PRACTICE GUIDE EFFECTIVE DISCIPLINE CHILD DEVELOPMENT 12 Months-Introduce 15 Months-Reinforce 2 Years-Reinforce FINDING OUTLETS FOR YOUR CHILD’S AUTONOMY/TANTRUMS PROBLEM SOLVING A BEHAVIORAL ISSUE NORMAL CHILDHOOD AGGRESSION All parents experience frustration as children grow through early childhood developmental milestones. Early childhood is a time of discovery: every day, the toddler learns new things about herself and her environment, and new ways to relate to others. Parents are learning, too, often trying frantically to keep pace with the child’s ceaseless exploration and growth. It would be remarkable, indeed, if all went smoothly. When one party or another is fatigued or stressed, when expectations exceed performance, tempers can flare. By helping parents keep their perspective and teaching appropriate developmental expectations, pediatricians can help prevent crises. It is essential that the child explore in order to grow; it is equally important that she do it safely. Babies and toddlers learn by being curious. Curiosity and intelligence compel babies to touch, handle, put things in their mouth, and take things apart. While this can be stressful, or even dangerous, there are steps that parents can take to respond more positively to their children and allow safe exploration. Responsible parents do their part by imposing limitations and structure to create safe spaces for them to explore and play, while recognizing and responding flexibly to the infant’s needs. A good “developmental IQ” can help parents to understand their child, and to develop effective strategies for responding. The pediatric office is an excellent place to begin to develop this understanding. Assessment When does your baby “lose it”? (hungry, tired…) • • • What makes you “lose it” with your baby? What do you do then? Anticipatory Guidance Strategies for parents: • Managing the stress of a frustrating situation: o Take a moment to remember that the child is the one with the problem. o Make sure the child is in a safe place. o Take ten deep breaths before responding to the behavior. o Call a friend or family member to talk about your emotions or to provide childcare. • Preventing problems before they start: • Remember to take time for yourself in the form of hot baths, exercise, reading, spending time with friends, or just being in a quiet room alone. • Consider your child’s limitations, temperament, and developmental level when planning your day, be flexible. • Childproofing reduces the number of times you have to say, “no.” Removing the “no’s” from the environment reduces stress for both of you. Remove valuable, breakable, and hazardous items from child’s reach. 1 Use child safety gates and lock doors to keep unsafe areas inaccessible to small children.
FINDING OUTLETS FOR YOUR CHILD’S AUTONOMY/TANTRUMS PROBLEM SOLVING A BEHAVIORAL ISSUE
NORMAL CHILDHOOD AGGRESSION All parents experience frustration as children grow through early childhood developmental milestones. Early childhood is a time of discovery: every day, the toddler learns new things about herself and her environment, and new ways to relate to others. Parents are learning, too, often trying frantically to keep pace with the child’s ceaseless exploration and growth. It would be remarkable, indeed, if all went smoothly. When one party or another is fatigued or stressed, when expectations exceed performance, tempers can flare. By helping parents keep their perspective and teaching appropriate developmental expectations, pediatricians can help prevent crises. It is essential that the child explore in order to grow; it is equally important that she do it safely. Babies and toddlers learn by being curious. Curiosity and intelligence compel babies to touch, handle, put things in their mouth, and take things apart. While this can be stressful, or even dangerous, there are steps that parents can take to respond more positively to their children and allow safe exploration. Responsible parents do their part by imposing limitations and structure to create safe spaces for them to explore and play, while recognizing and responding flexibly to the infant’s needs. A good “developmental IQ” can help parents to understand their child, and to develop effective strategies for responding. The pediatric office is an excellent place to begin to develop this understanding. Assessment
When does your baby “lose it”? (hungry, tired…) • • •
What makes you “lose it” with your baby? What do you do then?
Anticipatory Guidance Strategies for parents: • Managing the stress of a frustrating situation:
o Take a moment to remember that the child is the one with the problem. o Make sure the child is in a safe place. o Take ten deep breaths before responding to the behavior. o Call a friend or family member to talk about your emotions or to provide childcare.
