Parenting U: Toddler Behavior


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Providence Parenting U: Toddler Behavior featuring Rick Brandt-Kreutz, LICSW from St. Peter Family Medicine. May 31, 2011

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  • Of all the ‘lenses’ by which we can help parents to understand their children, temperament is one of the most useful and understandable as it individualizes the child, takes the onus off the parent for challenging traits, takes the blame off the child for challenging traits, helps parents to see what might be the most salutary environment for their child (i.e., improve “goodness of fit”).
  • Any parent with a temperamentally difficult child looks bad. Don ’t blame the victim!
  • One of main long-term goals of pediatric primary care: to improve “goodness of fit” between parent and child.
  • Mis-behavior comes from mistaken belief of how to find belonging and significance
  • Mis-behavior comes from mistaken belief of how to find belonging and significance
  • consistency – can avoid in the 1 st place with routines many times -Give them a chance to learn the rules Studies show a reinforcer should be applied within 5 seconds of a target behavior Children who receive inconsistent and delayed consequences are similar to employees who are paid on an inconsistent and arbitrary schedule Behavioral principle of extinction- stopping the delivery of a reinforcer that previously followed a behavior resulting in the decrease in future probability of the behavior Like scribbling with a pen that has run out of ink Also works well for swearing
  • Example: ??
  • (begin rule setting after 6-8 months, prior to this the baby ’s cognative abilities are not developed enough) Set only rules that you will enforce Set your child up for success Set as few rules as possible Give as many choices as possible But, not unlimited choices "What do you want for breakfast?" will lead to hassles. "Do you want eggs or cereal?" Much better. Give children a choice when they misbehave: Do you want to stop playing or leave the table? If no decision is made, make the decision for them. Explain rules ahead of time: “ Tell me what the rule is?” Different rules at different ages and stages E.g., before 6-7, children do not have the capability of abstraction, i.e., “don’t go into the street” is because “mommy says so,” versus later, “because I need to keep myself safe.” Younger children need repetition and consistent discipline.
  • Verbal abuse. The greatest mistake is using methods that cause permanent damage to our children. Emotional abuse may be even more disastrous than physical abuse.
  • Generally as a last resort , often with yelling 93% Justify it…85% Would use something else 54% Feel guilty about it
  • Decide words you will use Set out the potty chair Begin a routine (after naps, before baths) Let them watch you/siblings Praise all their efforts Consider going without the pull-ups
  • Parenting U: Toddler Behavior

    1. 1. Toddler Behavior Rick Brandt-Kreutz, LICSW Providence Medical Group – St. Peter Family Medicine
    2. 2. Objectives <ul><li>Improve your understanding of your toddler’s development, temperament and the “Goodness of Fit” between you and your child </li></ul><ul><li>Learn positive skills and strategies that can help you work with your toddler’s tantrums </li></ul><ul><li>Know how to develop effective routines for your toddler with sleep, eating and potty training </li></ul><ul><li>Learn what to look for and benefits of your toddler’s day care, at-home care or preschool </li></ul>
    3. 3. When is a toddler a toddler? <ul><li>When your baby starts toddling </li></ul><ul><ul><li>Walking independently </li></ul></ul><ul><ul><li>Range: 9-17 months </li></ul></ul><ul><li>When your baby starts talking </li></ul><ul><ul><li>First words besides “mama/dada” at 12 months </li></ul></ul><ul><ul><li>50-100 words on average by 18 months </li></ul></ul><ul><ul><ul><li>Learning to talk varies greatly </li></ul></ul></ul><ul><li>Walking, talking…just not your little baby anymore </li></ul>
    4. 4. Toddler Psychosocial Development
