1. Advice for Young Child Behavior Christopher Lever Community Pediatric Consultant

2. Objectives  Discuss typical negative behavioral encounters in pediatric medicine  Consider some medical evaluation when negative behavior presents  Have an approach to give advice to parents regarding negative child behavior

3. Stages  9-12 months  18-36 months  5-year-olds  Preadolescents  Adolescents

4. Cases?

5. Cases?

6. Cases?

7. Cases?  Food refusal  20-month-old refusing to eat supper  Oppositionality  3-year-old girl talking back after visits with her father  Sleep difficulties  For your old waking up six times at night after hospitalization for asthma

8. The Pediatrician’s Role  Listen  Consider pathology  Give specific advice  Give references and resource information

9. Medical Considerations  Iron deficiency  Nocturnal seizures  Thyroid disease  Steroid use  Pain syndromes [example-migraine]  Sensory impairment  Cognitive impairment

10. Mental Health Considerations  Anxiety  Obsessive-compulsive disorder  Major depressive illness  Personality type

11. Other Considerations  Attention deficit/hyperactivity disorder  Oppositional defined disorder  Conduct disorder  Child-parent interaction difficulty  Cognitive impairment  Learning difficulty  Autistic spectrum disorder  Fetal alcohol syndrome

12. Advice  Consider the developmental age of the child  Normalize behavior, if possible  Educate parents  The golden rules

13. Advice- The Golden Rules  Ignore what you can ignore  Praise specific desired behavior  Give appropriate consequences for native behavior  Be consistent-that means everybody!  Give the child choices if possible  Be a role model  Empower parents  Recognize special situations such as single parents, divorced parents, and different cultural views

14. Consequences  Natural consequences  Timeout principal  Token economies  Lost privileges  Corporal punishment

15. Advice-summary themes  Use simple language  Pick your battles  Allow for safe and unstructured activities

16. Other resources  Managing childhood behavior [www.sacyhn.ca]  Reference list’s-Canadian Pediatric Society or others  Counseling services  Private psychology

18. Summary  Negative behavior is common and should be asked about during any patient encounter  Consider medical problems directly contributing to negative behavior.  Know and use the golden rules of advice  Educate parents  A resource list is useful and should be readily available