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PEDIATRIC HEALTH & WELLNESS
This component focuses on the development of infants, toddlers and children of varying developmental stages. Our information is tailored specifically to the young parent, placing emphasis on parenting dilemmas and the challenge of providing a positive environment for the family.
Why Positive Reinforcement Works
Sometimes my child is very aggressive. What is the best way to prevent this type of behavior? The best way to prevent aggressive behavior is to give your child a stable, secure home life with firm, loving discipline and full-time supervision during the toddler and preschool years. Everyone who cares for your child should be a good role model and agree on the rules he’s expected to observe as well as the response to use if he disobeys. Whenever he breaks an important rule, he should be reprimanded immediately so that he understands exactly what he’s done wrong.
Self control
Your youngster has little natural self-control. He needs you to teach him not to kick, hit, or bite when he is angry, but instead to express his feelings through words. It’s important for him to learn the difference between real and imagined insults and between appropriately standing up for his rights and attacking out of anger.
Supervision
The best way to teach these lessons is to supervise your child carefully when he’s involved in disputes with his playmates. As long as a disagreement is minor, you can keep your distance and let the youngsters resolve it on their own. However, you must intervene when children get into a physical fight that continues even after they’re told to stop, or when one child seems to be in an uncontrollable rage and is assaulting or biting the other. Pull the children apart and keep them separate until they have calmed down. If the fight is extremely violent, you may have to end the play session. Make it clear that it doesn’t matter who “started it.” There is no excuse for trying to hurt each other.
Your example
To avoid or minimize “high-risk” situations, teach your child ways to deal with his anger without resorting to aggressive behavior. Teach him to say “no” in a firm tone of voice, to turn his back, or to find compromises instead of fighting with his body. Through example, teach him that settling differences with words is more effective— and more civilized—than with physical violence. Praise him on his appropriate behavior and help explain to him how “grown-up” he is acting whenever he uses these tactics instead of hitting, kicking, or biting. Always watch your own behavior around your child. One of the best ways to teach him appropriate behavior is to control your own temper. If you express your anger in quiet, peaceful ways, he probably will follow your example.
Discipline
If you must discipline him, do not feel guilty about it and certainly don’t apologize. If he senses your mixed feelings, he may convince himself that he was in the right all along and you are the “bad” one. Although disciplining your child is never pleasant, it is a necessary part of parenthood, and there is no reason to feel guilty about it. Your child needs to understand when he is in the wrong so that he will take responsibility for his actions and be willing to accept the consequences.
When to call the pediatrician
If your child seems to be unusually aggressive for longer than a few weeks, and you cannot cope with his behavior on your own, consult your pediatrician. Other warning signs include:
• Physical injury to himself or others (teeth marks, bruises, head injuries)
• Attacks on you or other adults
• Being sent home or barred from play by neighbors or school
• Your own fear for the safety of those around him
The most important warning sign is the frequency of outbursts. Sometimes children with conduct disorders will go for several days or a week or two without incident, and may even act quite charming during this time, but few can go an entire month without getting into trouble at least once.
Your pediatrician can suggest ways to discipline your child and will help you determine if he has a true conduct disorder. If this is the problem, you probably will not be able to resolve it on your own, and your pediatrician will advise appropriate mental health intervention.
The pediatrician or other mental health specialist will interview both you and your child and may observe your youngster in different situations (home, preschool, with adults and other children). A behavior management program will be outlined. Not all methods work on all children, so there will be a certain amount of trial and reassessment. Once several effective ways are found to reward good behavior and discourage bad, they can be used in establishing an approach that works both at home and away. The progress may be slow, but such programs usually are successful if started when the disorder is just beginning to develop.
Understanding Violent Behavior In Children and Adolescents
There is a great concern about the incidence of violent behavior among children and adolescents. This complex and troubling issue needs to be carefully understood by parents, teachers, and other adults.
Children as young as preschoolers can show violent behavior. Parents and other adults who witness the behavior may be concerned; however, they often hope that the young child will "grow out of it." Violent behavior in a child at any age always needs to be taken seriously. It should not be quickly dismissed as "just a phase they're going through!"
