Children acquire many skills as they grow. Some skills, such as
controlling urine and stool, depend mainly on the level of maturity of
the child's nerves and brain. Others, such as behaving appropriately at
home and in school, are the result of a complicated interaction between
the child's physical and intellectual (cognitive) development, health,
temperament, and relationships with parents, teachers, and caregivers
(see also Childhood Development). Other behaviors, such as thumb sucking, develop when children look for ways to help themselves cope with stress. Still other behaviors develop in response to parenting style.
Behavioral problems can become so troublesome that they threaten
normal relationships between the child and others or interfere with
emotional, social, and intellectual development. Some behavioral
problems include
Many of these problems arise out of developmentally normal habits that children easily acquire.
Some behavioral problems, such as bed-wetting (see Urinary Incontinence in Children),
can be mild and resolve quickly and spontaneously as part of normal
development. Other behavioral problems, such as those that arise in
children with attention-deficit/hyperactivity disorder (ADHD), can require ongoing treatment.
Stress-Related Behaviors in Children
Each child handles stress differently. Certain behaviors that
help children deal with stress include thumb sucking, nail biting, and,
sometimes, head banging.
Thumb sucking
Thumb sucking (or sucking a pacifier) is a normal part of early
childhood, and most children stop by the time they are 1 or 2 years old,
but some continue into their school-age years. Occasional thumb sucking
is normal at times of stress, but habitual sucking past the age of
about 5 can alter the shape of the roof of the mouth, cause misalignment
of teeth, and lead to teasing from other children.
Occasionally, persistent thumb sucking can be the sign of an underlying emotional disorder.
Occasionally, persistent thumb sucking can be the sign of an underlying emotional disorder.
All children eventually stop thumb sucking. Parents should intervene only if their child’s dentist advises them to or if they feel their child’s thumb sucking is socially unhealthy. Parents need to gently encourage the child to understand why it would be good to stop. Once the child signals a willingness to stop, gentle verbal reminders are a good start. These can be followed by symbolic rewards put directly on the thumb, such as a colored bandage, fingernail polish, or a star drawn with a nontoxic colored marker. Additional measures, such as a plastic guard over the thumb, overnight elbow splinting to prevent a child from bending it, or painting the thumbnail with a bitter substance can be used. However, none of these measures should be used against the child’s will.
Nail biting
Nail biting is a common problem among young children. The habit
usually disappears as the child gets older but is typically related to
stress and anxiety. Children who are motivated to stop can be taught to
substitute other habits (for example, twirling a pencil). A reward
system in which the child keeps more rewards for avoiding the behavior
reinforces desirable behavior. For instance, the child is given 10
pennies in the morning, and in the evening must return 1 penny for each
nail that is bitten over the course of the day.
Head banging and rhythmic rocking
Head banging and rhythmic rocking are common among healthy
toddlers. Although alarming to parents, the children do not seem to be
in distress and actually seem to derive comfort from these behaviors.
Children usually outgrow rocking, rolling, and head banging
between 18 months and 2 years of age, but repetitive actions sometimes
still occur in older children and adolescents.
Children with autism
and certain other developmental problems also may bang their head or
make other repetitive movements. However, these children have additional
symptoms that make their diagnosis apparent.
Although children almost never damage themselves by these
behaviors, this possibility (and the noise) can be reduced by pulling
the crib away from the wall, taking off the wheels or placing carpet
protectors under them, and applying padding to the bars of the crib.
Behavioral Problems and Parenting Style
Praise and reward can reinforce good behavior. If parents are
very busy, they may give their children attention only for negative
behavior, which can backfire when that is the only attention the
children receive. Because most children prefer attention for
inappropriate behavior to no attention at all, parents should create
special times each day for pleasant interactions with their children to
avoid increases in inappropriate behavior.
A number of relatively minor problems of behavior may be due to parenting styles.
Child–parent interaction problems are difficulties in the
relationship between children and their parents, which may begin during
the first few months of life. The relationship may be strained because
of
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A difficult pregnancy or delivery
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Postpartum depression affecting the mother
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Inadequate support of the mother by the other parent, partner, relatives, or friends
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Disinterested parents
Contributing to the strain of building a strong relationship are a baby’s unpredictable feeding and sleeping schedules. Most babies do not sleep through the night until 3 to 4 months of age. Poor relationships may slow development of mental and social skills and cause failure to thrive.
A doctor or nurse can discuss the temperament of an individual
baby and offer the parents information on the development of babies and
helpful tips for coping. The parents may then be able to develop more
realistic expectations, accept their feelings of guilt and conflict as
normal, and try to rebuild a healthy relationship. If the relationship
is not repaired, the baby may continue to have problems later.
Unrealistic expectations contribute to the perception of
behavioral problems. For example, parents who expect a 2-year-old child
to pick up toys without help may mistakenly feel there is a behavioral
problem. Parents may misinterpret other normal, age-related behaviors of
a 2-year-old child, such as the refusal to follow an adult’s request or
rule.
