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U N I T 2
Health Promotion of the Growing Child and Family
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.
EVIDENCE-BASED PRACTICE 4.1
CORPORAL PUNISHMENT AND BEHAVIOR PROBLEMS IN EARLY
CHILDHOOD
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.
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.
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.
Teaching Guidelines 4.4
PROVIDING TODDLERS WITH GUIDANCE
•
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.
•
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,
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.
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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