    5. 5. Four key parenting concepts <ul><li>Understand temperament </li></ul><ul><li>Behavior is purposeful-search for the meaning </li></ul><ul><li>Discipline with kindness and firmness </li></ul><ul><li>Enforce consistent standards </li></ul>
    6. 6. 1. Understanding Temperament <ul><li>Your child’s behavior style </li></ul><ul><li>At 6 months old mothers can identify accurately </li></ul><ul><li>Characteristics that will help shape your child’s personality </li></ul><ul><li>Characteristics that may be “easy,” “spirited,” or somewhere in-between </li></ul><ul><li>Tends not to change…though we as parents may need to change </li></ul><ul><ul><li>Example: 2-year old with “easy” parents </li></ul></ul>
    7. 7. Temperament activity (handout) <ul><li>Fill out as we go </li></ul><ul><li>Assess the temperament of yourself AND your child </li></ul>
    8. 8. Nine Traits of temperament <ul><li>Sensitivity: strong reactions to light, sound, etc. </li></ul><ul><li>Regularity: eat, sleep same or different each day </li></ul><ul><li>Activity level: “idle speed,” or “wigglyness” </li></ul><ul><li>Intensity: energy level of typical responses </li></ul><ul><li>Approach/withdrawal: first reaction to something new </li></ul><ul><li>Adaptability: adjusting to transitions and changes </li></ul><ul><li>Persistence: continues in the face of obstacles </li></ul><ul><li>Distractibility: aware of noises, people, touch or toys </li></ul><ul><li>Mood: tendency to react positively or negatively </li></ul>
    9. 9. <ul><li>How similar are you to your child? </li></ul><ul><li>How different are you from your child? </li></ul><ul><li>How does this help or hinder how you parent your child? </li></ul>Ask yourself:
    10. 10. Three Types of Temperament <ul><li>The nine temperament characteristics can be grouped into three groups: </li></ul><ul><ul><li>Easy child (40% of the population) </li></ul></ul><ul><ul><ul><li>Regular routines, cheerful, adaptable </li></ul></ul></ul><ul><ul><li>Spirited child (10% of the population) </li></ul></ul><ul><ul><ul><li>Irregular, strong reactions, slow to accept change and tending to respond negatively </li></ul></ul></ul><ul><ul><li>Slow-to-warm up child (15% of the population) </li></ul></ul><ul><ul><ul><li>Inactive, mild, low-key responsiveness </li></ul></ul></ul><ul><ul><li>Mixed (35% of the population) </li></ul></ul>
    11. 11. Temperament traits Easy (40%) Spirited (10%) Slow-to-Warm-up (15%) 1. Sensitivity Low High 2. Activity level Low High Low 3. Regularity Regular Irregular 4. Intensity Low High Low 5. Approach/ Withdrawal Outgoing Withdrawl Withdrawal 6. Adaptability Quickly Slowly Slowly 7. Persistence Low High 8. Distractibility Low or High High or Low 9. Mood Positive “ Serious”
    12. 12. “ Goodness of Fit” <ul><li>The match between your child’s traits and your caretaking style </li></ul><ul><li>Poor fit can lead to: </li></ul><ul><ul><li>Difficulty bonding with my child </li></ul></ul><ul><ul><li>Difficulty dealing with my child’s behavior </li></ul></ul><ul><ul><li>Difficulty for the child </li></ul></ul><ul><li>More challenging for families with children with spirited temperamental traits </li></ul><ul><li>Parenting goal: Improve the “fit” </li></ul>
    13. 13. Temperament helps me to understand my child <ul><li>My child is unique, different from me, different from brother or sister </li></ul><ul><li>My child is not “a problem,” though he may be challenging for me </li></ul><ul><li>Remember: “Spirited” children often become leaders </li></ul><ul><li>Adjust to temperament </li></ul><ul><ul><li>Active child needs more space </li></ul></ul><ul><ul><li>Slow-to-warm-up child needs more time to adjust </li></ul></ul><ul><ul><li>Spirited child needs more 5 and 1 minute warnings before ending a fun activity </li></ul></ul>
    14. 14. 2. Behavior is purposeful <ul><li>http:// =Gk- OfmmRaqs </li></ul><ul><li>Goal of every behavior is to increase our sense of belonging and significance </li></ul><ul><li>i.e., To get attention </li></ul>
    15. 15. Cycle of behavior Remember: There is REASON for the behavior you see interpretation belief perception decision (private logic)