• Preventing problems before they start: • Remember to take time for yourself in the form of hot baths, exercise, reading, spending time
with friends, or just being in a quiet room alone. • Consider your child’s limitations, temperament, and developmental level when planning your
day, be flexible. • Childproofing reduces the number of times you have to say, “no.” Removing the “no’s” from
the environment reduces stress for both of you. Remove valuable, breakable, and hazardous items from child’s reach.
1
Use child safety gates and lock doors to keep unsafe areas inaccessible to small children.
Children need routines to feel secure. 1,2 The parents’ job is to teach the child proper behavior, and learning depends on predictability. Providing structured daily routines while learning to recognize and respond flexibly to the child’s needs reduces resistance, conveys respect for the child, and renders negative experiences less stressful. Assessment
• Can your child anticipate daily activities (playtime, bath-time, meals, and sleeping)? • How predictable is your child?
Anticipatory Guidance
Understand that, while routines can be important, that they can be hard to establish for some infants. Routines are best established if you try to follow the baby’s cues and patterns rather than trying to impose routines that conflict with these patterns.
•
• Remember that a child whose routines are disrupted may have trouble regulating his behavior. When he misbehaves, ask “Is he hungry? Is he tired?” before you act.
Discipline is more than merely punishing improper behaviors – it’s teaching proper ones. Teaching desired behavior begins on a foundation of positive parenting that includes daily routines, praise for desired behavior, and a nurturing and understanding environment. Parents can then 1) communicate clear expectations, 2) show the children how to be successful, and 3) focus more attention on their child’s positive accomplishments than on perceived misbehavior. Building on this foundation, parents can support their children in moving to independence by helping them take responsibility for their actions and use effective coping skills to resolve conflicts. Teaching and rewarding become the center of their parenting. Tantrums begin at this age! If your child is safe, simply wait it out. Reasoning with toddlers does not generally work, especially when they are frustrated and enraged. Calm parents can often figure out why the child is frustrated. It is best to get curious, not furious. When a parent responds to a tantrum with anger, the child becomes the teacher. A parent who can predict which situations will lead to tantrums can anticipate and redirect before the situation gets out of control.
Assessment When your child is doing something good, how do you communicate this to him/her? •
• •
•
When your child is doing something bad, how do you communicate this to him/her? When you tell them what they are doing wrong, do you also show them what would be
right? Does your child have tantrums? What do you do when they occur?
• Does your child hit or bite? How do you handle this?
2
Anticipatory Guidance • Responses to misbehavior must be developmentally appropriate to be effective. Distraction
and diversion are the best disciplinary measures for infants and toddlers. Changing the environment or the activity is an effective way to change your child’s behavior.
• Redirect any activity using a neutral voice. Infants don’t understand the word or concept of “no” before they are about 9 months old, and need frequent reminding for a long time after that.
• TIPS: Never bite or hit back Redirect your baby; pull her away.
Show her alternative behaviors. Watch for the warning cues prior to the biting and redirect her to something else.
• Give immediate praise for behaviors you want to reinforce. Don’t laugh or smile at behaviors that you do not want to continue. Be consistent in communicating what you expect.
• Ignoring behaviors, such as whining or tantrums can be very effective. Negative behaviors are often attention-seeking behaviors, but sometimes just redirect a child who is over stimulated or tired. In either case, they stop faster without an audience.
• Build responsibility by offering your child choices, but make sure the child’s decisions will be acceptable to you: “We’re going to the supermarket. Do you want to wear your sweater or your jacket?”
• It is common for children to try out aggressive behaviors to try to get their way. A good response to hitting and biting can be simple limit setting: “No hitting.” and “No biting.”
Couple this with concrete suggestions to help play go more smoothly: “Why don’t you boys take turns.” Acknowledge good behavior, “I love to see you playing so nicely.”
