The timeout consists of a short period of isolation immediately after a problem behavior is observed. Timeout interrupts the behavior and immediately links it to an unpleasant consequence. This method requires considerable effort by the parents because the child does not wish to be isolated. A parent may need to hold the child physically in timeout. In this situation, the parent should become part of the furniture and should not respond to the child until the timeout period is over. When established, a simple isolation technique, such as making a child stand in the corner or sending a child to his or her room, may be effective. If such a technique is not helpful, a more systematic procedure may be needed. One effective protocol for the timeout procedure involves interrupting the child’s play when the behavior occurs and having the child sit in a dull, isolated place for a brief period, measured by a portable kitchen timer (the clicking noises document that time is passing and the bell alarm at the end signals the end of the punishment). Timeout is simply punishment and is not a time for a young child to think about the behavior (these children do not possess the capacity for abstract thinking) or a time to de-escalate the behavior. The amount of timeout should be appropriate to the child’s short attention span. One minute per year of a child’s age is recommended. This inescapable and unpleasant consequence of the undesired behavior motivates the child to learn to avoid the behavior.
Children with disabilities, severe chronic illnesses, congenital defects, and health-related educational and behavioral problems are children with special health care needs (SHCN). Many of these children share a broad group ofexperiences and encounter similar problems, such as schooldifficulties and family stress. The term children with special health care needs defines these children noncategorically,without regard to specific diagnoses, in terms of increasedservice needs. Approximately 19% of children in the UnitedStates younger than 18 years of age have a physical, developmental, behavioral, or emotional condition requiring services of a type or amount beyond those required by children,generally.
The goal in managing a child with SHCN is to maximizethe child’s potential for productive adult functioning bytreating the primary diagnosis and by helping the patientand family deal with the stresses and secondary impairmentsincurred because of the disease or disability. Whenever a chronic disease is diagnosed, family members typicallygrieve, show anger, denial, negotiation (in an attempt toforestall the inevitable), and depression. Because the child with SHCN is a constant reminder of the object of this grief,it may take family members a long time to accept the condition. A supportive physician can facilitate the process ofacceptance by education and by allaying guilty feelings andfear. To minimize denial, it is helpful to confirm the family’s observations about the child. The family may not be ableto absorb any additional information initially, so writtenmaterial and the option for further discussion at a later dateshould be offered.
The primary physician should provide a medical home to maintain close oversight of treatments and subspecialtyservices, provide preventive care, and facilitate interactions with school and community agencies. A major goal of family-centered care is for the family and child to feel in control. Although the medical management team usually directstreatment in the acute health care setting, the locus of control should shift to the family as the child moves into a moreroutine, home-based life. Treatment plans should allow thegreatest degree of normalization of the child’s life. As the child matures, self-management programs that provide health education, self-efficacy skills, and techniques such as symptommonitoring help promote good long-term health habits. Theseprograms should be introduced at 6 or 7 years of age or whena child is at a developmental level to take on chores and benefitfrom being given responsibility. Self-management minimizeslearned helplessness and the vulnerable child syndrome, both of which occur commonly in families with chronically ill ordisabled children.