    16. 16. Look for MEANING <ul><li>What is your child’s INTENT? </li></ul><ul><ul><li>Tired, hungry, scared, frustrated…curious? </li></ul></ul><ul><ul><ul><li>E.g., tired toddler in clinic </li></ul></ul></ul><ul><li>Did your child learn the behavior? </li></ul><ul><ul><li>Intentionally or unintentionally reinforced? </li></ul></ul><ul><ul><li>Did they copy someone? (central process = imitation) </li></ul></ul>
    17. 17. Developmental context of behavior (Milestone and Meaning Card) <ul><li>Tantrums </li></ul><ul><li>Potty training </li></ul><ul><li>Sleeping </li></ul><ul><li>Eating </li></ul><ul><li>Developmental Tasks </li></ul><ul><ul><li>Elaboration of locomotion </li></ul></ul><ul><ul><li>Fantasy play </li></ul></ul><ul><ul><li>Language development </li></ul></ul><ul><ul><li>Self Regulation and control </li></ul></ul>
    18. 18. Why Tantrums? <ul><li>18 month old: Walking + talking +understanding = CHOICES HOWEVER: </li></ul><ul><li>No delayed gratification! </li></ul><ul><li>= TANTRUMS </li></ul><ul><li>=“developmentally predictable” -Martin Stein, MD </li></ul><ul><ul><li>50%-80% = weekly </li></ul></ul><ul><ul><li>20% = daily </li></ul></ul>
    19. 19. Tantrums <ul><li>Tantrums affected by 3 things: </li></ul><ul><ul><li>Attachment: What is the emotional bond like with your toddler and are you transitioning to allow more independence? </li></ul></ul><ul><ul><li>Temperament: Easy, Spirited or Slow-to-Warm-up? Goodness of fit? </li></ul></ul><ul><ul><li>Your style of responding: </li></ul></ul><ul><ul><ul><li>React with anger? Stay calm? Assist your child to calm? </li></ul></ul></ul><ul><li>Tantrums are the child’s way of learning how to handle their anger </li></ul>
    20. 20. Tantrums: What to do? <ul><li>Accept tantrums as normal </li></ul><ul><li>Praise when not tantruming </li></ul><ul><li>Always stay calm, (“three deep breaths”) </li></ul><ul><ul><li>If you cannot stay calm then get some help </li></ul></ul><ul><li>EVERYONE Calm before talking </li></ul><ul><ul><li>Your child gets energy from you trying to stop it </li></ul></ul><ul><li>See if your child can calm themselves on their own first </li></ul><ul><ul><li>Distraction and Redirection </li></ul></ul>
    21. 21. <ul><li>Ignore when possible: </li></ul><ul><ul><li>Move away, but still monitor and keep safe </li></ul></ul><ul><ul><li>Stay quiet </li></ul></ul><ul><ul><li>Expect it to get worse before getting better </li></ul></ul><ul><li>When calm or calming, use helpful words </li></ul><ul><ul><li>“ Tell me when you are mad” </li></ul></ul><ul><ul><li>“ Use your words” </li></ul></ul>Tantrums: What to do?
    22. 22. When should I ask my doctor for help? <ul><li>Anytime you feel you need help, ask for help </li></ul><ul><ul><li>Especially if tantrums are more than 3 times a day and more than 20 minutes long </li></ul></ul><ul><ul><li>Explosive tempers = 5% throughout childhood in all kids </li></ul></ul><ul><li>Severe Tantrums = accompanied by sleep, eating or other problems </li></ul><ul><ul><li>Illness, disability, language delay, history of abuse or neglect may be factors </li></ul></ul><ul><li>Safety concerns </li></ul><ul><li>If what we discussed today does not work, ask for help </li></ul>
    23. 23. 3. Discipline with kindness and firmness (handout) High kindness (respect for child) Low kindness (mean) Authoritative (democratic) Authoritarian/Abuse Low firmness High firmness (respect for self) Neglect Permissive Rigid
    24. 24. 4. Enforce standards consistently <ul><li>Children need all caregivers to be “on the same page” </li></ul><ul><li>Children need parents to set limits </li></ul><ul><ul><li>Chose your battles </li></ul></ul><ul><ul><li>Selective = effective </li></ul></ul><ul><ul><li>Don ’t sweat the small stuff </li></ul></ul><ul><li>Consistency is essential </li></ul><ul><ul><li>Inconsistency leads to more testing of limits </li></ul></ul><ul><ul><li>Every child is “gambler” (intermittent reinforcement) </li></ul></ul><ul><li>Don ’t “do battle” often, but if you do, you need to win </li></ul>