Range of Violent Behavior
Violent behavior in children and adolescents can include a wide range of behaviors: explosive temper tantrums, physical aggression, fighting, threats or attempts to hurt others (including homicidal thoughts), use of weapons, cruelty toward animals, fire setting, intentional destruction of property and vandalism.
Factors Which Increase Risk of Violent Behavior
Numerous research studies have concluded that a complex interaction or combination of factors leads to an increased risk of violent behavior in children and adolescents. These factors include:
• Previous aggressive or violent behavior
• Being the victim of physical abuse and/or sexual abuse
• Exposure to violence in the home and/or community
• Genetic (family heredity) factors
• Exposure to violence in media (TV, movies, etc.)
• Use of drugs and/or alcohol
• Presence of firearms in home
• Combination of stressful family socioeconomic factors (poverty, severe deprivation, marital breakup, single parenting, unemployment, loss of support from extended family)
• Brain damage from head injury
What are the "warning signs" for violent behavior in children?
Children who have several risk factors and show the following behaviors should be carefully evaluated:
• Intense anger
• Frequent loss of temper or blow-ups
• Extreme irritability
• Extreme impulsiveness
• Becoming easily frustrated
Parents and teachers should be careful not to minimize these behaviors in children.
What can be done if a child shows violent behavior?
Whenever a parent or other adult is concerned, they should immediately arrange for a comprehensive evaluation by a qualified mental health professional. Early treatment by a professional can often help. The goals of treatment typically focus on helping the child to: learn how to control his/her anger; express anger and frustrations in appropriate ways; be responsible for his/her actions; and accept consequences. In addition, family conflicts, school problems, and community issues must be addressed.
Can anything prevent violent behavior in children?
Research studies have shown that much violent behavior can be decreased or even prevented if the above risk factors are significantly reduced or eliminated. Most importantly, efforts should be directed at dramatically decreasing the exposure of children and adolescents to violence in the home, community, and through the media. Clearly, violence leads to violence.
In addition, the following strategies can lessen or prevent violent behavior:
• Prevention of child abuse (use of programs such as parent training, family support programs, etc.)
• Sex education and parenting programs for adolescents
• Early intervention programs for violent youngsters
• Monitoring child's viewing of violence on TV/videos/movies
Children and TV Violence
No. 13; Updated November 2002
American children watch an average of three to four hours of television daily. Television can be a powerful influence in developing value systems and shaping behavior. Unfortunately, much of today's television programming is violent. Hundreds of studies of the effects of TV violence on children and teenagers have found that children may:
• become "immune" or numb to the horror of violence
• gradually accept violence as a way to solve problems
• imitate the violence they observe on television; and
• identify with certain characters, victims and/or victimizers
Extensive viewing of television violence by children causes greater aggressiveness. Sometimes, watching a single violent program can increase aggressiveness. Children who view shows in which violence is very realistic, frequently repeated or unpunished, are more likely to imitate what they see. Children with emotional, behavioral, learning or impulse control problems may be more easily influenced by TV violence. The impact of TV violence may be immediately evident in the child's behavior or may surface years later. Young people can even be affected when the family atmosphere shows no tendency toward violence.
While TV violence is not the only cause of aggressive or violent behavior, it is clearly a significant factor. Parents can protect children from excessive TV violence in the following ways:
• pay attention to the programs their children are watching and watch some with them
• set limits on the amount of time they spend with the television; consider removing the TV set from the child's bedroom
• point out that although the actor has not actually been hurt or killed, such violence in real life results in pain or death
• refuse to let the children see shows known to be violent, and change the channel or turn off the TV set when offensive material comes on, with an explanation of what is wrong with the program
• disapprove of the violent episodes in front of the children, stressing the belief that such behavior is not the best way to resolve a problem
• to offset peer pressure among friends and classmates, contact other parents and agree to enforce similar rules about the length of time and type of program the children may watch
Parents can also use these measures to prevent harmful effects from television in other areas such as racial or sexual stereotyping. The amount of time children watch TV, regardless of content, should be moderated because it decreases time spent on more beneficial activities such as reading, playing with friends, and developing hobbies. If parents have serious difficulties setting limits, or have ongoing concerns about their child's behavior, they should contact a child and adolescent psychiatrist for consultation and assistance.