• When these other strategies don’t work, it may help for child to take a “time out”. Rather than a punishment, a time out is a chance for the child (and often for the parent as well) to cool off and regroup. To be effective they must be consistent and shouldn’t last too long: try one minute for each year of age. Try to give a few warnings about a time out before actually instituting it, and follow it up with a brief explanation of the misbehavior, and of the desired behavior.
Children learn from their parents. Parents should model positive ways to deal with angry feelings. Parents who can remain calm during stressful situations set an example for their children to do the same. Keep voices at a moderate level; use words to state how you’re feeling, and stick to the issues at hand. Make it clear to the child that while the behavior might not be acceptable, the parent’s love for the child is unchanged. Avoid using negative terms to label the child. Never shame or humiliate a child when addressing undesirable behavior. A child whose feelings are respected will learn to respect the feelings of others. Maintain kindness to your child and have a sense of humor. There are several undesirable consequences of spanking and hitting, children learn to use physical force to express anger and deal with conflict, parents often use physical force when they are angry themselves, and it does nothing to teach alternative ways of behaving.
Assessment: • How were you disciplined as a child? Do you plan to do the same with your child? • Do you discuss discipline methods with your partner? Do you agree on what’s best in
disciplining your child?
3
• How does your child see you handling conflict?
Anticipatory Guidance: • Set a good example. • Help children to express their feelings with words rather than hitting. • Avoid spanking or hitting. It can hurt your child physically and emotionally. • BE firm and consistent with limit setting and expectations • Criticize the behavior, not the child. “Don’t run into the street” is better than “You’re a bad
boy.” Make the consequence match the circumstance. Use natural and logical consequences. A natural consequence, e.g., might be having a friend not want to play for some time because of getting hurt; a logical consequence might be not going to the store for a few times if the toddler is disruptive or destructive when he/she does go.
In closing, the Practicing Safety effective discipline materials support the positive parenting approach by providing information connecting child behavior to child development.
THE PARENTING PYRAMID: Teaching Desired Behavior-putting punishment at the top of the pyramid.
The Parenting Pyramid, "Developed by Rose Allen, Family Relations Specialist, University of Minnesota Extension Service. All rights reserved. www.parenting.umn.edu," offers tangible suggestions parent can use to help them guide their child’s behavior. This information and guidance changes as the child grows in order to help parents achieve age-appropriate balances between fostering skills, independence, self-reliance, and disciplinary practices. This balance is schematically reflected below:
4
PARENT EDUCATIONAL MATERIALS
“How do Infants Learn” brochure Based on current brain development literature, this brochure developed by, Connected Kids: Safe, Strong, Secure, offers practical suggestions to parents. It promotes activities like reading or singing that encourage brain growth. Since some parents interpret an infant’s normal exploration as bad behavior, it helps parents understand that exploration is a natural developmental need and this can lay the groundwork for later discussions of toddler behavior and discipline.
“Teaching Good Behavior – Tips on Discipline” brochure
With increased mobility and rudimentary verbal skills, the toddler years can be an especially trying time for parents. New parents often look back to their own childhoods, and either emulate or negatively react to the way their parents raised them. This brochure developed by, Connected Kids: Safe, Strong, Secure describes the basics of a behavioral approach to parenting:
• Children seek parental attention. The most effective way to teach a child is to provide positive reinforcement for desired behaviors.
• Limit setting evolves from simple distraction (appropriate for infants), to the recitation of a simple rule (“No hitting.”), to the use of a brief time-out.
• Time-outs work best when children have learned they get positive attention for wanted behaviors. Think of a time-out as “time-out from positive reinforcement.”
“Temper Tantrums: A Normal Part of Growing Up” brochure
This brochure developed by the American Academy of Pediatrics, helps parents understand the many reasons children have tantrums. Strong emotions are difficult for children to express. They may become angry, frustrated, or disappointed which leads to temper tantrums. The information in the brochure addresses:
• Why children have tantrums. • How to help prevent temper tantrums. • What to do when tantrums occur. • When tantrums are serious.
