A top developmental pediatrician counsels parents on how to respond to their kids' behavioral difficulties.
Discipline Strategies, p.1
What should you do when your 5-year-old won't go to sleep or do anything you ask without a negotiation? Or your 19-month-old throws temper tantrums when she doesn't get what she wants? While eliciting good behavior from children has always been a concern of parents, some experts believe this generation is struggling more because they're determined to use reason, not commands, with their kids.
"Parents want to listen to their children and treat them respectfully, but the downside is that sometimes their kids talk back or refuse to do what's asked of them," says Barbara Howard, M.D., an assistant professor of pediatrics at the Johns Hopkins University School of Medicine, in Baltimore, MD, who calls this the democratic approach to parenting. "And parents don't know how to respond."
Recently, Child gathered a group of parents who were stymied by discipline issues and gave them an opportunity to pose their questions to Dr. Howard. A developmental and behavioral pediatrician -- a relatively new and growing subspecialty that puts particular emphasis on discipline-related problems -- Dr. Howard was president of the Society for Developmental and Behavioral Pediatrics and is co-director of the Center for the Promotion of Child Development through Primary Care in Annapolis.
After listening and asking a few key questions, Dr. Howard was able to quickly discern why the children were misbehaving and offer practical solutions. Indeed, by the end of the three-hour lunch meeting, Dr. Howard had detailed a discipline method designed not only to improve children's conduct but also to strengthen parents' relationship with their kids for years to come. (To protect the participants' and their children's privacy, names were changed.)
Discipline Strategies, p.2
How can I get my daughter to sleep through the night?
Liz: For the last 18 months, my 4-year-old has been waking up at night. It started when I was pregnant with my son, who's now 15 months old. At first, she'd wake only once a night. Now she gets up five or six times and climbs into our bed. Each time, I put her back into her room. I can't sleep with her. She's a mover and shaker.
Dr. Howard: What's your bedtime routine?
Liz: I give both of the kids a bath, then I put the child who's more tired to bed first. Last night it was my daughter, so we went into her room. Usually we read stories while my son plays on the floor. And when the story's over, I either sit with her until she falls asleep or I leave right before she goes to sleep.
Dr. Howard: Let's start off with a question. How routine does this family's bedtime routine sound? The answer is, not very. Mom doesn't always put the kids to bed exactly the same way or in the same order.
Children need a consistent bedtime routine -- read two books, kiss the rabbit, pull down the shade, and that's it -- every single night. And the younger sibling should always be put to bed first. Then Big Sister has Mom to herself and doesn't have to worry about all the wonderful things Mom is doing with Baby Brother after she goes to sleep. Now, I realize that if toddlers take a long nap during the day, they may not be ready to sleep. Therefore, try to schedule your son's day so he's in bed first, even if that means keeping your daughter awake later than usual. Then you must leave her room before she falls asleep. Children who fall asleep only under certain circumstances need to recreate those circumstances to fall back asleep in the middle of the night.
By the way, I am not against co-sleeping. Our culture is one of the few that expect children to sleep alone from an early age. This is not the natural state of affairs. It certainly doesn't hurt children to sleep on their own, however, and if you want your daughter to sleep alone, make sure she falls asleep alone. If she wakes up in the middle of the night, put her back to bed without talking. Do it over and over again, if necessary. Or put your daughter in bed, close the door, hold the handle, and tell her that the door will stay closed and the light will stay off.
Discipline Strategies, p.3
Why is my son so disrespectful?
Teresa: My 5-year-old calls me stupid and says he doesn't love me. Sometimes I say, "That's not nice." Other times I get angry and tell him if he can't say anything nice, he shouldn't talk to me. At times, I've even thrown out a favorite toy. Nothing works.
He also doesn't sleep through the night. We've tried sleep training, but every night he climbs into our bed with us and starts talking. I don't even know if he's awake.
Dr. Howard: And to curb your son's mean behavior, you've tried everything from being nice to --
Teresa: -- washing his mouth out with soap. I know it sounds horrible, but if you have a kid who's constantly saying, "Mommy is stupid," in front of 9 million other people, you're going to put some soap in his mouth. He knows he's hurting my feelings. He doesn't care.
Dr. Howard: I think he cares quite a lot about your feelings. He is what's now called an intense child. In the 1970s, psychologists Alexander Thomas and Stella Chess found there were three basic types of children's temperaments: easy, slow to warm up, and difficult, which I call intense. Intense kids are more sensitive and prone to outbursts.
