Transcription:
Child Behavior

Melanie Cole (Host):  There’s no handbook for your child’s health. But we do have a podcast, featuring world class clinical and research physicians covering everything from your child’s allergies to zinc levels. This is Kids Health Cast by Weill Cornell Medicine. I’m Melanie Cole and our topic today is child behavior. Joining me is Dr. Jane Rosini. She’s an Assistant professor in Clinical Pediatrics at Weill Cornell Medicine and an Assistant Attending Pediatrician at New York Presbyterian Weill Cornell Medical Center. Dr. Rosini, it’s such a pleasure to have you join us today. Let’s just start with some of the most common child behavior questions you get from parents every day.

Jane Rosini, MD (Guest):  I think that probably of the visits that I have, and I’ll see children from newborns up until they are 21 years old; and I think probably about 50% of what people come in with is questions about their children’s behavior. Often and it depends on how early people decide to address this, the first questions that I get are about how do I make my child do what I want? How do I get them to follow the rules? How do I get them to behave? And they are very general questions and certainly I could talk for hours about each aspect of that. I think really what’s most important and what I usually try to emphasize and again, like I said, seeing children from the time they’re born makes it easier to be able to set up a relationship where you can start early and start with good behaviors.

Often, what I’ll tell people is to start as early as they possibly can. So, as soon as their child is old enough to understand the idea of cause and effect, that they have to have rules. They have to have consistency. They have to have ways that they act in each situation so the child can expect what’s coming next. And so, just again, as an introduction, what I often tell people to do is make sure that you are consistent from the very beginning. So, if you have a rule, let’s say for your two year old that they are not allowed to jump on the bed. It can’t be that one day you say you know what, today is the day we’re allowing you to jump on the bed. It has to be you never jump on the bed. This is what we do.

The second part to that is that there has to be consequences. Now that’s a little bit different than there being punishments and people don’t like the term punishments and I don’t like the term punishments. But basically, the idea is that the child knows that if they jump on the bed, you are going to pick them up and put them on the floor and that activity is done. Also, one thing that sort of leads into them understanding this is to have your go to way of talking to a child so that they know that you don’t approve of what they are doing. And again, it’s never too early to start that and set it up so that your child knows exactly what you mean by the way that your voice modulates, the way that you look at them, the words that you say.

There are people who don’t like to use the word no, they like to use positive aspects instead. And I absolutely understand that. So, if you don’t want to say no, don’t touch the hot stove; instead you want to say come away from there, let mom help you, let dad help you, then I think that’s absolutely fine. You don’t have to use the word no but on the other hand, you have to have a way of speaking so if you are saying come over here; it can’t be oh honey, I’m so sorry, come over here when it’s a dangerous situation. There has to be that go to voice where you basically are speaking in a way that your child stops in their tracks, looks at you and knows that they must respect what you’re saying.

Host:  That is such an excellent point and as a mom, I remember, you have different voices for when you mean different things and the child has to understand that one voice which may be a little more stern, right, so, as we’re looking to these behaviors that parents would like help on; taking a nap for example. There comes a point when children stop wanting to take naps but at some point, they still kind of have to. How do we do things like that?

Dr. Rosini:  Absolutely. Again, I think consistency is really the key. So, not that you want to be so stern or so particular that every day the nap has to be at 12:10 but if you have an afternoon and you know again, the child’s not looking at the clock, so they don’t know today it’s 12:30 and yesterday it was 11:45 but if they know that there’s an afternoon nap and that’s a quiet time no matter what; then hopefully they are set up for it. again, I feel like I’m saying the same thing over and over again, but the consistency is important. So, if you have a routine, if let’s say your routine is the afternoon nap is there’s lunch and then there’s a little play time and then there’s a story and then you basically wash up, get into comfortable clothes and then they are taking a nap; then when they start to see that routine, when that routine is happening each day; their body and their mind without them even realizing it is going to move towards all right this is nap time.

I often say to parents that it’s sort of the same idea that when you go to be yourself is that when you go into your own room and you lower the lights and you put on comfortable clothes and you – whatever you need to do wash up, brush your teeth, again, the same thing without you really realizing it, your body is slowing down and saying these are the ques that I’m expecting for nap time or for sleep time obviously. I wish there were nap time for adults but more often bedtime. So, for kids, the same thing is you want to keep that consistency, you want to have the routines, so they know.

Then again, the same thing and I keep emphasizing but I do want to make that point is that if you’ve made a choice like let’s say you’re saying 12:10 is that nap time and you say to your child okay, this is what we’re going to do now. We’re going to take that nap. You have to stick with it. So, if you say it’s naptime and the child has a fit and throws themselves on the floor and in the back of your brain, you are saying to yourself, you know what, maybe we don’t need a nap today. Maybe my child is getting a little old for this and there’s other things to do and we don’t need to do it; that’s absolutely fine but you keep that to yourself, you go through the routine, you let them know that because you said it’s nap time, it’s nap time and then the next day; when they have behaved when they are doing what they are supposed to, you say, you know what, today is the day where I think we’re going to skip the nap or today is the day where we’re going to have the nap a little later. Let’s play a little bit longer.

