How Can I Discipline My Child Who is Already Suffering?

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How Can I Discipline My Child Who is Already
Suffering?

• Positive Behavioral Strategies for Children with
  Medical Conditions and their Siblings

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Stephanie P. Farrell, Ph.D.

• American Family Childrens Hospital
• April 15, 2008

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Discipline

• Not punishment
• Instead think of as an opportunity to teach
• Right from wrong
• How to respect care for others
• Which behaviors are acceptable
• Responsibility
• With the goal of helping your child
• Feel secure, loved, confidant
• Learn self control frustration tolerance with
  the normal stresses of everyday life

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Effective Discipline

• Proactive
• Rules help keep a child safe
• Strengthens parent-child relationship, as well as
  promotes positive social relationships in future
• Advances development

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Guiding Principles

• Predictability, Consistency, Stability
• Provide structured, predictable routines (eating,
  sleeping, meds, etc.)
• Consistency across caregivers
• Rules
• Choose your battles

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Guiding Principles cont.

• Ignore low level annoying behaviors
• Children give up behaviors that get no attention
• Catch a child doing good
• Give attention to that behavior which you want
  repeated
• Provide frequent praise
• Most powerful reinforcer of learning
• Eye contact
• Smile
• I messages I like it when you
• Deliver positive messages immediately

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Guiding Principles cont.

• Provide choices when feasible
• To increase childs sense of control
• Provide safe, loving environment
• Be creative in how you organize, enhance, sooth,
  redirect and safe proof to promote a childs
  sense of security self-control
• Be a good role model
• Children learn more by watching adults

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Guiding Principles cont.

• State limits clearly and simply
• Children test limits frequently to find out where
  their boundaries are
• Children need to know what the limits are that
  they stay the same each time
• Be specific about the behavior you do not like
• Intervene early so that negative behavior does
  not escalate
• Give fair warning (e.g., If you dont stop that
  by the time I count to 3), then Follow- through
  

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Guiding Principles cont.

• Use humor
• Allow for negotiation flexibility
• Particularly, with older children teens
• Helps build your childs social problem solving
  skills
• Reduces noncompliance with parental expectations
• Involving child in decision making has been
  associated with long term enhancement of moral
  judgment

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But my Child is Sick

• Or hospitalized or undergoing horrible
  treatments/procedures..
• Importance of continued limit setting
• Routine Structure Consistency Limits
  Boundaries Sense of Security Safety for
  Children
• Consider alternate messages we may give child if
  suddenly anything goes Hmm, I must really be
  sick if theyre letting me get away with this.

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But my Child is Sick cont.

• Need rules expectations to help them learn
  appropriate behavior
• Develop sense of self-discipline which leads to
  positive self-esteem
• Ensures our little ones grow up to be respectful,
  caring well-behaved adults

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But my child is sick, cont.

• Resort back to guiding principle 2 Choose your
  battles
• Is it really critical that my child uses please
  thank you when he/she is nauseated has a fever?
  Certainly not.
• What is important in your family?
• For many, it is gentleness towards one another
  (No hitting, kicking, swearing, etc.)

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Sick children may.

• Lash out, especially if they feel out of control,
  helpless scared
• be prepared, because often it is the one
  closest to them that is on the receiving end
• Toddlers in particular or early pre-verbal
  children as they have limited coping skills
  moreover lack effective ways to verbally
  communicate their distress
• It is still appropriate to give the clear message
  that We dont hit. Hitting hurts.

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Then.

• Help the child label their feelings
• I wonder if you are mad about not getting what
  you wanted.
• I bet it is scary having to get pokes
• Provide support reassurance
• Re-direct/distract
• Remove child from situation substitute with
  safe, less messy or less destructive alternative
• Teach coping skills

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Understand/Appreciate Triggers

• What sets most children off
• Tired
• Sick
• Hungry
• Overstimulated
• Bored
• Now, think of how often your hospitalized child
  or child in treatment feels these
• Tired - not resting as well, secondary to
  illness or treatments, beeping IVs or vitals
  during night, etc.
• Sick chemo, infections, etc.
• Hungry NPO for procedures, loss of appetite
  from illness/treatments
• Overstimulated new environment, new people,
  medical equipment, unfamiliar sounds

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Know your own Limits too!

