Am Fam Physician. 1998 Sep 15;58(4):1001.
A policy statement from the American Academy of Pediatrics (AAP) addresses how physicians should counsel parents on the use of discipline for their children, including the use of positive reinforcement and the potential negative effects of corporal punishment. “Guidelines for Effective Discipline” covers the developmental approach to discipline, strategies for effective discipline, punishment and the physician's role in encouraging parents to develop methods other than spanking in response to undesired behavior. Lists of specific physician activities and supplementary information are also included. The statement appears in the April 1998 issue of Pediatrics.
According to the AAP, an effective discipline strategy has three essential components:
A positive, supportive, loving relationship between the parent or parents and child.
Use of positive reinforcement strategies to increase desired behaviors.
Removing reinforcement or applying punishment to reduce or eliminate undesired behaviors.
All three components must be functioning well for discipline to be successful, according to the policy statement. They must also occur in the context of a relationship in which children feel secure. The AAP stresses that children learn best from people they care enough to want to emulate and please, and who are good role models. The AAP strongly discourages the use of corporal punishment, because it has negative consequences and is no more effective than other approaches for dealing with undesired behavior in children.
The AAP recommends that physicians counsel parents to develop alternatives to spanking, such as “time outs” and removal of privileges. The statement includes a list of the negative consequences of spanking, including modeling aggressive behavior as a solution to conflict. The policy cites research showing that 90 percent of American families reported having used spanking as a means of discipline at some time, and that most adults were spanked when they were children.
Strategies for parents and other caregivers that help children learn positive behaviors include the following:
Providing regular positive attention, sometimes called special time (opportunities to communicate positively with parents are important for children of all ages).
Listening carefully to children and helping them learn to use words to express their feelings.
Providing children with opportunities to make choices whenever appropriate options exist and then helping them learn to evaluate the potential consequences of their choice.
Reinforcing emerging desirable behaviors with frequent praise and ignoring trivial misdeeds.
Modeling orderly, predictable behavior, respectful communication and collaborative conflict resolution strategies.
The policy statement acknowledges that discussing discipline with parents can be difficult. Both the physician's beliefs about discipline and the parents' beliefs were formed in childhood under emotional circumstances. Also, some religious groups have positions on the issue. Some parents, because of the increasing recognition of child abuse in the home, may also be reluctant to talk about their own ways of discipline. The AAP recommends that physicians begin a discussion by making an observation about the child's behavior and asking about the child's behavior at home. A negative response by the parent may indicate that the extent of the problem should be determined.
The AAP recommends a number of specific physician activities when counseling families about discipline. These include the following:
Be clear about what is acceptable discipline.
Avoid displaying strong emotions during the visit.
Work to understand the parents' justification of their current practices and address their reasoning when presenting alternatives (offer privacy from children during this discussion).
Demonstrate interest and expertise in child development and behavior during general visits to develop credibility for future discussions about discipline.
Look for examples of the parents' effective discipline approach; help them gain strength and generalize from those positive experiences to other situations. Suggest ways to modify the family's techniques to make them more effective and appropriate.
Participate in public education and advocacy to change cultural attitudes about discipline.
Copyright © 1998 by the American Academy of Family Physicians.
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