Pediatrics Book

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Discipline

Aka: Discipline, Misbehavior
  1. See Also
    1. Verbal Punishment
    2. Time-Out
    3. Positive Parenting Techniques
    4. Electronic Media Use in Children
  2. Causes: Misbehavior
    1. Intrinsic factors
      1. Child tired, bored or hungry
      2. Child needs greater adult attention
    2. Psychosocial confounding factors
      1. Parent divorce or separation
      2. Severe poverty
      3. Parental mental illness or Substance Abuse
    3. Associated conditions
      1. Attention Deficit Hyperactivity Disorder (ADHD)
  3. Background: Components of an effective Discipline system
    1. Positive, supportive parent-child relationship
      1. Playful and warm, affectionate relationship
      2. Periodically take time to observe a child's behavior
      3. Respond to best behaviors with increased attention
      4. Keep consistent daily schedule and activity patterns
        1. Regular and reasonable times for meals, homework, chores and bedtime
      5. Response to a given behavior should be consistent
      6. Listen, negotiate, and involve child in decisions
      7. Parents are strong role models, with children following a parent's words and actions
        1. Model the behavior desired from children
        2. Parents should take time for themselves, when friends, family or sitters are available
    2. Strategy for teaching and reinforcing best behaviors
      1. Examples: Sharing, good manners, empathy, studying
      2. Let children help with adult activities (e.g. cleaning, meal preparation)
      3. Limit rules to a few clear, unambiguous rules
      4. Schedule special-time for one-on-one communication
      5. Set Limitations onv Electronic Media Use in Children
      6. Listen to your child carefully
      7. Offer choices when possible and help them to evaluate
      8. Contract for targeted behaviors with the child (e.g. chart with task picture vs days of the week)
        1. Child will perform specific, realistic and measurable activity by a certain time
        2. Child will receive a certain reward (e.g. sticker, points)
        3. Contract is written and child shakes hands or signs the contract
        4. Parents and children review the contract periodically
      9. Praise best behaviors frequently ("catch them being good")
        1. Acknowledge good behavior with brief verbal reward (e.g. 10 seconds)
        2. Reinforcer should immediately follow the good behavior
      10. Consider point system to buy prizes (secondary reinforcers)
        1. Win points for positive behaviors
        2. Lose points for negative behaviors
      11. Ignore trivial misdeeds
      12. Model respectful communication and collaboration
      13. Model organized and consistent behavior
    3. Strategy for extinguishing undesirable behaviors
      1. Clearly define the problem behavior
        1. Fighting with other children
        2. Poor social skills
        3. Disruptive behavior
      2. Lay out in advance the consequences for that behavior
        1. Choose a strong and related consequence
        2. Explain why the consequence is related
        3. Example: withhold pens for drawing on wall
      3. Monitor behavior (including beaseline frequency of behavior prior to intervention)
        1. Daily tally of behavior occurrence
        2. ABC chart
          1. Date and time of behavior
          2. Precipitating events
          3. Behavior
          4. Consequences of behavior (response by others)
      4. Respond to behavior immediately with consequence
        1. Deal with behavior consistently each time
        2. Calmly apply a consistent Discipline strategy
        3. Avoid threats, nagging and long lectures (be matter-of-fact)
        4. Be sympathetic, but do not "give in"
      5. Instruct and correct child calmly and empathically
      6. Use effective measures of Discipline sparingly
        1. Time-Out
        2. Extinction (withholding reinforcing behaviors, e.g. Trained Night Crier)
        3. Removal of Privileges
      7. Avoid less effective or harmful punishment measures
        1. Verbal Punishment (e.g. reprimand)
        2. Corporal Punishment (e.g. Spanking)
  4. Resources
    1. See Parenting Resources
  5. References
    1. Wyckoff (1984) Discipline without Shouting, p. 8
    2. Banks (2002) Am Fam Physician 66(8):1447-52 [PubMed]
    3. Kavan (2018) Am Fam Physician 97(10): 642-8 [PubMed]
    4. Stein (1998) Pediatrics 101(4 Pt 1):723-8 [PubMed]

discipline (C0237070)

Definition (OMS) Nurturing practices that promote appropriate behavior, conduct, and self-control.
Definition (NCI) Activities designed to promote appropriate behavior, conduct, or action including time out, limits, and controls.
Concepts Health Care Activity (T058)
English discipline, disciplines, Discipline
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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