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A “disciple” is a student, and “discipline” is “teaching”–not “punishment.” Doing it properly is straightforward, but hard. Implementing effective methods vary with a child’s age, development, and temperament. Support for the statement “a good hard spanking is sometimes necessary to discipline a child” has dropped from 84% in 1986 to below 70% in 2012, and <50% of parents <36 years report EVER having spanked their child.
This is a positive trend. The American Academy of Pediatrics officially opposes all forms of corporal punishment(CP)–parents should NEVER hit, slap, threaten, insult, humiliate, or shame their child. There is sound reason for this. A 2016 study found no evidence of long term benefit to the child from CP and only one study from 1981 could demonstrate any short term advantage. A 1998-2000 study of >5000 children showed increased aggressiveness among 3 year olds subjected to CP with increased externalized behaviors and lower vocabulary scores by 9–they acted out more and communicated less. Other studies associate depression in either parent with more negative appraisals and increased frequency of CP. And there were these increased risks:
- physical injury
- more negative parent/child interactions
- increased–not decreased–levels of defiance
- mental health and learning disorders
- child abuse
- conduct problems in adolescence
- adverse events(suicide, substance abuse) in adults
There were even biologic consequences–decreased brain volume(both white and gray matter) as well as higher cortisol levels (toxic stress hormones).
So what does work? Basic principles for younger children, but with applicability across the age spectrum include:
- “Show and tell”–explain “good” behaviors. Note that this should be done at a “calm time”–when parent and child’s tempers are under control–NOT when the offense has just occurred and everybody is upset.
- Consequences should be clear, relevant, and explained at the same time and in the same way–calmly, when things are under control. Emphasize the situation and not the child (“if things go well/badly”–NOT “if you are good/bad”)
- Appropriate intervention–“the punishment should fit the crime”(so to speak). Don’t overdo. If the child breaks something they must make restitution–simple. The intervention should have a beginning, middle, and END. Adjust attitude and MOVE ON.
- Say what you mean and mean what you say. Threats are counterproductive, especially when not fulfilled. “If you don’t hurry we aren’t going to Grandma for Christmas.” STUPID–you ARE going to Grandma’s, of course. So you cannot back up that statement. You just lost the battle, and the war. The kid now KNOWS he can call your bluff. And threatening the same thing repeatedly without desired result is similarly foolish–if that intervention did not produce success before, time to think of a new strategy, not just repeating the same thing LOUDER.
- Never lose an argument: don’t start something you cannot finish. Example–you cannot make her eat, so don’t endlessly argue over it. But she cannot make you give her dessert, so when she melts down just ignore her, saying “tomorrow if you eat a good dinner you can have dessert.”
- Be prepared–many adverse behaviors are predictable. You often know when/where they will misbehave. Yelling and hitting is usually a tantrum on the parent’s part. Know what you are going to do when it happens, explain it (as above) and then calmly implement it when necessary. This is CONTROL.
- Ignore tantrums–NEVER try and”get them out of it.” You cannot–they are unreachable then. Put the child in a safe place(playpen, bedroom)–“when you calm down we will talk.” Let it blow over. Then deal with the problem.
- Nobody is perfect about discipline, and everyone will do better and worse at times. It’s a daily process. So do your best, every day.
Finally–perspective, and humility. They are children; misbehavior happens. They’ll NEVER be as perfect as we were back then, right? Just ask Grandma!
Thanks for following.
Happy Holidays to all! As a Jewish American, I still, like everybody else, so enjoy seeing all of the holiday decorations coming out. Who doesn’t get excited about this time of year?
Let’s review some highlights for indoor holiday decoration safety. My advise about outdoor decorations is actually very simple–the younger the child, the less involved in the decorating process, the better.
- If using “artificial” make sure they are “fire resistant".
- For live trees–fresh trees are green, have some sticky resin on the trunk, needles don’t snap in half when bent and don’t fall off if the tree is shaken.