“Playing is How Toddlers Learn” brochure
Connected Kids: Safe, Strong, and Secure developed this brochure, which helps parents understand normal toddler behavior. Its two main goals are to help parents:
• Provide a stimulating environment during this explosive period of brain development. • Understand the natural curiosity and exploration of toddlers.
Parents can come away appreciating how their toddlers think and not interpret natural curiosity as purposeful misbehavior.
“Splash Water On Your Face” brochure
Prevent Child Abuse America, developed this brochure that gives the parent 12 simple ways to take time out to cool down before addressing their child’s undesirable behavior.
Suggested Reading List
5
This booklist was suggested as a parenting resource to support the information that has been outlined in this module. Therefore, this list is just a starting point, as there are many books about discipline for young children on the market. The resources listed have not been reviewed or endorsed by the American Academy of Pediatrics.
These posters can be placed in exam or waiting rooms and can be used as a marketing tool to discuss the idea that each of these components needs to be operating effectively in the home for discipline to result in improved child behavior. This poster can also be used with other modules.
“Discipline: Teaching Limits With Love” – Video
The Parents Action for Children formally the I am Your Child Foundation developed this video featuring Dr. T. Berry Brazelton, to show parents that setting limits is not punishment, but a loving way to teach a child how to control his or her own behavior. This video can be played in the waiting room area or parents can check the video out when needed. (Available in English & Spanish)
STAFF TOOLS
Physician Prescription Pads
This pad is a tool that pediatricians or staff can give parents to remind them of things they can do when their child’s behavior makes them feel angry and frustrated. Generally, speaking, toddlers like to please their parents. Their curiosity, impulsiveness, and emotions can get in the way. Parents can help a great deal by noticing - with a word or a kind look - when their children are struggling to do the right thing. This sort of positive reinforcement powerfully communicates the "You can do it!" message, and is an important twin to the corrective discipline toddlers also require!
Cool Down Before Things Heat Up
This pamphlet designed by, Prevent Child Abuse America, can be used by staff to offer parents helpful ways to respond to behaviors such as: screaming, tantrums, whining, biting, toilet training and eating problems.
Guidance for Effective Discipline Policy Statement and Speaking Points
The American Academy of Pediatrics has provided speaking points from their policy statement on effective discipline that can be used as a cheat sheet for staff to highlight specific issues to address with parents when they have concerns about disciplining their child.
MODERATE/INTERACTIVES TANGIBLES ACTIVESANGIBLE
Behavior Chart
Use this instrument to record the kind of discipline you use. A good chart should include the time, a description of the child’s behavior, and a description of your response. Over the course of one week, you may realize that some forms of discipline do not work for your child or do not reap the desired behavior you were expecting. In this case, try using another style of discipline and then record how your response allowed for encouragement of good behavior. The objective is to find methods that work with your child while developing a healthy parent-child relationship.
Practicing Safety Timers
6
This tool can be given out to parents on an as-needed basis. The timer can allow for a few minutes to deal with stress in various situations. When used as a tool for effective discipline, the timer can help to structure time-out periods (removal of positive parental attention). Set the timer for one minute per year of age.
Practicing Safety Stress Ball The tennis-ball size stress ball, made of polyfoam, serves two purposes in helping parents to take the time to calm down before reacting to a child’s behavior. First, as a visual cue, it reminds parents of their goals in dealing more effectively with discipline issues. Second, the action of squeezing the ball can help to channel angry energy into harmless activity and reduce the impulse to respond physically to the undesirable behavior.
ISSUES MANAGEMENT
A toddler continues to act out, have tantrums, hurt other children despite time outs, removing from the activity, diverting to other activities.