    25. 25. Rules for Rules <ul><li>Set only rules that you will enforce </li></ul><ul><li>Give as many choices as possible </li></ul><ul><ul><li>But, not unlimited choices </li></ul></ul><ul><li>Teach and explain rules ahead of time: </li></ul><ul><ul><li>Ask the child: “Tell me what the rule is?” </li></ul></ul><ul><ul><li>Child’s ability to understand what you say is likely 10 times greater than their ability to speak </li></ul></ul>
    26. 26. Avoid Power Struggles <ul><li>Rules help avoid power struggles by establishing expectations </li></ul><ul><li>Respect child’s temperament and preferences when possible </li></ul><ul><li>What are the 3 things you can never force a child to do? </li></ul><ul><ul><li>SET : </li></ul></ul><ul><ul><ul><li>Sleep </li></ul></ul></ul><ul><ul><ul><li>Eat </li></ul></ul></ul><ul><ul><ul><li>Toilet </li></ul></ul></ul>How the parent does it makes all the difference 
    27. 27. No Need to Yell <ul><li>Nagging, threatening, pleading, screaming demean the parent. </li></ul><ul><li>Humiliation, name-calling, and inducing guilt demean the child. </li></ul><ul><li>Neither are necessary. </li></ul>
    28. 28. Time out <ul><li>When should you use Time out? </li></ul><ul><ul><li>Some say after 18 months, some say after 36 months </li></ul></ul><ul><ul><li>Try it, see if it works </li></ul></ul><ul><li>Preparation: Place, timer, rehearsals, rules </li></ul><ul><li>Use single warning </li></ul><ul><li>Send to time out immediately after behavior and calmly explain why </li></ul><ul><li>Start timer-reset if not cooperating </li></ul><ul><ul><li>One minute per year of age </li></ul></ul><ul><li>Ignore child while in time out </li></ul><ul><li>End with buzzer and move on </li></ul>
    29. 29. <ul><li>Question: What do you do if it does not work? </li></ul><ul><ul><li>Shorten the time (object is to get success) </li></ul></ul><ul><ul><li>Try sitting with the child </li></ul></ul><ul><ul><li>Talk with your health care professional </li></ul></ul>Time out
    30. 30. Spanking?
    31. 31. Use Time-In! <ul><li>Special Time (handout) </li></ul><ul><ul><ul><li>Regular child directed play </li></ul></ul></ul><ul><ul><ul><li>Daily </li></ul></ul></ul><ul><ul><ul><li>Not used as punishment </li></ul></ul></ul><ul><ul><ul><li>Scheduled 15-30 min </li></ul></ul></ul>
    32. 32. Reduce undesired behaviors <ul><li>Talking </li></ul><ul><li>Reasoning </li></ul><ul><li>Ignoring </li></ul><ul><li>Distracting </li></ul><ul><li>Removing </li></ul><ul><li>Time out </li></ul><ul><li>Time in! </li></ul>QUESTION: HOW might the parent reduce this undesirable behavior? http:// =Gk- OfmmRaqs
    33. 33. SUMMARY: <ul><li>4 key parenting concepts </li></ul><ul><ul><li>1. Understanding temperament helps understand behavior </li></ul></ul><ul><ul><ul><li>Goodness of fit? </li></ul></ul></ul><ul><ul><li>2. All behavior serves a purpose </li></ul></ul><ul><ul><ul><li>Including tantrums </li></ul></ul></ul><ul><ul><li>3. Authoritative parenting style is the most effective </li></ul></ul><ul><ul><ul><li>With kindness and firmness </li></ul></ul></ul><ul><ul><li>4. Consistent rules and limits are essential </li></ul></ul><ul><ul><ul><li>Everybody on the same page </li></ul></ul></ul>
    34. 34. Toilet Training <ul><li>Average age 30 months </li></ul><ul><li>98% of children are dry during the day by 36 mo of age </li></ul><ul><li>Avoid toilet teaching during stressful times </li></ul><ul><li>Do not rush or pressure the child </li></ul><ul><ul><li>“ pull” not “push” </li></ul></ul><ul><li>Introducing the concept earlier than you expect to train is helpful </li></ul>
    35. 35. When is my child ready? <ul><li>Dry at least 2 hours or dry after naps </li></ul><ul><li>Bowel movements become regular and predictable </li></ul><ul><li>Facial expressions, posture, or words reveal that your child is about to urinate or have a bowel movement </li></ul><ul><li>Can follow simple instructions </li></ul><ul><li>Can help undress </li></ul><ul><li>Seems uncomfortable with soiled diapers and wants to be changed </li></ul><ul><li>Asks to use toilet or potty chair </li></ul><ul><li>Asks to wear grown-up underwear </li></ul>
