Behavioral problems in preschool children are a common concern. For most parents I encounter, preschoolers can be difficult to manage at times, even for parents who are committed to using the most-up-to-date strategies by experts in the Pediatric Behavioral field. These frustrating problems are common because children are human and, like adults, they aren’t always at their best when they are tired, stressed or hungry. Usually a meal, nap or calm home environment is all that is needed to restore their normal good behavior and the sanity of their parents.
Some children are prone to more frequent behavioral issues that don’t respond to those simple steps, however. They tend to act out and are can be extremely difficult to control and manage. We have all seen the embarrassing grocery store temper tantrum. These children may be from normal homes and just stressed; they are in the store at the wrong time. Or, they may come from a stressed home, an unstable transitional home, or one where drug and alcohol use cause a disruption of the daily routine and unpredictable emotional responses from their care-givers. Or, it’s also possible they could be difficult and moody from an illness or even be Lead toxic from environmental sources. There are many possible reasons for unpredictable, difficult behavior.
As with any problem, it is probably easier to prevent problem behavior that to change it once it starts. There are steps that new parents can take to minimize behavioral problems in preschoolers. Studies have shown it does not matter who is raising the children: single parents, grandparents, straight parents, gay parents or Aunt Jean, all can be effective and successful. Regardless of the home makeup, I believe there are three important, foundational steps to good behavior and thus a happy and content child;
1. Parents must start setting some guidelines and expectations early-even before a year of age.
2. Parents (and Grandparents) must be consistent and react with same level of intervention with what the family has set as the limits and rules.
3. That limit setting, expectations and parental responses to the child must be developmentally “age appropriate.” This means that the parent should learn about and expect the age appropriate response for their child.
Social development is fairly consistent. We know that at eight weeks most babies smile, at four months they laugh out loud, and by seven months they respond to changes in the emotional content of the room. We know that predictable, progressive social development occurs through preschool years. Thus, we would not give a two year old a task with more than one or two simple steps to complete. Expecting children to respond to adult social expectations and explaining those “house rules” in concepts that are above their ability to understand is dangerously unrealistic.
Children respond best when discipline, which is really education, occurs within a supportive loving family. Positive responses, when earned, are extremely effective in decreasing negative behavior; positive or neutral responses to borderline anti-social behavior are not effective and can undermine the normal socialization process. The responses to discipline should be age appropriate; for a child under one year that may be just the brief withdrawal of attention and in older toddlers a brief enforced time out can be effective. The delay between response and transgression must be immediate if possible and the response should be appropriate but not meant to generate fear. The reason for the consequences should be explained and the duration short, 5-15 minutes based on age in preschoolers. Physical punishment is not recommended. It is usually resorted to when the parent is angry; it is often inconsistent; and it tends to actually promote aggression in the child.
It is not easy being a parent, but it is the most important job you will ever have. Fortunately, I think most parents do a better job at it than they think they do.
Michael R Jordan, MD, CPE, FAAP
Michael R. Jordan, MD, CPE, FAAP, chief of Pediatrics of Newark-Wayne Community Hospital is board-certified in Pediatric Medicine. He attended the College of Human Medicine at Michigan State University and completed his residency training at the University of Rochester. In addition to his leadership role as chief of Pediatrics at Newark-Wayne, he is the medical director of Rochester Regional Medical Group (RRMG) and is also chair of RGMG’s Quality Committee. He works in the Sodus Rochester General Medical Group Pediatric office. To send questions on children’s health, please email Wendy Fisher, Pediatrics’ Practice Manager at wendy.fisher@rochestergeneral.org and write “Ask a Doc” in the subject line. To schedule an appointment, call (315) 483-3214.