1. Make sure that the parents are being consistent and supportive to each other 2. Try to better understand the home environment, the role of the parents, family, or other caregivers 3. Consider a home visitor assessing the home environment and discipline approaches 4. Role Play in the office 5. Make sure there are not other reasons for the tantrums: family dysfunction, neurodevelopmental
issues, attentional problems, and parental emotional problems. 6. Involve the child in day care for respite for the parent and to have other caretakers involved 7. Support the parent; use follow up phone calls or have them return on a regular basis 8. Consider a referral to child development 9. Consider enrolling the parents in a parenting class
Portions of this guide were adapted, with permission, from Spivak H, Sege R, and Licenziato V, eds. “Clinical Guide for Connected Kids: Safe, Strong, Secure.” Elk Grove Village, AAP, 2005 in press. 1,2American Academy of Pediatrics, Committee on Psychosocial Aspects of Child and Family Health Guidelines for Effective Discipline. Pediatrics. 1998; 101: 723-728.
7
No doubt about it, toddlers are ahandful! At times, it will seem likethey can be in two places at thesame time, and be headed fortrouble in a third one yet. Many aparent can recite nerve-rackingstories of toddlers perched on top ofthe bookcase, or of a fall that re-sulted in an emergency room visit.
Setting limits and maintainingsome kind of control are difficulttasks with toddlers because they areso independent, yet have so fewskills to communicate and solveproblems. The key to discipliningyour toddler includes love, under-standing, and quick thinking!
■ UnderstandingtoddlersToddlers are limited in theirability to communicate
Toddlers are interesting littlepeople. Like babies, they still like tobe held, talked to, and comforted.And they still often express them-selves by crying, shrieking, jabber-
ing, grunting, and pointing. Unlikebabies, however, toddlers can say afew words, which can mean manythings. “Cup!” may mean “Handme my cup,” “I want more milk,”“The cup just fell off the table,” or“The dog just stole my cup!” Atoddler, with this limited capac-ity to communicate, is thereforevery hard to understand.
Toddlers can tryyour patience
Sometimes, toddlers dothings that drive parents crazy.They reach out and grab things(like eyeglasses). They are ratherclumsy and awkward with ges-tures; a loving pat often turns intoan accidental whack. A spoonfulof peas may wind up on the floorrather than in the mouth.
Toddlers cannot shareToddlers are also very
possessive. “No,” and“Mine,” are favorite wordsand they are quite willing to hit
or bite to get (or keep) a favoritetoy. In fact, toddlers may spendas much time carrying aroundand protecting toys as they doplaying with them.
Toddlers are always “on thego” and often play until they“run out of gas.” They have verylittle skill at pacing themselvesand can be happy one minuteand cranky the next. Much ofthis behavior depends on thenew skills they are developing.The same toddler who screamsfor an unreachable cookie maylead or drag you to the jar andpoint at another time. Learningto do things in a socially accept-able way is a big step fora toddler.
■ How parentscan helpSet up a safe environment
One of the most importantthings a parent can do is toestablish a safe environment.“Toddler-proof” your home bylocking up dangerous chemicalsand medicines, covering electri-cal outlets, and storing breakableobjects up high, especially ifyour toddler is a climber!
You also may want to take aclose look at toys and how yourtoddler uses them. Getting hitaccidentally on the head with afoam block is no big deal, but a“bonk” on the head with a hardwooden block is more serious.A safe place to play and appro-priate toys to play with will saveyou from saying “No” and makeyour job as parent much easier.
Establish a routineToddlers need naps and rea-
sonable bedtimes. Small stomachsneed nutritious snacks and mealsfrequently. Growing bodies needtime to run, jump, and play everyday. Riding around all day in acar seat, sleeping in a stroller, andeating fast food is OK once in awhile, but if it’s happening oftenyou may want to rethink yourschedule. Taking care of basicneeds can go a long way inpreventing a cranky, whiny child.
Remove or isolateWhen a child is running out
into the street or about to get intothe household bleach, there is notime for negotiation. ParentsMUST remove a child from adangerous situation. Picking up,holding, or putting a child in thecrib for a few minutes until thingscan be made safe is perfectly OK.Your child may protest loudly,but your primary responsibility isto keep him or her safe.