And again, the most important aspect of that is that once you’ve said that rule whether it’s sitting in the stroller, whether it’s taking the nap, whether it’s putting the shoes on; even if in the back of your head you say to yourself ah, maybe not this time; you don’t want to give that in because if you do then the child is going to pick up on that and know that there are exceptions and there’s times where they can bend those rules.

So, more specifically about the naps; you want to pick the time which is best for the child. Again, you’re going to pick times that sort of match their body clock. So, if you have a child who wakes up at 7 and you’re trying to put them down for a nap at 8 or 9 in the morning; that may not be appropriate. They may not be ready for it. On the other hand, if you wait too long and you have a child who is overtired and anxious and fussy and such; then it makes it really hard. So, over time you are going to get to know what the ques are that are going to indicate that the child is ready for a nap, you’ll go through the regular routine and you’ll let the child know – when they are younger it’s more with the activities and when they are older it’s with warning, it’s with saying remember it’s almost nap time, we have five minutes, we have four minutes, we have three minutes and so they know what’s coming next and then keep it going until you get to the point where the crying to get them into the nap takes longer than the actual sleeping does and then at that point you’re probably done with the nap.

Host:  Wow, that’s really great advice. And something I know that every parent struggles with and while we’re talking about things that parents struggle with; tantrums and getting fussy and maybe even around those times when they are starting to be extra tired but really maybe not needing that nap; what if they have a tantrum? Do time outs work? I know you’ve mentioned consistency and I think that’s such an important point. But what if the tantrum is like in a public place or what if it’s on a playdate or at the grocery store? What’s a parent to do when that time of life starts with kids?

Dr. Rosini:  Yeah, that’s a good question because kids are and I don’t think they always mean to be, and of course there are some who get to the point where they are testing their limits, but they can be a little manipulative in that way. So, it’s very common for parents to come in and say strangest thing, they are well behaved at home and as soon as I’m in a situation where a tantrum is going to be very embarrassing or difficult or hard to deal with; that’s when the child chooses to act that way. To give the child a little bit of a break, sometimes it’s because those are difficult situations, those are situations where they have to sit still, they have to behave, they are with people who they are not comfortable with and so they may be more likely to have a temper tantrum.

Still, again, the bottom line is that each episode of the tantrum is an opportunity for a parent to show the child that the tantrum doesn’t work. So, if you are someplace and your child throws themselves on the floor and you pick them up and give them a piece of candy or a cookie; then basically in their head, whether they do it consciously or subconsciously they are saying to themselves oh good, this works. If I throw myself on the floor, I get what I want. So, it’s very difficult for parents to do especially in crowded places and you always feel like every single parent is looking at you and saying oh my goodness, that parent doesn’t know what they are doing. I guarantee you most of the times, the people who have children, are looking at you saying I’ve been there, done that, I know what it’s like. Rather than them judging.

So, the best thing to do is just stay calm in the situation, speak to your child in a clam voice, let them know. If they are too young to understand it’s mostly body language; if they are older than you can speak to them as it happens and basically say I can’t listen to you when you talk like this, I’m going to have to wait until you’re ready and then remove them from that situation. But not give into the tantrum. If the tantrum is in the supermarket, and they are asking for a cookie; you can’t give the cookie. You have to also keep in mind which I always think is interesting; you have to think about what the child is trying to get from that tantrum. So, not uncommonly what people will tell me is the child is saying I don’t want to go to the store, I want to go to the park. They go into the store, they have a temper tantrum, the parent takes them out of the store and then when you think about it, basically they’ve gotten their way. What you’ve said to them is if you have that tantrum, even though mom or dad or babysitter wants to go to the store; we’re not going to go because you’re getting your way.

It may not be going to the park but still there’s sort of a trade off there. The child may be saying to themselves, well park would be nice, but you know what, I’ll take just not being in the store. So, that means that there are going to be plenty of times for parents where they’re going to have to fight through those uncomfortable situations where the child is being difficult, being loud and just move through and smile and nod at the other parents and the people in the store and let them know that this is just something you’re going through, your child is safe and you’re doing your best as a parent.

Host:  Again, great advice. Dr. Rosini so, before we wrap up, I mean really, it’s so usable this advice. When parents are dealing with these things, the struggles, the tantrums, the behavior; when do they know that something is not normal? Between normal activity, hyperactivity or when do you tell parents to seek additional help when behavior becomes an issue?

