The Cribsiders podcast

#106: Parenting for the Pediatrician Part 2: Discipline and Limit Setting

March 27, 2024 | By

Audio

Summary:

Unlock prescriptions for parenting success in this episode as we delve into tips to address behavior concerns! Join us and expert guest Dr. Nakiya Showell (@NShowell) as we discuss unique challenges and opportunities for addressing everything from the ‘terrible twos’ to teenage tumult. Tune in to learn parenting pearls tailored for the pediatric provider!


Parenting Pearls

  1. Remind caregivers to give both themselves and their children “space and grace” to navigate the constantly changing landscape of parenting/growing up.
  2. Consistency is key – children should know ahead of time what behavior is expected of them, as well as the potential consequences and rewards. 
  3. Children look to caregivers for how to behave – role modeling how to react in challenging and new situations is an essential part of parenting. 
  4. Be open to parents’ diverse experiences with and opinions around discipline – asking how they were raised and what they value allows clinicians to provide more effective and respectful guidance.


Parenting Notes 

General Guidance

  • Parenting is hard! It’s ok to let parents “pick their battles”; a reminder for parents to give themselves “space and grace” – it can go a long way. Recognize that all first time parents are “just figuring it out” and can’t be expected to be experts – as clinicians we can partner with them to provide support on the journey. 
  • Regardless of age, successful discipline strategies are consistent, clearly communicated, and incorporate positive reinforcement
  • Role modeling is critical!
  • Reassure parents (when appropriate) that their child’s behavior is normal and expected for their developmental phase.
  • When counseling parents on discipline, ask them what they’ve already tried and what they are willing to try.
  • Expect that things are not always going to go according to plan; parents should prepare ahead of time for how they will react when a child pushes back or breaks a rule.
  • There are significant cultural variations in approaches to discipline – asking how caregivers were raised, what they agree/disagree with, and what their values are can help pediatricians to provide guidance that aligns with families’ perspectives. 
  • There is not one best approach that works for all children – be responsive to the particular child’s needs and behaviors. 

Toddlers/Preschoolers

  • For toddlers, developmentally normal behaviors include testing limits, experiencing “big” feelings, and struggling to express emotions verbally.
  • In moments of big feelings, help the child to put their emotions into words (e.g., “I see that you’re feeling sad. What happened?”).
  • With new siblings, try to help the child to anticipate changes and be involved in caregiving, as well as reserving one-on-one time with the older child. Some behavior regression is common, but evaluate further if there is persistent regression in developmental milestones.  
  • Role modeling is essential. This can be things like desired behaviors (e.g., soft touch) or using language to express wants or feelings. 
  • Use praise whenever possible – “catch” the child doing the desired behavior and immediately provide positive reinforcement. (E.g., “You used soft touch with your baby brother. You’re a great big sister!”) 
  • With harmful/unwanted behaviors, use redirection (changing the scenario) and immediate consequences (this helps the child link the behavior with the consequence).
  • Time-outs can be effective for reinforcing particular rules, but to be effective the child must know what rule they are breaking. First warn the child that they are breaking a rule and what the consequence will be if they continue. If the behavior continues, follow through with the timeout while again stating why you are doing the timeout (use straightforward language). Consistency is key. 
  • Establish rules and limits when a child is calm – try to anticipate situations that might arise. During a tantrum, a child is unlikely to be able to process limits; instead focus on keeping the child safe, and, as appropriate, ignoring the unwanted behavior (tantruming).
  • A behavior change can be a child’s way of indicating that they want more parental attention – try to provide this to the extent possible. 
  • Parents know their children best. If a parent is persistently concerned that there is something wrong, respect that concern and offer further evaluation while reassuring where appropriate. 

School-Aged Children

  • At this age, parents and clinicians can start to have conversations about behavior – sometimes asking something as simple as “What’s going on?” can go a long way.
  • Start with clarifying the child’s understanding of rules and expectations.
  • Recognize social and physical changes that can affect school-aged children’s experiences of the world. 
  • Set clear and consistent expectations and limits and discuss the potential consequences ahead of time. Try to keep limits and expectations the same across settings.

Adolescents

  • Adolescents are developing a stronger sense of self and starting to assert their independence. It is normal for teens to start to test limits.
  • Frame discussions around limits/rules from a place of mutual respect and honesty.
  • Address limit setting by sharing goals and expectations for the teen, as well as setting clear and consistent boundaries.
  • It can be helpful to have both consequences where privileges are removed and rewards of earned freedoms. These need to be centered around things that are important to the teen. As always, communicate the potential consequences ahead of time.
  • Recognize that adolescents may not always want to share everything with caregivers; it can go a long way towards relationship-building to try to be available whenever the teen is ready to talk.
  • As a provider, frame one-on-one conversations with teens as being a trusted ally, rather than taking sides with the parents. It can go a long way to start by asking the teen about their dreams, goals, and fears.
  • Normalize emotional struggles, and normalize getting help when needed.
  • Help teens to identify 1) emotional outlets, 2) support systems beyond their parents, and 3) strategies to improve sleep and move their bodies.

Resources


Goal

Listeners will explain strategies to address common parenting challenges related to behavior and discipline.

Learning objectives

After listening to this episode listeners will…  

  1. Identify strategies to address unsafe or unwanted behaviors consistent with developmental age
  2. Describe techniques to provide positive reinforcement and model positive behavior.
  3. Recognize when to be concerned about pathologic causes of behavior and initiate further medical work-up 
  4. Counsel families on strategies to support their child from toddlerhood to adolescence.

Disclosures

Dr. Showell reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures. 

 

Citation

Engel S, Zhang AY, Showell N, Masur S, Chiu C, Berk J. “#106: Parenting for the Pediatrician Part 2: Discipline & Limit Setting”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ March 27, 2024.


 

Episode Sponsors

Freed

Freed, an AI scribe that listens, transcribes, and writes medical documentation for you, is offering all Cribsiders listeners $50 off their first month with code CRIB50 at getfreed.ai.

Episode Credits

Producers & Writers: Sydney Engel FNP & Angela Zhang MD
Infographic: Angela Zhang MD
Showrunner: Sam Masur MD
Cover Art: Chris Chiu MD
Hosts: Justin Berk MD, Angela Zhang MD & Sydney Engel FNP
Editor: Clair Morgan of nodderly.com
Guest: Nakiya Showell MD, MPH, MHS

CME Partner

vcuhealth

The Cribsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit cribsiders.vcuhealth.org and search for this episode to claim credit.

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