DistractThis works especially well with
very young children.When a child is doingsomething unac-ceptable, try to callattention to anotheractivity—perhapsplaying with anothertoy or reading abook together. Thegoal is to temporarilydistract the child fromthe current problem. For example,if a child wants to play with break-
able knickknacks at a friend’s home,perhaps you can distract him orher with a stuffed toy. Since youngchildren’s attention spans are soshort, distraction is often effective.
RedirectIf your toddler is throwing
blocks, hammering on tables, ordrawing on books, remove thematerials while saying somethinglike “Blocks are for building, notthrowing.” At the same timesubstitute anotherappropriate toyfor the materialyou just tookaway and say“If youwant tothrowsome-thing,throw the bean bag into thebasket.” By redirecting the activ-ity into a more acceptable situa-tion, you let children know youaccept them and their play, andyou channel a problem activityinto a more acceptable activity.
IgnoreThe goal in this strategy is to
have the child stop the undesir-able behavior by not payingattention to it. This can be effec-tive in some situations with oldertoddlers. Withhold all attention,praise, and support. Without thedesired attention, children even-tually quit whatever they’redoing. This takes patience.
logical consequences teachestoddlers to help with the cleaningand to understand that cleaning upour mess is a part of growing up.
Set a good exampleToddlers love to imitate their
parents. If you want your toddlerto treat the dog kindly or havegood eating habits, be sure todemonstrate how to do it. Re-member also to talk about whatyou do. Even though toddlersmay not fully understand every-thing you say, they will begin tounderstand that there are reasonsfor doing things a certain way.
Help your toddlerunderstand “sharing”
As was mentioned earlier,sharing is not something thattoddlers do very well. Theyaren’t able to understand theprocess yet. Toddlers do enjoyplaying next to other children, butare not very good at playing withother children.
If you have several youngchildren, it is better (and easier) toprovide several similar toys thanto require sharing. Two toytelephones can prevent manysquabbles and may even encour-age children to cooperate andcommunicate better.
Toddlers usually find it difficultto share because they don’t reallyunderstand what ownershipmeans. They may think sharing atoy is the same as giving it away.
It is very common for a toddlerto give someone a toy, but expectit to be given right back. Older
brothers and sisters sometimeshave trouble understanding this.Sometimes it helps to explain thatyour toddler is just “showing” herbrother the toy. If your toddlerdoes share, give praise, but respectthe need to protect treasures.
Is it ever OK to spank?Toddlers often respond well to
physical action when you need todiscipline them. Touching themon the arm, taking them by thehand, picking them up, holding,or restraining them are all goodways to get their attention.
Spanking will also get theirattention, but doesn’t do a very
Use natural or logicalconsequences
Natural consequences areresults that naturally happen aftera child’s behavior. For example,the natural result ofrefusing to eat ishunger. Thenatural conse-quence ofdropping acookie in thebathtub is thatit becomessoggy.Naturalconsequences can be very effec-tive for teaching children whathappens when they do certainthings.
Logical consequences shouldbe used whenever natural conse-quences are dangerous or unprac-tical. For example, it would bedangerous for a child to experi-ence the natural consequence ofrunning into the street and beinghit by a car! Logical consequencesshould be logically connected to achild’s behavior and should teachresponsible behavior.
For example, if a child persis-tently flings peas across thekitchen or spills milk over theedge of the table, you may wantto use logical consequences. Firstremove the peas or milk untilthey can be used in an appropri-ate manner. Second, provide anopportunity for your toddler to“clean-up.” Peas that are droppedmust be picked up; milk that isspilled must be wiped up. Using
good job of teaching them how tobehave. In fact, it generallydistresses children so much thatthey can’t pay attention to yourexplanations or directions. It’shard to reason with a screaming,crying child.
Some parents who frequentlyslap a toddler’s hand are dis-mayed to find their toddlerslapping back. Or worse yet,slapping and hitting others.