- Cut off approximately 2″ from the base and keep in water.
- Keep away from fire or heat source like heaters, radiators.
- Keep away from traffic areas like doorways.
- Secure to walls with thin wire for stability.
- Use only non-flammable.
- Avoid sharp or breakable objects.
- Avoid leaded materials (note–besides patriotism, “Made in America” is usually, but NOT ALWAYS, best).
- Avoid small parts.
- Avoid artificial candy or food.
- Keep away from trees.
- Keep away from paper.
- Non-flammable holders.
- Extinguish all flames if you go out or retire for the evening (this means YOU, fellow Jews celebrating with the Hannukah menorah!) .
- Check for broken or cracked sockets.
- Check wires.
- Never use electric light on metal tree–the tree can conduct electricity causing shocks or fires.
- Shut off all electric ornaments upon retiring for the evening.
- Do not overload sockets–no more than 3 standard light sets per extension cord.
- Don’t keep paper by open flame like fireplace or candles (DUH!!)
- Do not burn used wrapping paper in fireplace.
6. Spun glass–“angel hair” decorations of sprayed artificial snow can be inhaled and cause serious lung injury.
7. Poinsettias are poisonous–is it really necessary to include them in decorating your house when there are young children around?
Bottom line that I remind all patients : Christmas decorations, and in particular, the tree, are the definition of “attractive nuisance”–little kids are drawn to them. I mean–that’s the point, isn’t it? So you cannot keep the child away from the tree. You must endeavor to keep the tree away from the kid.
Please keep all of these things in mind. And let’s make this the Happiest and HEALTHIEST Holiday Season yet!!
Let’s take note of 2 consumer products with troubled safety records for children.
The first is instant soup/”ramen” noodle preparations for microwave ovens. An 11 year study finds that 20% of all scald burn injuries presenting to the ER, 9500 children aged 4-12 each year, are caused by microwaved soup containers. The peak age is 7 years; girls make up 57% of injuries. Most burns occurred when the small package was opened after heating, spilling contents on the child, causing burns to the torso (40% of all injuries). The added water can quickly overheat and when tipped over can cause a scald wound. While most incidents result in only mild burns with full and uneventful recovery, still up to 10% were more severe, including those requiring scar management and skin grafting. So prudence is still the order of the day.
The authors recommend that improved product design, like smaller opening and wider base, will help to limit risk here. But, of course, there is no substitute for common sense: Don’t let younger children handle these products; close supervision for adolescents. Counsel them to focus on the task at hand–PUT THE DARN PHONE DOWN when using microwave and handling hot food.
The other warning references hover boards. Between 2015-16 researchers report almost 27,000 youth injuries treated in US Emergency Departments. As one might expect, boys predominate here (52%) wth peak incidence at age 12. Most injuries involved the upper extremity(34%) with fractures making up 40% of those problems; head injuries were second but the most common to result in hospitalization (14%). Burns from the board spontaneously catching fire was actually a rare occurrence. A frequent risk factor was “multitasking” involving–you guessed it–the child trying to use a smart phone or listen to music while operating the hover board. Wouldn’t it be at least a small welcome change if reading a book while hover boarding caused some of this problem(sorry, couldn’t resist)?
One added comment: this same study reported > 120,000 skateboard injuries in the ED over the same 2 year period; 75% of those among boys. One word: HELMETS!!
Let’s really go back to the very beginning and review some basics of baby formula preparation. Of course, we pediatricians still advise that the best infant nutrition is breastfeeding, but at some point most babies’ diets will likely include some formula. The AAP recommends the following:
- Prepare the formula according to the manufacturer’s directions ONLY. DO NOT dilute the formula (to save money) or concentrate it (to increase calorie concentration). Both can cause diarrhea at least and sometimes disruption of blood electrolyte levels like sodium and potassium which can lead to severe problems with normal nerve or heart function.
- Make sure the water source is safe. If your home has well water, it’s best to boil the water for 1 minute (“rolling boil”) and then allow 30 minutes to cool before mixing your formula.