But your son is now in a rut where he thinks of himself as a bad person and acts accordingly. One way I know that is because of his sleeping problems. It's common for kids who feel out of control during the day to have sleep issues. Kids must feel safe in order to be able to sleep soundly. To feel that, they need their parents; they know that if their parents gave up on them, they'd be sunk. I call it the lifeboat theory. Your son doesn't feel safe because he thinks you have a good reason to dump him out of the lifeboat.
Instead of using soap, work on making your responses boring. Most parents don't know how to do this, so I'll clue you in. When a child performs a repetitive behavior, he's getting a charge from it. He calls you stupid, and he gets an interesting response -- he never knows what it will be. So you have to start being boring.
Many experts would recommend that you simply ignore him. That's hard to do when a child is hurtful. I recommend instead that you use pat phrases. Here's one: "Oh, you know I don't like it when you say that." It's important to say the pat phrase the same way every time, without emotion. Be completely boring.
Initially, your son may have what's called a response burst: When you first start changing your behavior, your child will test it. And your son's behavior may get worse as he finds a whole new basket of words to dump on you. But your response must stay flat and emotionless. If you can't do that, walk into another room. Once his behavior improves, he should sleep better.
Discipline Strategies, p.4
How can my husband and I just say no?
Nora: My 3-year-old son has started begging me to buy him toys. I don't know where this is coming from. One day we were in the car, and he screamed that he wanted to go to the toy store. My daughter joined in, screaming that she wanted a toy too.
Dr. Howard: Your son is trying out a new behavior. You need to make your decision about the toy quickly, before the whining escalates into a fit. So is it okay to go to the toy store? Say yes or no. Avoid saying yes after the fit, because that sends the wrong message. If you say no, you can explain why, but keep it brief and don't let it turn into a negotiation. Then keep driving.
Nora: But what if my husband and I have different views? After gymnastics, our son now screams that he wants a juice box from the vending machine, even though I have one in the car. I don't want to get him one, but my husband is saying, "Just give it to him!" He can't stand all the screaming.
Dr. Howard: Whether you give him the juice box doesn't matter as much as whether you and your husband argue about it in front of your son. If a child senses tension on a particular topic, he'll work you over longer. You and your husband might need to come up with a signal that means the other should just stop talking.
Another piece of marriage advice: Whoever starts handling a situation should finish, and the other parent should stay out of it. If you disagree, discuss it later in private. Don't worry if you both don't handle every situation the same. A child can adjust between Mom's and Dad's ways, as long as each parent is consistent.
Discipline Strategies, p.5
Is time-out the answer for my toddler?
Gail: I have a 21-month-old who is strong-willed. Lately she's started throwing food from the high chair. I tell her to stop. She looks straight at me, smiles, and does it again. We don't know how to handle it. Time-outs don't seem right for a child her age.
Dr. Howard: Let me translate for you what's happening. When you say no to your 21-month-old and she looks at you with a gleam in her eye and throws the food anyway, she's actually in an early stage of moral development. She's testing to see what reaction you'll have. It's as if she's saying to herself, "I was right! She told me not to do it. That's the rule!" It's quite normal.
Because she isn't sensitive to criticism, you need to rethink what you're willing to do. Children as young as 9 months old can learn from time-outs. Am I recommending that for your daughter? No. Use the least amount of discipline that works. Take her out of the high chair and don't give her anything to eat for an hour. Do this without any emotion: "Oh, well, I guess you're finished."
Gail: What if she wants to go back into the high chair?
Dr. Howard: Too bad, not now. Soon she'll learn not to throw food because she'll want to eat. As for time-outs, reserve them for aggressive acts such as hitting, kicking, and biting. Time-outs can change a child's conduct within a few weeks -- if parents use the time-out whenever the child exhibits the unwanted behavior. But if you use it for every little transgression, your child will be in time-out all day, and the technique will lose its power.
When the time-out is over, forget about it. Don't give your child a lecture -- that only makes her feel she's mean. And if your child continues to struggle, consult a social worker, psychologist, or child psychiatrist. You won't need a lifetime of therapy to see results; a child psychiatrist typically has just six sessions with a family. Those early years are so crucial to your child's development. Make the investment now, and you'll be helping your child forever.
Copyright © 2004. Reprinted with permission from the November 2003 issue of Child magazine.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.