Spanking and slapping canquickly get out-of-hand for bothparents and children. Most re-ported cases of abuse involveloving, well-meaning parentswho just lost control. Studiesshow that children who experi-ence or witness a great deal ofspanking, slapping, or hitting aremuch more likely to becomephysically aggressive themselves.
toddler needs guidance if youunderstand the reasons for his orher behavior and know youroptions. Good luck!
■ Read more about it!For more information about
children and families contact yourcounty extension office and askfor the following.Is Your Baby Safe At Home,
PM 954A-DUnderstanding Children: Temper
tantrums, PM 1529JUnderstanding Children: Toilet
training, PM 1529KUnderstanding Children: Biting,
PM 1529AUnderstanding Children: Fears,
PM 1529D
Also visit the ISU ExtensionWeb site athttp://www.extension.iastate.edu/store/
Toddlers love to imitate. Mostparents find it more successful toteach a child what to do ratherthan what not to do. It may help tothink of behavior problems asopportunities to teach your childnew skills. After all, the worddiscipline comes from the worddisciple, which means “to teach.”
■ A final noteDisciplining toddlers is not
easy. And you won’t always feelgood about how you handled asituation. It’s important to recog-nize that you are human. Afterall, it’s hard to be calm when yourtoddler tries to drown the catwith orange juice or smack you inthe face with a banana. You canrespond quickly when your
Written by Lesia Oesterreich, extensionfamily life specialist. Illustrations byLonna Nachtigal. Graphic design byValerie Dittmer King.
File: Family life 8
. . . and justice for all
The U.S. Department of Agriculture (USDA) prohibitsdiscrimination in all its programs and activities on thebasis of race, color, national origin, gender, religion,age, disability, political beliefs, sexual orientation, andmarital or family status. (Not all prohibited bases
apply to all programs.) Many materials can be madeavailable in alternative formats for ADA clients. To filea complaint of discrimination, write USDA, Office ofCivil Rights, Room 326-W, Whitten Building, 14th andIndependence Avenue, SW, Washington, DC 20250-9410 or call 202-720-5964.
Issued in furtherance of Cooperative Extension work,Acts of May 8 and June 30, 1914, in cooperation withthe U.S. Department of Agriculture. Jack M. Payne,director, Cooperative Extension Service, Iowa StateUniversity of Science and Technology, Ames, Iowa.
Temper Tantrums and Management Case: You are in a local shopping store on one of your days off, when suddenly you hear an infant screaming at the top of his lungs in the next aisle. You run over to examine the scene, and you witness a toddler throwing his toys all over the floor in addition to his screaming. Just as important you can sense that the mom is slightly embarrassed as well as frustrated. At that moment in time you begin to think….At what ages do temper tantrums normally occur? What are the causes of temper tantrums? What are the most effective ways to prevent and handle them? What are temper tantrums and when do they normally begin? Temper tantrums are behaviors that are attention seeking, which is typically unwanted by the caretaker, and occurs when the child encounters either physical or emotional challenges. Tantrums can include yelling, crying, complaining, throwing things etc. It is estimated that 50- 80% of toddlers (2-3 years of age) experience a tantrum once a week and 20% of them have them daily. Temper tantrums typically begin between the ages 18 to 36 months as the child continues to develop and gain independence from his or her caretakers. For example they want to be able to decide what pick up, what to eat, etc. As the child attempts to master more complex tasks, he or she will become more frustrated. However because of limited verbal skills they are not able to effectively communicate their frustration, which leads to the acting out of undesired behaviors. In addition, the environment surrounding the child can also contribute to the development of tantrums. Some of the risk factors are being exposed to violence, depression, substance abuse, and marital stress. It is important to remember that children have different temperaments which also contribute to the way that they express their frustrations. What are some methods that can be used to prevent temper tantrums? 1. Consistency Toddlers have trouble adapting to different environments which require different behaviors/expectations from them. They tend to adopt better when they have regular patterns or schedules. All care takers who are involved with the child should be consistent in regards to what is acceptable and the consequences for unacceptable behaviors. Inconsistency in reinforcement can often cause children to be confused as to what is right vs. wrong. Try to respond in the same way every time the child misbehaves. It is equally important for parents/caregivers to be firm with their toddler with expectations because when there is a lack there off the child is often left confused as to what is wrong or right. 2. Positive Reinforcement