- Be careful to maintain proper formula temperature. Use a bottle warmer or place the bottle in a container of hot water for 5-10 minutes. It is best not to microwave the bottle. Microwaving can heat the insides of any container in an uneven fashion which can cause burns, and also it can disrupt the nutritional value of some formula ingredients. At any rate, its best to always check the formula temperature on yourself prior to giving it to the baby.
- “Cleanliness is next to Gdliness.” Always wash your hands prior to preparing or feeding your baby. Wash all countertops and surfaces carefully. A dishwasher will not clean the inside of a long, thin bottle very well, so wash by hand using a bottle brush for the inside. Bottles and nipples should all be cleaned with hot, soapy water and be sure to rinse all soap off thoroughly. By the way, best to boil nipples for approximately 10 minutes prior to using for the first time. This is not for cleanliness as much as to boil off residue of chemicals used to soften the rubber.
- Be aware of proper storage times. All leftover formula should be discarded 1 hour after feeding to the baby. Powder based preparations can be refrigerated for 24 hours; bottles of unused concentrate can be refrigerated for 48 hours prior to usage.
As stated initially, breastfeeding is still best and what I and all pediatricians recommend as the first line nutritional source for your baby’s best health. This seems like a good place for me to give a shout out to Dr. Rose St. Fleur and my colleagues at the Center for Breastfeeding at Jersey Shore Medical Center. They can be reached at 732-776-3329 and are an excellent resource/clearinghouse for questions from nursing mothers. Tell them Dr. G sent you (they won’t care).
OK, I may make some enemies in our community with what I am about to say, but here goes. There is a growing consensus among health professionals who care for children–including pediatricians like me, neurologists, radiologists, and others–that organized tackle football should be avoided in younger players. Children have larger heads and weaker neck muscles compared to adults, making collisions riskier. Moreover, younger, less experienced players more often utilize poorer tackling technique which also raises the risk threshold. While hard shell helmets do limit skull fractures, the evidence regarding concussion prevention is actually quite poor.
Of course, at these younger ages the brain is still developing. Researchers at Wake Forest Medical School recently followed children 8-13 yrs during football season with MRI scans. None of the boys had developed concussion symptoms during the study period, yet their scans showed subtle but clear disruptions of normal brain metabolism from pre to post season. Related studies done at Boston University Medical School looked at former NFL players and found that those who had started in the sport < 12 years old had a significantly higher incidence of “white matter” brain changes and more frequent difficulties with depression, cognitive impairment and behavioral problems in later life. There are additional studies reporting similar patterns in people playing other contact sports from an early age compared to those who did not.
So where does that leave us? Well, I am certainly NOT “anti-football”(well, maybe anti-NE Patriots, but anyway…). > 1 million boys play high school football. As I spend a good part of my time begging/yelling at my teen patients to get off their darn phones and to be more active, I strongly support this and all high school sports. Presently there are approximately 1.2 million US 9-12 year olds playing youth football (numbers have decreased in the last few years because of these concerns) and those kids sustain approximately 240-585 head hits each season. Note that youth football is a relatively recent phenomenon–when I was growing up in the 1960’s-70’s it hardly existed. Back then, tackle football was something we played on weekends in the park if we could collect enough guys to make 2 teams. There were no non-HS football “leagues”–tackle or otherwise– to speak of.
We need a new paradigm, and I believe this is where flag football comes in. The nonpartisan Aspen Institute recently issued a White Paper advocating for flag only < 14 years. Here in NJ, Assemblywoman Valerie Vainieri-Huttle (D-Bergen) has introduced a bill (A-3760) that would allow flag football but ban tackle statewide < 12 yrs. Given the above, the arguments against–that teaching younger boys proper tackling technique improves safety–are, at best, unconvincing. I believe this bill deserves serious consideration; personally (and professionally) I support it.
Don’t all yell at me at once– but send along questions and comments, and thanks for following.