It is normal for young children to come across emotional or mental obstacles, and responses include behavior problems such as tantrums, anger, aggression, or crying. While some children with emotional, learning, or behavior problems will need further care by a pediatric-behavioral specialist, you can help families give younger kids the reassurance and emotional tools they need to overcome emotional obstacles with responsive, positive parenting.
What is Positive Parenting?
According to zerotothree.org, a non-profit that promotes early emotional connections in infants and toddlers, “Positive parenting describes a set of parental behaviors that support a child's capacity to love, trust, explore and learn.” The theory of positive parenting is that with a trusting, nurturing relationship with their parents, a child can form secure attachments, which can positively affect both their present behaviors and future health outcomes.
Positive parenting is also a two-fold solution for families of babies and toddlers, because by training themselves to notice their child’s behavior and interpret emotions and needs, parents can react more calmly to stressful situations and provide more helpful responses, reducing overall family stress.
Claire Lerner, LCSW of Lerner Child Development and Rebecca Parlakian of Zero To Three, say that positive parenting strategies are founded on 9 skills, which they shared in their course, Positive Parenting Strategies to Address Behavioral Concerns, Promote Resilience as part of the AAP’s 2020 National Conference & Exhibition. Some of these important skills include:
- Sensitive responses to child’s cues. Parents can learn to respond to their infant’s cries, movements, gestures, and gazes. Timely responses in the first year of life, along with responsive feeding practices are effective ways to build secure connections, and over time, are associated with communication and socio-emotional skills.
Pediatricians can guide parents to understand a child’s cues and interpret their meaning by observing body language together, asking the parent for their interpretations, and building trust with empathy for the parents’ stress. Possible questions during this conversation could be: “I wonder how it feels to be a child in this situation?” or “I know, it can be confusing to know what to expect from an energetic little one. She is wired to be very independent at this stage!”
Parents can also engage with their child by speaking through the child: “Who is this stranger? I’m a little freaked out!” or by empathizing with a child’s responses: “I know, you’re so mad Daddy took your toy, but you’ll get it back after this exam.” Pediatricians can reinforce and encourage this behavior and provide guidance where necessary, moving to direct questions to help reinforce the parents’ expertise on their child, such as “How do you know if your baby is hungry? What works to soothe him? Is this behavior typical?”
- Ability to be fully present and share connections with the child. Parents can build a secure and nurturing relationship with their child by taking joy in their shared moments together. This is shown, according to Lerner and Parlakian, to grow parent-infant synchrony, and they report that “shared pleasure” at 2 months is related to social-emotional outcomes at 2 years.
Parents will likely engage in these behaviors without even noticing, so pediatricians can help build these connections by observing when they happen. For example, a loving gaze or a positive response to a baby’s gesture. Physicians can also ask about when parents feel close to their child, and about any instances when a parent does not understand what their baby needs. Reframing the difficult situation in a positive light by reflecting on shared connections can be a simple and efficient way to promote secure relationships and help parents resolve “miscommunications” with their babies.
- Ability to set age-appropriate limits on behavior. While difficult for many parents, appropriate boundaries and rules are founded on empathy for the child and are an important part of a child’s life.
Lerner and Parlakian caution that parents often expect too much of toddlers during a time of intense socio-emotional development. “We respond to child behavior driven by what we expect of them,” Lerner said during the course. “Parents expect much more from toddlers as far as sharing, self-control et cetera that toddlers are able to give. Parents who expect too much may interpret these behaviors as willfulness or resentfulness.”
Pediatricians can give parents valuable insights on their child’s stage of development, and can offer them the ability to build their knowledge, which can help align their expectations to what kids can do. The Centers for Disease Control have advice on development stages of kids for parents, as well as The Department of Health & Human Services. Reframing misbehavior by describing its uses, learning opportunities, or rationale within the child’s development stage can help the parents’ perspective on “willfulness” or “defiance” shift. For example, “You have such an explorer! It can be so exhausting, but she’s definitely at that age where she’s learning how the world works. Let’s talk about child-proofing at home.” or “Kids may hear the words you’re saying, but their bodies aren’t always able to comply, and that’s frustrating for them. It takes time to learn to cope with not getting what he wants!”
Anticipatory guidance can help prepare parents for upcoming issues before they arise. For example, during a well exam, the pediatrician can offer advice on separation issues, tantrums, sleep regression before they occur, giving parents tools to cope when they arise. Lerner and Parlakian noted specifically that parents sometimes need to be reminded that toddlers’ “manipulative” behavior is actually a sign of strategic thinking and development of the child’s personality and temperament. Discussing temperament as “wiring” can help parents understand and empathize with a highly active or highly sensitive child.
The Foundations of Positive Parenting
At the core of responsive parenting is a cycle of a parent’s continual learning, adapting, and repairing moments of discord. Parenting is stressful, so empathy with parents is key to helping them to find the self-care strategies that will help them avoid negative responses such as yelling or spanking. The AAP does not support corporal punishment, and research shows that it is not effective as a teaching or parenting strategy.
If corporal punishment is discussed or suspected, pediatricians can guide parents to avoid these behaviors by asking them how they feel after using them and whether or not they are effective. Research indicates that parents don’t want to resort to yelling or physical punishment, but that they don’t know what else to do and may be as exhausted and distraught as their child is. Strategies for pediatricians include modeling behavior and framing boundaries as caring limits that are in the child’s best interest, such as “I know you want to play, but jumping off of the chair is dangerous! Let’s stand on the floor for our exam instead.”
Physicians can also ask about parents’ coping strategies, and encourage stepping away from situations where they feel out of control if they need to. Leaving a child in a safe room and stepping away can help both the parent and child take a “mom/dad moment” to self-soothe and respond more calmly to a problem. It’s also important for parents to show their child they make mistakes: saying “I’m sorry” repairs relationships and helps the child understand their parents have their own emotions, needs, and flaws, and helps build empathy as well as love.
When is positive parenting not enough?
Positive parenting strategies are effective for all families to put into use with babies and toddlers, and even families learning to parent independent teens for the first time! Further, the American Psychological Association posits that psychological strategies like positive parenting are more effective for kids than prescriptions in moderating moods and behavior. However, there are situations where further interventions may be needed for a child or teen showing more pronounced emotional or behavioral problems. These might include:
- Risk of harm to themselves or others
- Delay in speech or motor disorders
- An ADHD or ADD diagnosis
- Mood disorders such as anxiety or depression
- Trouble learning, sleeping or eating
- Difficulty in daycare or school activities or risk of expulsion for behavior
- Trauma related to toxic stress or Adverse Childhood Experiences
These situations may call for a family to see a developmental-behavioral specialist, which might include a counselor, social worker, or specialized pediatrician. Together with a child’s medical home, the right care plan can be explored for each case, supported by positive parenting.
A pediatrician’s role in a child’s life is two-fold: they are experts in pediatric health, but are also crucial members of a parent’s support network, especially as they are constantly learning how to be the best parents possible for their unique child.
While time in the exam room is short, simple measures to reframe negative behaviors into positive learning experiences can help families embark on growing and learning in ways that help their child feel safe, secure, and confident. If your practice is looking to expand your behavioral health options, make sure to review all the options for accessible options with our ebook.