General Parenting Strategies: Practical Suggestions for Common Child Behavior Issues

 

Am Fam Physician. 2018 May 15;97(10):642-648.

  Patient information: See related handouts on using time outs as a parenting technique and general parenting tips, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Parents often seek guidance from physicians on child behavior problems. Questions may range from general parenting strategies to managing specific child behaviors. Physicians and their staff can identify problematic parent-child interactions or behaviors within the office setting and assist parents by providing effective monitoring tools for behavior problems. Effective strategies for influencing a child's behavior include positive reinforcement to increase appropriate behavior, extinction (planned ignoring) for most low-level problematic behaviors, and time-out from reinforcement for more problematic behaviors. Written contracting provides parents the opportunity to communicate with their children about important behaviors and strengthens the commitment of each party to improve behavior. Parents should be cautioned about the use of punishment (e.g., scolding, taking away privileges or possessions) because it suppresses behavior only temporarily. Physicians should discourage physical or corporal punishment because it is related to negative parent-child relationships, increased aggressiveness, antisocial behavior, lower cognitive ability, lower self-esteem, mental health problems, and increased risk of physical abuse.

Parents often ask physicians about general parenting strategies or management of specific child behavior problems.13 Common concerns include problems at bedtime, excessive crying, tantrums, fighting with siblings, and nonadherence to rules.4,5 Children's electronic media use has also become a critical area for physicians to address with parents.6

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Anticipatory parenting education and interventions, especially reinforcing positive parent-child interactions (e.g., while reading aloud and during play), have a positive impact on a child's behavior, socioemotional development, and later functioning.

B

10

Monitoring child behavior problems and providing parents with general guidelines on parenting and child behavior management strategies appropriate to the child's age can decrease the likelihood of the child developing further behavior and emotional problems.

C

13

Effective parent training models share common principles that engage parents as partners with physicians in assessing and managing behavior problems. They also focus on reinforcing positive behaviors, especially while reading aloud and during play; ignoring low-level provocative behaviors; and providing clear, consistent, and safe responses to unacceptable behaviors.

C

16, 22

Parents should be discouraged from using corporal or physical punishment because of its negative impact on a child's behavior and mental health.

C

3135


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Anticipatory parenting education and interventions, especially reinforcing positive parent-child interactions (e.g., while reading aloud and during play), have a positive impact on a child's behavior, socioemotional development, and later functioning.

B

10

Monitoring child behavior problems and providing parents with general guidelines on parenting and child behavior management strategies appropriate to the child's age can decrease the likelihood of the child developing further behavior and emotional problems.

C

13

Effective parent training models share common principles that engage parents as partners with physicians in assessing and managing behavior problems. They also focus on reinforcing positive behaviors, especially while reading aloud and during play; ignoring low-level provocative behaviors; and providing clear, consistent, and safe responses to unacceptable behaviors.

C

16, 22

Parents should be discouraged from using corporal or physical punishment because of its negative impact on a child's behavior and mental health.

C

3135


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

Physician guidance is important because children with behavior and emotional disorders are at greater risk of school failure and dropping out, poor social relationships, abuse, antisocial behaviors, and increased use of health services.79 Family physicians can provide anticipatory parenting education and interventions that have a positive impact on a child's behavior, socioemotional development, and later functioning.10

Identification of Child

The Authors

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MICHAEL G. KAVAN, PhD, is a professor in the Dept. of Family Medicine and the Dept. of Psychiatry at Creighton University School of Medicine, Omaha, Neb....

SHAILENDRA K. SAXENA, MD, PhD, is a professor in the Dept. of Family Medicine at Creighton University School of Medicine.

NAUREEN RAFIQ, MD, is an assistant professor in the Dept. of Family Medicine at Creighton University School of Medicine.

Address correspondence to Michael G. Kavan, PhD, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178 (e-mail: michaelkavan@creighton.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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show all references

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