Sales Training Feb 2014 - Nursing

U N I T 2 Health Promotion of the Growing Child and Family

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EVIDENCE-BASED PRACTICE 4.1

CORPORAL PUNISHMENT AND BEHAVIOR PROBLEMS IN EARLY CHILDHOOD

Extinction involves systematic ignoring of the undesired behavior. Parents sometimes unknowingly contribute to the occurrence of an unwanted behavior simply by the attention they give the toddler (even if it is nega- tive in nature, it is still attention). Parents who want to extinguish an annoying (nondangerous) behavior should resolve to ignore it every time it occurs. When the child withholds the behavior or performs the opposite (appro- priate) behavior, they should use compliments and praise. It may be difficult to ignore a difficult behavior, but the results are well worth the effort. Teaching Guide- lines 4.4 provides tips on avoiding power struggles and offering appropriate guidance to toddlers. STUDY A large volume of research indicates that there are few, if any, positive developmental outcomes associated with the use of corporal punishment (spanking). In order to determine if negative consequences resulted, the authors used data from a large longitudinal ongoing multicenter study, the National Institute of Child Health and Human Development Study of Early Child Care and Youth Devel- opment. They reviewed the data from over 100 chil- dren, performing analyses that specifically controlled for contextual and parenting variables as well as for partial child effects. The Home Observation for the Measurement of the Environment (HOME) was administered when the children were 15, 36, and 54 months of age. The HOME measurement determined the use of corporal punish- ment. To determine the presence of behavior problems, the Child Behavior Checklist was administered at 36 months of age and again when the child was in the first grade. • When giving the toddler instructions, tell the child what to do, NOT what not to do. This allows for a positive focus. If you must say “no,” “don’t,” or “stop,” then follow with a direction of what to do instead. • Offer limited choices, when a choice is truly avail- able. Say, “Do you want to wear your blue hat or your red hat?” NOT “Do you want to put on your hat?” This gives the toddler some, but not all, control. • Role model appropriate communication, but don’t feel like you have to speak nicely all the time. If the situation warrants, use a firm and even tone to get the point across. Avoid yelling. Teaching Guidelines 4.4 PROVIDING TODDLERS WITH GUIDANCE

Findings Multiple regression analysis was performed on the data sets, controlling for variables such as the child’s gender, ethnic- ity, and temperament as well as maternal sensitivity and depression. The results established a causal link between the use of corporal punishment and child adjustment, particu- larly an increase in behavior problems during toddlerhood. Nursing Implications Targeted interventions may have a positive impact on decreasing the use of corporal punishment in young children. Advise parents about the risks associated with corporal punishment. Provide them with education about appropriate alternative methods of discipline, including limit setting with consistent follow-through, extinction, and time-out. Support parents’ efforts to use alternative methods of discipline. • Pay attention to the inflection in your voice. A state- ment or direction should not end in a questioning tone or with “Okay?” Be clear. Statements should sound like statements, and only questions should end in a questioning tone. • When a toddler behaves aggressively, label the child’s feelings calmly, but be firm and consistent with the expectation. For example, “I know you’re mad at your friend, but it is not okay to hit.” Adapted from American Academy of Pediatrics. (2004). Guidance for effective discipline . Retrieved March 11, 2011, http://aappolicy.aappubli cations.org/cgi/content/full/pediatrics;101/4/723; and Anderson, J. (2008). Discipline techniques: The 12-month-old. Contemporary Pediatrics , 25(9), 84–87.

Adapted from Mulvaney, M. K., & Mebert, C. J. (2007). Parental corporal punishment predicts behavior problems in early childhood. Journal of Family Psychology, 21 (3), 389–397.

Addressing Common Developmental Concerns

Common developmental concerns of the toddler period are toilet teaching, temper tantrums, thumb sucking or pacifier use, sibling rivalry, and regression. An under- standing of the normalcy of negativism, temper tantrums, and sibling rivalry will help the family cope with these issues. Prepare parents for these developmental events by giving appropriate anticipatory guidance. Toilet Teaching When myelinization of the spinal cord is achieved around age 2 years, the toddler is capable of exercising

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