"If a child lives with approval, he learns to live with himself."
Dorothy Law
After a long day at the office, with more work facing you at home, the last thing you might feel like doing is being positive. But it is crucial that, even during conversations aimed at correcting behavior, you keep your tone positive.
What is positive communication?
Positive communication is a tool to reinforce good behavior and eliminate bad behavior; it builds self-esteem and inspires confidence in children. And it's easy — once you get the hang of it! A child's feelings of esteem is highly influenced by interaction and relationship with parents. All children need to feel loved and accepted, and you can communicate those feelings to your children by the way you speak.
Once you develop the habit of consistent positive reinforcement at home, you'll see that communicating is easier, and you will also be helping your son or daughter learn to communicate with the outside world. By the time they are in elementary school, kids need the self-esteem boost gained when positive reinforcement is in practice.
Rules of the road
Face your child and maintain eye contact.
• Always allow your child to finish talking and complete his statements.
• "Labeling is disabling" — label the behavior instead of the child. Incorrect: "Billy, you are a bad boy." Correct: "Billy, it is irresponsible to leave your toys all over the place."
• Help your child learn to talk positively.
• Try to start your statements with a reinforcer, such as, "Sara, you are a very bright girl; now, let's talk about the best way to get your homework finished." People are more responsive to positive statements, but make sure your compliments are truthful. Children, as well as adults, will see through false flattery.
In the book Meta-Emotion: How Families Communicate Emotionally, by John M. Gottman, Lynn Fainsilber Katz, and Carole Hooven, the authors discuss educator and psychologist Dr. Haim Ginott's basic plan for positive reinforcement.
The four basic parts are: 1. Recognize and acknowledge the child's wish. 2. State the limit calmly and clearly. 3. Point out ways that her wish may be partially fulfilled. 4. Help the child express the resentment that arises when limits are imposed. "I know you would like to watch the TV show now, but we will tape it and you can watch it after your homework." by - Brenda L. Gargus Rewarding vs. bribing Reinforcers vary from child to child. You should be aware of the re-inforcers that your child values, and use them. Extra TV time, phone privileges, a Saturday at the mall — most kids enjoy these things. Use rewards when you feel your child has finished a difficult task, such as making the honor roll at school, getting a B (or even a C+) on a difficult test, or not arguing with her brother for two weeks. Don't confuse rewarding with bribing! You should not offer extra treats, money, or gifts for tasks you expect your child to do on a daily basis. Instead, use reinforcers and positive communication — to encourage your child to use the same form of communication with others. Try this at home Here are some time-tested hints for positive communication with your child. • Be firm and consistent. • Try not to force petty, time-consuming decisions, such as "Which color toothbrush do you want?" • Give your child chores when she's young. Chores build self-discipline and a sense of responsibility, but remember that she may need many calm reminders to complete them. • Accept the fact that children need to be told things over and over. If you have to repeat a direction, say it as if it were the first time. • A short list of chores is better than a long, possibly confusing or frustrating list. In general, lists (in either words or pictures) are better than simply telling your child what to do, because a list addresses two learning styles — auditory and visual — and a list lets your child be in control by checking off each task as he completes it. • Remember that some kids do not process multiple requests quickly or accurately. Get your child's attention first, and never shout from one room to the other. • Speak slowly; it will help your child absorb more of what you are saying. • If your child has a learning disability, she may be disorganized, and may have trouble relating an event in proper sequence. Keep a calm, uncritical, and non-irritable manner when explaining something to your child. James Baldwin once said, "Children have never been very good at listening to their elders, but they have never failed to imitate them." By being positive with your child and reinforcing the behavior you want repeated, you give her the blueprint for interacting with people outside of your home.
Please click here to read more about Positive Reinforcement
We are all faced with questions about our families' health and wellness. The following are a few of the topics that are addressed:
Also included are discussions on topics such as; childcare concerns, early learning, behavior problem solving, single parenting, working parents, potty training, understanding tantrums and much more.
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