Dr. Rosini:  There’s two aspect to that. At any point where a parent feels like they are overwhelmed that they can’t handle the situation, that they feel something is wrong, especially if they are getting to the point where they feel so frustrated that they are feeling angry at their child; then that’s a good time to seek help and that’s really from the parents’ side. Because there should be a point where you feel like you don’t want to deal with it. You can’t deal with it. You feel overwhelmed. That’s not good for the parent and that’s not good for the child. So, if you get to that point, it may be something as simple as talking to another parent, talking to a therapist, talking to your own parents or your relatives, your sisters, your brothers, people who have gone through it or getting to the point where you go to see a child specialist or you go to see a behavior specialist or a teacher or go to a support group or anything like that.

So, that’s one side of it. On the other side of it, looking at the child’s behavior; if you’re getting to the point where these behaviors are occurring in multiple situations. So, if it’s only and this is not uncommon, like parents will tell me that at home their child is a mess or with one parent they are a mess. Mom comes home from work and suddenly the child is throwing themselves on the floor and the babysitter will say heh they were great all day. Or you send them to school, the teacher says they were fantastic all day, they come home, and they just give it to the parents. That is a little bit more usual and basically is the child’s way of seeking attention. It would be great if they always looked for positive attention; but sometimes kids if they get to the point where they don’t think that they are getting the attention they want; again, somewhat subconsciously, they’ll act out because even though it’s not good attention, it’s not you’ve been so good, I’m so proud of you; they still get the full attention of the parent for that temper tantrum.

So, sometimes that will happen. If you are finding on the other hand, the teachers are saying things, the babysitters are saying things, the grandparents are saying things, everybody is in sort of together saying that they are in accord that they are saying there’s something going on here. This child isn’t acting like other children that we deal with, that we see, that have been in the family and such. That may be the point where you think about seeking other help. Now that doesn’t mean again, keep in mind I often find that especially here in New York City, people send kids to school on the early side. So there are kids who are in school from the time they are six months old, eight months old and its really sort of a school setting, they have to tow the line. They have to be in a certain place. They have to sit for circle time. And I’ll often have parents come in and say I’m sending my 18 month old to classes and the teachers are saying how come this child is taking off their shoes, how come this child isn’t sitting still and you have to take it with a grain of salt because they have to remember that developmentally, an 18 month old isn’t expected to do that.

But if on the other hand, the teachers are saying things like your child is biting, your child is hitting, your child is doing other behaviors that are a little bit more out of character for that age and it makes sense developmentally and you’re seeing it in different situations; then that might be time at least to talk to your pediatrician about it. Because I think that’s a good place to start. Hopefully you have a relationship with a doctor who can give you advice, who has known your child all along and can tell you, yes this is normal for this child in this situation or this is something that you need to seek some help for.

Host:  Thank you so much Dr. Rosini. Do you have any final thoughts that you’d like to leave parents with about child behavior and working, as you just said, with their pediatrician so that they can really find out what’s normal, how to get involved, how to be consistent, all of the great advice you gave today. can you wrap it up for us?

Dr. Rosini:  Excellent. Sure. Everything about behavior in two minutes. Let me try that. Basically, what I would say is when you go in to see your pediatrician, I think that they are usually a great resource so have questions. Often, I’ll have people come in and sometimes I can be a huge list and we can’t get through everything, but if you have a list of questions as things occur to you, just write them down. Put them in your phone. Put them in the computer so that when you go in you can be like oh yeah, I had to ask you this question. I think that’s really helpful.

The other thing is as we discussed with all the behaviors, I think the bottom line from everything I have said to you is really the consistency and I think the other point that people tend to sort of put on the back burner and not think about so much is that there really should be consistency between all the caregivers and all the relatives as well. So, you are not going to get anywhere if one parent is allowing like I said at the beginning, the jumping on the bed and the other is not allowing the jumping on the bed. Or one parent is saying all right you are having a temper tantrum, I’m going to give you a cookie and the other parent is saying you are having a temper tantrum, you have to have a time out. So, you’ve got to all be on the same page and that may mean that you need sort of a parenting meeting. You need to sit down with grandparents and parents and babysitters and teachers and make sure that you are all doing the same thing. Because kids will really pick up on the fact that they can get one thing from one parent and one thing from another or a teacher or a babysitter and they are smart enough to work that into a way that’s going to get them what they want.

So, have that consistency. Make sure that everyone who is taking care of a child is on the same team. And if you do that, then again, starting early, being on the same team, being consistent; you’re going to end up with well behaved children.

Host:  What a great segment. Thank you so much Dr. Rosini, really great advice and so important for parents to hear. Thank you to our guest Dr. Jane Rosini and to our listeners. This concludes today’s episode of Kids Health Cast. Please remember to subscribe, rate and review this podcast and all the other Weill Cornell Medicine podcasts. For more health tips and updates on the latest medical advancements and breakthroughs please follow us on your social channels. I’m Melanie Cole.