations of the problem behaviors and its possible consequences.
Alternative to corporal punishment include: time out (1 minute a year up
to 4-5 minutes); verbal reprimands.
Discipline vs. punishment: Dr. Barton Schmitt: Approach
needs to be age-appropriate:
Set limits (i.e. begin discipline) after the child is 6 months of age:
- 6 months to 3 years of age: Structure the home environment,
distract the child, ignore harmless behavior, and express verbal and
nonverbal disapproval, by using temporary time-out.
- 3 to 5 years of age: Internal controls (self-control) now all
of the above, use natural consequences, use logical consequences, restrict
places where child can misbehave.
- 5 years to adolescence: Above plus delay privileges.
Conclusion: Discipline or limit setting is an important
part of parenting and should begin after six months of age. Punishment can
take a number of forms including corporal punishment. The Academy of
Pediatrics recommends an age-appropriate approach to try and find forms of
punishment other than spanking while others promote spanking in a controlled
fashion after the age of 15 months. In a society in which greater than 90%
spank their children, parents will be emotional on this subject. If you are
going to advise parents to not spank, as long as your advice is presented
carefully, and supported with the AAP’s statement, parents will listen
calmly to your advice - even if it differs from their approach.
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