Frequent mild physical punishment (corporal punishment) may become less effective over time and tempt the parent to escalate the physical punishment, increasing the risk of child abuse. Corporal punishment teaches a child that in certain situations it is proper to strike another person. Commonly in households that use spanking, older children who have been raised with this technique are seen responding to younger sibling behavioral problems by hitting their siblings.
Threats by parents to leave or to give up the child are perhaps the most psychologically damaging ways to control a child’s behavior. Children of any age may remain fearful and anxious about loss of the parent long after the threat is made; however many children are able to see through empty threats. Threatening a mild loss of privileges (no video games for 1 week or grounding a teenager) may be appropriate, but the consequence must be enforced if there is a violation.
Birth and/ Crib safety Assess bonding and Back to sleep Exclusive breastfeeding Discuss parenting skills or 3−5 Hot water heaters attachment Crib safety encouraged Refer for parenting education days <120° F Identify family strife, lack of
Formula as a second-best Car safety seats support, pathology 2 months Burns/hot liquids Reassess firearm safety Back to sleep Parent getting enough rest and managing returning to work
Healthy snacks Read to child
Discuss strategies to avoid interpersonal conflicts Avoiding media violence Avoiding fights and walking away Discuss conflict resolution techniques Junk food versus healthy eating
Review school work Begin career discussions and college preparation (PSAT) Review substance abuse, sexuality, and violence regularly Discuss condoms, contraception options, including emergency contraception Discuss sexually transmitted diseases, HIV Providing no questions−asked ride home from at-risk situations
HIV, Human immunodeficiency virus; PSAT, Preliminary Scholastic Aptitude Test. *Reassess means to review the issues discussed at the prior health maintenance visit.
Parenting involves a dynamic balance between setting limits on the one hand and allowing and encouraging freedomof expression and exploration on the other. A child whosebehavior is out of control improves when clear limits on theirbehavior are set and enforced. However parents must agree on where the limit will be set and how it will be enforced. The limit and the consequence of breaking the limit mustbe clearly presented to the child. Enforcement of the limitshould be consistent and firm. Too many limits are difficultto learn and may thwart the normal development of autonomy. The limit must be reasonable in terms of the child’sage, temperament, and developmental level. To be effective,both parents (and other adults in the home) must enforce limits. Otherwise, children may effectively split the parentsand seek to test the limits with the more indulgent parent.In all situations, to be effective, punishment must be briefand linked directly to a behavior. More effective behavioralchange occurs when punishment also is linked to praise of the intended behavior.
Extinction is an effective and systematic way to eliminate a frequent, annoying, and relatively harmless behavior by ignoring it. First parents should note the frequency of the behaviorto appreciate realistically the magnitude of the problem and toevaluate progress. Parents must determine what reinforces thechild’s behavior and what needs to be consistently eliminated.An appropriate behavior is identified to give the child a positive alternative that the parents can reinforce. Parents shouldbe warned that the annoying behavior usually increases in frequency and intensity (and may last for weeks) before it decreaseswhen the parent ignores it (removes the reinforcement). A childwho has an attention-seeking temper tantrum should be ignoredor placed in a secure environment. This action may anger the child more, and the behavior may get louder and angrier. Eventually with no audience for the tantrum, the tantrums decreasein intensity and frequency. In each specific instance, when the child’s behavior has become appropriate, he or she should be praised, and extra attention should be given. This is an effectivetechnique for early toddlers, before their capacity to understandand adhere to a timeout.