A self-perpetuating cycle is a cycle of negative
(inappropriate) behavior by the child that causes a negative (angry)
response from the parent or caregiver, followed by further negative
behavior by the child, leading to a further negative response from the
parent. Self-perpetuating cycles usually begin when a child is
aggressive and resistant. The parents or caregivers respond by scolding,
yelling, and spanking. Self-perpetuating cycles also may result when
parents react to a fearful, clinging, or manipulative child with
overprotection and overpermissiveness.
The self-perpetuating cycle may be broken if parents learn to
ignore inappropriate behavior that does not negatively affect others,
such as temper tantrums or refusals to eat. Redirecting the child's
attention to interesting activities allows for the rewarding of good
behavior, which makes the child and parents feel successful. For
behavior that cannot be ignored, distraction or a time-out technique can be tried.
Discipline problems are inappropriate behaviors that
develop when structure is ineffective. Discipline is more than just
punishment. It is providing children with clear, structured,
age-appropriate expectations that allow them to know what is expected.
It is much easier and more satisfying to both parents and children to
reward desirable behavior than to punish inappropriate behavior.
In older children and adolescents, behavioral problems may arise
as children seek to free themselves from parental rules and supervision
(see Behavioral Problems in Adolescents). Parents should learn how to distinguish such problems from occasional errors in judgment.
Treatment
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Early intervention
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Behavior-modifying strategies for parents
The goal of treatment is to change undesirable habits by getting
children to want to change their behavior. This goal often takes
persistent changes in actions by the parents, which in turn results in
improved behaviors by the children.
Behavioral problems need to be addressed early because behaviors
are harder to change the longer they exist. Sometimes, parents need only
to be reassured that the particular behavior is normal or to hear a few
simple suggestions. One simple suggestion is for parents to spend at
least 15 to 20 minutes a day in a pleasurable activity with the child or
to call attention to desirable behaviors (“catching the child being
good”). Parents are also encouraged to regularly spend time away from
the child.
Additional strategies for modifying behavior include the following:
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Identifying triggers for the child's behavior and factors (such as additional attention) that may inadvertently reinforce it
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Clearly defining for the child which behaviors are desired and which are undesired
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Establishing consistent rules and limits
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Tracking how well the rules and limits are followed
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Providing appropriate rewards for success and consequences for inappropriate behavior
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Minimizing anger when enforcing rules and increasing positive interactions with the child
Efforts to control a child’s behavior through scolding or
physical punishments such as spanking may work briefly if used
sparingly. However, these approaches generally tend not to alter the
inappropriate behavior sufficiently and may reduce the child’s sense of
security and self-esteem.
Moreover, spanking can get out of hand when the parent is angry and may send the child the message that physical aggression is an acceptable way to deal with undesirable situations. A time-out procedure can be helpful. However, punishments become ineffective when overused or are used inconsistently. Furthermore, threats that the parents will leave or send the child away can be psychologically damaging.
Moreover, spanking can get out of hand when the parent is angry and may send the child the message that physical aggression is an acceptable way to deal with undesirable situations. A time-out procedure can be helpful. However, punishments become ineffective when overused or are used inconsistently. Furthermore, threats that the parents will leave or send the child away can be psychologically damaging.
If a behavior problem does not change in 3 to 4 months, doctors may recommend a mental health evaluation.
The time-out technique
This disciplinary technique is best used when children are aware
that their actions are incorrect or unacceptable and when they see
withholding of attention as a punishment. Typically, children do not
understand that withholding attention is a punishment linked to
undesirable behavior until they are 2 years old. Care should be taken
when this technique is used in group settings such as day care centers
because it can result in harmful humiliation.
The technique can be applied when a child misbehaves in a way
that is known to result in a time-out. Usually, the child should receive
verbal statements and reminders before the time-out technique is used.
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The inappropriate behavior is explained to the child, who is told to sit in the time-out chair or is led there if necessary.
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The child should sit in the chair for 1 minute for each year of age (a maximum of 5 minutes). Physical restraints should be avoided.
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A child who gets up from the chair before the allotted time is returned to the chair, and the time-out is restarted. Talking and eye contact are avoided.
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When it is time for the child to get up, the caregiver asks the reason for the time-out without anger and nagging. A child who does not recall the correct reason is briefly reminded. The child does not need to express remorse for the inappropriate behavior as long as it is clear that the child understands the reason for the time-out.
As soon as possible after the time-out, the caregiver should make
an effort to identify good behavior and praise the child for it. Good
behavior may be easier to achieve if the child is redirected to a new
activity far from the scene of the inappropriate behavior.
Sometimes, a child's inappropriate behavior escalates when the
child is in a time-out. In such cases, the caregiver may want to
redirect the child to another activity before the full time has run out.
Redirections should be done only after the child understands why the
time-out had been given.
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