• It is challenging to remain calm, be creative and
  maintain energy when ..
• You too are sleep deprived
• Not eating well
• Not maintaining your exercise routine
• Juggling family roles
• Be gentle with yourself
• We all make mistakes use them as opportunities
  to model problem solving

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Examine your Expectations

• Be realistic
• Have appropriate expectations given childs
  developmental age
• Parents should not expect reasoning or verbal
  commands to manage behavior of infants toddlers
• Preschoolers begin to develop an understanding of
  rules their behavior is guided by these rules
  and the consequences associated with them

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Expectations cont.

• Similarly, examine your expectations of siblings
• Remember, they are just kids too!
• Dont expect your children to be perfect allow
  for mistakes and help your children learn from
  them

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Behavioral Strategies Techniques

• Reward Systems
• Sticker charts
• Small simple
• 1 behavior at a time
• Token economy
• Tangible rewards
• Small gestures of approval
• Privileges

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Behavioral Strategies Techniques cont.

• Time outs
• Not a punishment, but rather a time to calm down
  collect oneself
• Used to interrupt unacceptable behavior
• Remove child from situation that brought about
  loss of control
• Should be short enough so child has chance to go
  back to original situation be successful with
  acceptable behavior
• Be consistent on when a time out is given, for
  what purpose, how long where only for actions
  you have previously warned are not acceptable,
  not for first time offenses
• Use sparingly
• Not appropriate for all children

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Behavioral Strategies Techniques cont.

• Consequences
• Allow your child to experience the natural
  consequences of his/her behavior
• (e.g., if child throws toy and breaks it, can no
  longer play with it)
• Logical consequences for misbehavior helps them
  learn that they are accountable for their
  actions, without damaging their self esteem
• When possible, should be delivered immediately,
  should relate to rule broken be short enough so
  that you can move on again to emphasize the
  positives.
• Withholding privileges

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A Word (or 2) about Temper Tantrums

• Developmentally appropriate
• Need to release frustration, given strong drives
  for mastery autonomy being continually stymied
  either by adults or own limitations
• Need to express their feelings
• To them, a tantrum speaks louder than words
• Need to assert themselves
• I am important. What I want counts.
• Lack of control over their lives
• With adults always telling them what to do what
  not to do, a tantrum is often the only way to say
  Enough. This is my life!

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Temper Tantrums cont.

• Encourage better outlets anticipate
  frustration
• Reduce need to say no
• Get down to childs physical level
• Kneeling to ensure eye contact
• Reduces power differential

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Caveats

• Not all discipline approaches work with all
  children
• Need to consider temperament factors
• Need to modify based on developmental age
• Sometimes when trying new behavioral techniques,
  behaviors may get worse, before they get better
• Hmm, this used to elicit this response..I
  better take it up a notch

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What to Avoid

• Avoid yelling, as this models loss of control
  when you dont get your way
• Sarcasm
• Guilt trips
• Criticism
• Instead, provide unconditional love, helping your
  child understand that it is the misbehavior you
  are unhappy with
• Physical punishment
• Spanking is not effective and teaches kids its
  okay to hit when they are angry
• Nagging
• Unrealistic threats
• Be prepared to follow through

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What if my childs behavior is really out of
control? What if all else fails?

• Parent time-outs
• Psychological consultation

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Parenting Truly is the Most Challenging Job!

• Gentleness, patience firmness are required over
  and over
• Research shows that effective parents raise
  well-adjusted children who are more self-reliant,
  self-controlled and positively curious than
  children raised by parents who are punitive,
  overly strict or permissive.

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References

• American Academy of Child Adolescent Psychiatry
• American Academy of Pediatrics
• Child Welfare League of America
• Guidance for Effective Discipline Committee on
  Psychosocial Aspects of Child Family Health
• National Network for Child Care
• Parent Center - The Discipline Tool Kit
  Successful strategies for every age