    36. 36. Steps to toilet training <ul><li>Decide on what you will call it (potty? Throne time?) </li></ul><ul><li>Potty chair in convenient and accessible place </li></ul><ul><li>Encourage child to tell parent when he/she needs to void </li></ul><ul><li>Parent learns behavioral cues and reminds child to go </li></ul><ul><li>Praise efforts and success: sticker chart </li></ul><ul><li>Ignore mistakes </li></ul><ul><li>Avoid coercion and shaming </li></ul>
    37. 37. Toilet training refusal <ul><li>Battle you can’ t win-child ultimately has control </li></ul><ul><li>If your child begins holding it in, this can result in constipation and encopresis </li></ul><ul><li>More common with spirited temperament and if you are having difficulty setting limits </li></ul><ul><li>What do you do? </li></ul><ul><ul><li>Cease all efforts for 1-3 months </li></ul></ul><ul><ul><li>Assure soft stools </li></ul></ul><ul><ul><li>Resume with incentives but not punishment </li></ul></ul><ul><ul><li>See your medical provider if your child is over 4 years old </li></ul></ul>
    38. 38. Toddler Sleep <ul><li>Toddlers sleep about 12 hours a day </li></ul><ul><li>1 nap per day after 18 months, 1.5-3.5 hours long </li></ul><ul><li>Up to 18 months, toddler may wake more due to normal separation anxiety </li></ul><ul><li>Important to set “time to sleep” routine </li></ul>
    39. 39. Bedtime struggles <ul><li>Bedtime = favorite time for tantrums </li></ul><ul><li>Resistance and clinginess are common </li></ul><ul><li>Transitional objects are very important (doll, blanket) </li></ul><ul><li>Predictable bedtime routines </li></ul><ul><li>(books, songs, prayers, not TV or activating games) </li></ul><ul><li>“ Curtain calls” </li></ul><ul><ul><li>“ I want a story…water…doggie…kiss…” </li></ul></ul><ul><ul><li>Set your limit: calm, firm, matter of factly </li></ul></ul><ul><li>Try sitting in the room with your child and progressively move your chair closer to the door on successive nights </li></ul><ul><li>Or, try a sticker chart </li></ul>
    40. 40. Toddler picky eating <ul><li>Parents report 1/3 of Toddlers do not want to eat or try new foods </li></ul><ul><ul><li>54% often not hungry </li></ul></ul><ul><ul><li>33% don’t like mealtimes </li></ul></ul><ul><ul><li>34% have strong food preferences </li></ul></ul><ul><ul><li>26% refuse to eat </li></ul></ul><ul><ul><li>21% request certain foods and then refuse to eat them </li></ul></ul><ul><ul><li>42% try to end a meal after a few bites </li></ul></ul><ul><li>On average, a food is offered 10 times before a child will accept it </li></ul><ul><li>So, why the problem with so many toddlers? </li></ul>
    41. 41. Picky eaters <ul><li>From an evolutionary perspective, for simple survival children should be skeptical about eating any new food </li></ul><ul><li>Children have a more acute sense of taste than adults </li></ul><ul><li>Spirited Temperament children are more likely to have battles over eating </li></ul>
    42. 42. Toddler Eating Basics #1 <ul><li>Don’t expect your toddler to eat all the foods you do </li></ul><ul><li>Have your child sit at the table at least 10 minutes </li></ul><ul><li>Child feeds her or himself </li></ul><ul><li>Involve your child in food selection </li></ul><ul><li>If your child has difficult behavior, remove for the remainder of the meal, but offer healthy food 30 – 60 minutes later </li></ul>
    43. 43. Toddler Eating Basics #2 <ul><li>Families that eat together and establish clear eating routines early on, do better </li></ul><ul><li>Never “force feed” </li></ul><ul><ul><li>Remember SET : No control over , Sleep, Eat, Toilet </li></ul></ul><ul><ul><li>You control what and when food is available </li></ul></ul><ul><ul><li>Your child controls whether and how much </li></ul></ul><ul><li>With a “spirited eater,” can you put up with a bit more mess? </li></ul><ul><li>Learn to breathe and relax: Most kids get the right nutrition </li></ul>
    44. 44. <ul><li>Anytime you feel you need help, ask for help </li></ul><ul><li>Poor weight gain </li></ul><ul><li>Misses more than a meal or 2 </li></ul><ul><li>Gorging, begging for food, refusal to eat, hoarding food </li></ul>When should I ask my doctor for help?