Parents should remember to give positive reinforcement for desired behaviors. The reward should be developmentally appropriate for the childe and can range from encouraging words to material things. (Hugs, smiles, stickers). The goal is to make the child feel satisfaction for behaving in a way that is highly favored or acceptable. 3. Avoid Known Problems Simple things such as not taking your child out when they are hungry or sleepy can prevent a temper tantrum from taking place. If you plan to take your child out for a long duration, bring a snack, etc. In addition do not keep objects that are pleasurable to a child at their eye leveled. 4. Warnings The goal is to familiarize them with the rules. 5. Expectations Parents should ensure that they are setting reasonable/appropriate expectations on their child. Often children do not understand what is required or requested of them. This can be especially true for children who are developmentally delayed or larger for their age. How should a parent handle a temper tantrum? 1. Stay Cool It’s important to remember that as parents, you want to remain a role model to your child. If your child does engage in a tantrum the best thing that one can do is take a deep breath and return to the situation. The more attention you give the behavior, the more likely that the child is going to repeat it. 2. Time Outs Temper tantrums often responds to time outs or cooling out periods. Typically time outs are used as last resorts when other methods of discipline have failed. Time outs have been shown to be more effective when they take place in a specific chair, room, and of course when the object of dispute is removed. It is recommended that a child receive 1 minute of time out for each year of the child’s age. 3. Ignoring is another effective stratergy for dealing with minor discipline/temper tantrums. When tantrums occur in a safe environment, it is acceptable to withdraw both physical and verbal attention (positive reinforcement) from the child. It is important to consider that ignoring will not delete the behavior immediately, and it is imperative that this strategy is practiced by everyone in the home. Ignoring seems to be more effective for smaller discipline problems in which you want to conserve your energy. Remember to pick your battles. If the behavior puts the child or others at risk (ex biting, throwing items, etc) then one should intervene. The parent should briefly explain to the child why they were ignoring them and the proper way to behave. 4. Distraction
Often parents know the precipitating factors or events which can lead their child to develop a tantrum. If this is the case one can try to prevent a tantrum by focusing their attention to some other object or activity. 5. Verbal Reprimand If your child is old enough it is a good idea to discuss what happened and a better way to handle the situation next time. 6. Punishment It is not recommended that parents use punishment (ex spanking) as a method for controlling tantrums. It has been shown that punishment can promote withholding and anger and frustration in children and may increase the frequency of the tantrums. Most developmental specialists recommend the use of positive reinforcement as a tool when the child is behaving properly or ignoring when the child is in a safe environment having a tantrum.
As pediatricians, parents will often consult us with worries or frustrations in regards to their child’s temper tantrums. With sustained tantrums it is imperative that the pediatrician take a thorough history which includes: time, location, duration and frequency of the tantrums. It is also imperative to inquire about precipitating factors, parties involved, and how the tantrums are managed. Children with severe temper tantrums (three or more tantrums per day those last more than 15 minutes) have been associated with behavior/emotional problems. In addition once the pediatrician discusses a management plan with the family, follow up is important. It is important to remember that between tantrums the child’s behavior should be normal. Tiffany Cooke M.D. Reviewed by: Lawrence Gray M.D. References:
1. Needlman, Robert. Temper Tantrums: When to Worry. Contemporary Pediatrics 6 (8): 12 -34, 1989.
2. Howard, Barbara. Advising Parents on Discipline: What Works. Pediatrics 1996; 98; 809-815.
3. Beers, Nathaniel and Howard, Barbara. Managing Temper Tantrums. Pediatrics in Review 2003; 24; 70.
4. Temper Tantrums: A Normal Part of Growing Up. American Academy of Pediatrics 1989.
5. Spencer, Paula. The Golden Rules of Toddler Discipline. Parenting; May 2000.
