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U N I T 1
Foundations of Pediatric Nursing
choices when possible. Discipline involves teaching and
is ongoing, not something that is done just when the
child misbehaves.
The American Academy of Pediatrics (2004) sug-
gests three strategies for effective discipline (see also
Teaching Guidelines 2.1):
•
Maintaining a positive, supportive, nurturing care-
giver–child relationship
•
Using positive reinforcement to increase desirable
behaviors
•
Removing positive reinforcements or using punish-
ment to reduce or eliminate undesirable behaviors
Teaching Guidelines 2.1
TEACHING TO PROMOTE
EFFECTIVE DISCIPLINE
•
Set clear, consistent, and developmentally appropri-
ate expected behaviors; offer choices whenever pos-
sible.
•
Maintain consistency in responding to behaviors;
provide encouragement and affection.
•
Role-model appropriate behaviors.
•
Provide an age-appropriate explanation of the con-
sequence that will occur if the child demonstrates
unacceptable behavior.
•
Always administer the consequence soon after the
unacceptable behavior.
•
Keep the consequence appropriate to the age of the
child and the situation.
•
Stay calm but firm without showing anger when
administering the consequence.
•
Always praise the child for displaying appropriate
behavior.
•
Set the environment to assist the child in accomplish-
ing the appropriate behavior; remove temptations
that may lead to inappropriate behavior.
•
Reinforce that the child’s behavior was bad, not that
the child was bad.
POSITIVE REINFORCEMENT
Attention from parents is a very powerful form of positive
reinforcement and can help increase desirable behaviors.
The key is to focus on the child’s appropriate behaviors
rather than emphasizing the inappropriate ones. Immedi-
ate, consistent, and frequent feedback is crucial. This feed-
back can be in the form of smiles, praise, special attention,
or rewards such as extra privileges or a special token or
activity. Providing the feedback immediately is important
so that the child learns to associate the feedback with the
appropriate behavior, thereby reinforcing the behavior.
EXTINCTION
Another form of discipline is extinction, which focuses
on reducing or eliminating the positive reinforcement for
inappropriate behavior. Examples are ignoring the temper
tantrums of a toddler, withholding or removing privileges,
and requiring a “time-out.” Withholding or removing privi-
leges such as TV, music, or computer or phone use is most
effective for older children and adolescents. The adoles-
cent may be grounded for a short time or not allowed to
drive the car. To be effective, the privilege being withheld
or removed must be something that the child values.
Time-out is an extinction discipline method that
is most effective with toddlers, preschoolers, and early
school-aged children. It involves removing the child from
the problem area and placing him or her in a neutral,
nonthreatening, safe area where no interaction occurs
between the child and parents or others for a specifically
determined period (Fig. 2.5).
Take Note!
The amount of time that a child spends in time-out
is typically 1 minute per year of age; for example,
a 3-year-old would spend 3 minutes in time-out (American
Academy of Pediatrics, 2011).
PUNISHMENT
Discipline is often confused with
punishment
, but
punishment involves a negative or unpleasant experi-
ence or consequence for doing or not doing something.
Although punishment is sometimes a necessary element
of discipline, to be an effective tool it must be coupled
with rewards for good behavior (American Academy of
Pediatrics, 2004).
FIGURE 2.5
Although he might not like it, quiet solitude
helps the child develop inner control.
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