    45. 46. Quality Child Care <ul><li>Higher quality child care associated with: </li></ul><ul><li>Better language abilities at 15, 24, and 36 months. </li></ul><ul><li>Higher cognitive development at age 24 months. </li></ul><ul><li>Greater school readiness skills at 36 months. </li></ul><ul><li>Caveat: </li></ul><ul><li>The combination of family income, mom’s vocabulary, home environment, and how mom helped their child learn are bigger factors promoting child development than child care alone </li></ul><ul><li>Take Home Point: Children need BOTH a nurturing home and stimulating environment to thrive </li></ul>(NICHD)
    46. 47. Tips for Child Care In-home or out <ul><li>Pretend Play </li></ul><ul><ul><li>Develops their ideas, imagination, language </li></ul></ul><ul><ul><li>Reading, Art…having fun </li></ul></ul><ul><li>Read lots of books with them </li></ul><ul><li>Limit and set boundaries on screen time </li></ul><ul><li>Remember </li></ul><ul><ul><li>Your child’s talents are multiple: </li></ul></ul><ul><ul><ul><li>Music, athletic, creative, interpersonal </li></ul></ul></ul>
    47. 48. What Do I Look for Safe, Quality Child Care? <ul><ul><li>What is the child : caregiver ratio? </li></ul></ul><ul><ul><li>Do the caregivers/teachers seem to enjoy talking, playing and nurturing the children? </li></ul></ul><ul><ul><li>Are there plenty of toys and learning materials within a child’s reach? </li></ul></ul><ul><ul><li>How does the center deal with discipline and misbehaviors? </li></ul></ul><ul><ul><li>Resources: </li></ul></ul>
    48. 49. Child Care and Parenting Resources CHILD CARE Child Care Action Council 360-754-0810 or 1-800-845-0956 or (360) 786-8907 Crisis short-term child care and assistance, referrals to child care.   Head Start: 360-464-6800. Español 464-6827 Free quality preschool for children 3-5 years old from low-income families. Sites located in Olympia, Lacey, Tumwater, Rainier, Rochester and Yelm.   DSHS Olympia Community Services Office (CSO) 360-725-6650 or 1-877-501-2233 Working Connections program 6860 Capitol Blvd, Tumwater, WA 98501 Show up at 7:30AM and apply for subsidized child care for low income persons
    49. 50. Child Care and Parenting Resources
    50. 51. Child Care and Parenting Resources
    51. 52. Questions?
    52. 53. References <ul><li>Straus MA. Spanking and the making of a violent society. Pediatrics. 1996;98:837–842 </li></ul><ul><li>Graziano AM, Hamblen JL, Plante WA. Subabusive violence in child rearing in middle-class American families. Pediatrics. 996;98:845–848 </li></ul><ul><li>Eron LD. Research and public policy. P ediatrics. 1996;98:821–823 </li></ul><ul><li>AMERICAN ACADEMY OF PEDIATRICS, Committee on Psychosocial Aspects of Child and Family Health Guidance for Effective Discipline. PEDIATRICS Vol. 101 No. 4 April 1998 </li></ul><ul><li>Needlman, R. Temper Tantrums, IN, Parker, S., Zuckerman, B., Augustyn, M. Developmental and behavioral pediatrics: a handbook for primary care, 2 nd ed. Lippincott Willimas and Wilkins, Philadelphia, 2005. P. 338. </li></ul>