Discipline/Behavior

Objectives:

1. Identify and manage infantile colic​
2. Understand the interplay between temperament and behavior
3. Know various discipline techniques based on a child's age
4. Become familiar with helpful resources to share with parents

Articles:

• 2012 Brief Review of Colic
• Teaching Parents About Infant Temperament
• 2018 AAP Policy Statement on Effective Discipline

Additional Resources:

• Check out the Hopkins Curriculum topics on Discipline and Colic and Temperament to learn more and assess your knowledge.
• Check out this website for Parenting Tips and Resources on discipline
• HealthyChildren.org has more strategies for discipline by age
• If you like physical books, head to Monick's office to borrow 1,2,3 Magic! Effective Discipline for Children 2-12. Learn more about it here, in the Parenting Books section.

Self-Assessment:

1. During the initial health supervision visit, the mother of a newborn girl tells you that she is having a difficult time adjusting to life as the parent of 2 children. She tells you she is exhausted from the demands of feeding and caring for her newborn, and has been having a difficult time with her 2-year-old son who has been having more frequent tantrums. She is a single parent whose family lives in another state. The mother asks you where she can get help. Of the following, the BEST next step in this situation is to refer this mother to

1. a breastfeeding support group
2. an early intervention program
3. a Head Start program
4. a home visiting program
5. The Women, Infants, and Children Program

2. During a health supervision visit for her biological child, a mother mentions that the family is considering adopting 2- and 4-year-old brothers who have been in foster care for more than 1 year. The mother asks for information about health and behavior issues that may arise with these children. Of the following, the MOST accurate information to provide the mother is that

1. international adoptees have more health problems than domestic adoptees
2. sleep and feeding problems are anticipated as these children adjust to their new environment
3. the incidence of special health care needs among these children is equivalent to that in the general population
4. these children are likely to recognize that this family may be “different” from their friends’ families
5. these children often have minor developmental delays initially, but nearly always catch up within a few months

3. You are seeing a 9-month-old female infant for her routine health supervision visit. She has been healthy, but her mother raises concerns about the infant’s behavior. Her mother reminds you that the infant was “colicky” until about 5 months of age and that she took extra time off work to stay at home as the primary caregiver. Now the mother would like to resume her career, but she is worried that her daughter is very attached to her. The infant does not adapt well to new environments and cries if left with a babysitter. The mother describes the baby as usually quiet and content, but easily upset around new people. After she gets to know them, she is less fussy and becomes more friendly. She sleeps well with an established sleep routine. She has been growing at a normal velocity, but the mother reports she does not easily accept new foods as they are introduced into her diet, so she eats a limited number of puréed vegetables. You discuss the infant’s temperament with the mother to help her understand how best to plan for the upcoming change in daytime caregivers. Of the following, the category of temperament that BEST describes this infant is

1. difficult
2. easy
3. overanxious
4. routine regulated
5. slow to warm

4. A 15-year-old boy is brought to your office for behavioral concerns. His parents report that they have been struggling with their son’s lack of respect toward adults and his disregard for household rules. He frequently returns home after curfew and his parents are concerned that he may be involved with a gang. The adolescent has been referred to his school’s attendance review board for skipping multiple days of school and has been in trouble for vandalism of school property. He often intimidates his siblings and children in their neighborhood. The boy’s parents are worried that their son will turn out like his uncle, who has been incarcerated and has “anger management” issues. Of the following, the BEST next management step for this boy’s behavior is to

1. prescribe a mood stabilizer
2. prescribe an atypical antipsychotic
3. recommend a family and community-based treatment program
4. recommend a wilderness camp or boot camp
5. recommend participation in a Scared Straight program

5. A 3-year-old boy is brought to your office by his parents for concerns about his behaviors. His parents have observed him to have several episodes of facial flushing and irregular breathing. They report that they have noticed him reaching into the front of his pants when this happens. When his parents touch him or distract him, the boy resumes his usual play. The episodes occur both at home and in public. He is a healthy child whose development has been within normal limits. His physical examination findings are normal. Of the following, the MOST appropriate advice you can provide the boy’s parents is that

1. their son is likely to continue these behaviors in public
2. their son needs an evaluation by a child abuse expert
3. these behaviors indicate a serious health concern
4. they should guide him to limit these behaviors
5. they should ignore these behaviors

6. A 3-year-old boy is brought to the office by his adoptive mother who is concerned about her son's future. A year ago, he was removed from his biological parents' home due to neglect and exposure to domestic violence. The family lived in poverty and his biological mother has a history of depression. His adoptive mother asks how she can help her son overcome his early history of adversity. Of the following, the MOST appropriate recommendation is that she:

1. allow her son to wake, eat, and sleep when he wants
2. make as many decisions as possible for her son
3. protect her son from every potential risk
4. use an authoritative parenting style

7. At a boy’s health supervision visit, his father wishes to know how to manage the child’s recent behaviors.  Last week, after a trip to the store, he found a new toy in his son’s jacket pocket. When asked, the boy stated that he did not know how the toy came to be there.  He later admitted to taking the toy because he did not think that his parents would buy it for him.  The boy’s father has also noted that when playing board games, his son will change the rules to his advantage. The child has been in good health and his development and behaviors have been age appropriate up to this point. Of the following, this child’s behavior is MOST like that of a

1. 2 year old
2. 4 year old
3. 6 year old
4. 8 year old

8. During a health supervision visit, the parents of a healthy 4-year-old boy raise concerns about his behavior. A review of the medical record shows that the boy has had normal growth and development. The boy entered a preschool program this year. His teacher reports that he does not always share well or follow the rules, and sometimes he is aggressive toward other students to “get his way.” The boy’s parents deny behavior issues at home. He is their first child, so they have many questions about the most effective way to change his behavior.Of the following, the BEST intervention to recommend to this boy’s parents is to

1. discuss with him alternative acceptable means to “get his way”
2. initiate time-outs at home after bad conduct days
3. provide positive praise and rewards after good behavior days
4. take away a favorite toy or activity after bad conduct days

9. A 4-year-old boy has behavioral problems. His foster mother states that when he is upset, he will have a tantrum, throw toys, and hit anyone near him. He was dismissed from preschool because of concerns for the safety of his classmates. The boy was recently placed in the care of his foster mother who does not know the circumstances leading to his removal from his biological family. She asks about possible contributors to his aggressive behaviors.Of the following, the MOST accurate response is that these behaviors have been associated with

1. an authoritative parenting style
2. decreased dopamine and serotonin levels
3. a lower number of siblings
4. prenatal exposure to cocaine

10. An 8-year-old boy is evaluated because of his mother’s concerns of challenging behaviors. She reports that he is unpleasant and refuses to do anything that is asked of him. He loses his temper easily and is argumentative. He deliberately annoys his siblings and blames them when he gets in trouble. He is disrespectful to his teacher and the staff at school. Of the following, the BEST next step is to recommend a treatment program that teaches the parent to

1. apply consequences for challenging behaviors
2. delay response to unwanted behaviors
3. increase positive reinforcement of disruptive behaviors
4. vary response to undesired behaviors
   

Find the answers here.