Time out for time outs: Why pediatricians now promote 'positive parenting'
Canadian Paediatric Society calls for shift away from shaming, blaming and other types of negative discipline
The latest parenting advice from Canada's pediatricians is to shift away from shaming, blaming and any other types of negative discipline to what they call positive parenting.
Positive parenting is a set of principles to correct children's misbehaviour with greater empathy and communication and less punishment — and sticking with it at the times when it's most challenging. Experts say positive parenting fosters loving, predictable and secure relationships between a child and their parent or guardian.
The Canadian Paediatric Society (CPS) said in its latest position statement, released Thursday, that this is the first time it is asking all primary care practitioners to encourage positive parenting. Doing so, the society says, buffers against the effects of stressors and traumatic events.
Gold-standard randomized trials have demonstrated how positive parenting techniques are more effective at reducing negative behaviour in children, said Jenny Jenkins, the Atkinson Chair of Early Child Development and Education at the University of Toronto. Jenkins, a clinical and developmental psychologist, wasn't involved in the position statement.
"Negative comments, negativity or harshness towards children has been shown to be much more problematic developmentally for kids," Jenkins said.
"Rather than parents getting mad at kids and being irritable with them and negative with them, the interaction becomes a more positive one," she said.
If parents ignore the low-level problematic things that kids often do and intervene only when there's a safety concern or really bad behaviour, then their interactions with a child can shift in a more positive direction.
"The parents are trying to pick their battles," Jenkins said.
But today's parents may be at a loss on how to practise positive parenting since many of their parents didn't use it with them, said Dr. Andrea Feller, a member of the CPS's early years task force that wrote the position statement.
Past parenting advice was well intentioned and based on what was known at the time, she said. But experts in child brain development no longer recommend discipline that includes punishments like shaming and blaming.
Feller encourages parents who feel conflicted between the way they were raised and adopting positive parenting to trust themselves.
"Parents are a child's first, best and most important teacher," said Feller,a pediatrician in the Niagara Region and a mother of two children under 12.
In fact, the CPS said the reason behind the new statement is that while there are many factors that can put kids at risk for developmental problems, parenting is one that can be easily changed. The focus is on children aged zero to six years.
At every visit, clinicians should ask questions about a child's behaviours and family routines, such as "What is your child's bedtime routine?"
Parents of young children commonly ask doctors for advice on crying, sleep and challenging behaviours, so that could serve as an opening for those types of conversations.
Clinicians are also encouraged to broach difficult and sometimes uncomfortable topics, such as trauma, and ask questions like "Has anything stressful happened to you or your family since I last saw you?"
To promote positive parenting behaviours, the society's other recommendations to clinicians include:
Primary care providers can also direct parents to positive parenting books or free community supports such as local early years centres.
A time out creates a brief break in the child's behaviours, even if it's a positive one such as expressing curiosity or reaching for a hug. In a time in, on the other hand, the caregiver invites the child to sit and talk about feelings and behaviour in an age-appropriate way.
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A time in focuses on connecting with the child, acknowledging his or her feelings and redirecting them in positive direction.
"Time outs have a place," Feller said, but should be considered a "last resort," since time outs can drift inappropriately into punishment.
What's more, time outs have no place in disciplining children under the age of three, who only understand that a parent or caregiver has turned them away. Often, Feller added, it is the parent who needs a break.
Feller noted social workers and early childhood educators already encourage positive discipline.
Now medical professionals are making the shift toward helping parents recognize that a young child's misbehaviour is often a way for them to communicate: "I can't handle things right now. I need your help."
Pediatrician Daniel Flanders, founder and director of Kindercare Pediatrics in Toronto, said the position statement is reasonable.
"It's a positive step in right direction, but it's a really small one," Flanders said. What's missing is practical ways to help parents implement it.
"It's all fair and good to say this is how parents should parent, but it's a whole other ball game when a single mom is trying to make it through the day, and she doesn't really have any resources or any support to really help her parent in all the ways this position statement is encouraging."
ABOUT THE AUTHOR
Amina Zafar has covered health, medical and science news at CBC since 2000. She has a degree in environmental science and a master's in journalism.
According to Castle, lots of sugary foods can also equate to elevated amounts of food dyes, artificial flavors or other additives that could be problematic for a child with ADHD, often making it difficult to tease out whether sugar is the culprit.
Complicating the issue is the fact that we don't have a way to determine whether there is a link. "Is there a biomarker? A hormone level?" King asked. "It's disheartening for parents. ... They want answers. And unfortunately, nutrition is such an individual thing."
"His diet eliminated artificial flavorings, sweeteners and preservatives -- and so sugar kind of got lumped in, as well," King said.
This diet may have led parents to perceive that sugar is a culprit when it comes to kids' excitable behavior - even if it is not the true cause of one's hyperactivity.
In one study from the mid-'90s, researchers gave children a drink containing a sugar substitute. One group of moms was told that their kids were drinking a high-sugar drink; the other group was told the truth, that their kids were consuming a sugar substitute. Mothers who were told that their kids consumed sugar rated their kids as more hyperactive, even though they didn't consume any sugar.
"Just thinking their children were consuming sugar caused moms to perceive their children as being more hyperactive," King said.
"When children consume sugar, it's usually around something fun: holidays, birthdays, celebrations; there's already that excitement there," she said. "I don't think you can say the sugar made them run around and play with friends. ... That would be very hard to separate out."
Instead, a release of the hormone adrenaline might explain a child's overly energetic behavior. "It's a flight or flight hormone; when you are excited or fearful, it increases heart rate and directs blood flow to the muscles, which may make children more antsy and have the urge to keep moving, so you may be perceiving that as hyperactivity," King said.
To try to determine whether your child is truly sugar-sensitive or just excited about a celebration, Castle recommends eliminating sugary foods from the diet for a few weeks and then testing the child with a sugary food like soda, frosted cake or a tablespoon of sugar in 100% juice, and watching the child's response. "It may be a quick way to determine how sugar may be affecting the child," Castle said.
Then again, like the parents in that study, you may just think they're being hyper just because you know that they consumed sugar.
To keep kids healthy, the American Heart Association recommends that children ages 2 to 18 consume less than 6 teaspoons - or 24 grams - of added sugars daily. To put that number in perspective, consider that 24 grams is the amount of sugar in just one 1.55-ounce chocolate bar. A 12-ounce can of regular soda contains about 40 grams of sugar, well over a day's worth.
Establish routine meals and snacks on a predictable schedule. "Anecdotally, this is one of the main things I work on with families, and they tell me they feel their child is calmer and better-behaved. There is something to be said for nourishing the brain and body on predictable, consistent intervals of three to four hours," Castle said.
When introducing foods with added sugars, pair them with protein, healthy fat or fiber. This helps to blunt the effects of blood sugar surges and drops, and it optimizes satiety.
Castle and King suggest the following combinations:
Experts say you can also include your treat as part of a snack or meal. "If you're at a party, try veggies and hummus and then having some dessert!" King said. "Or eat a small, sensible meal with lean protein, like turkey meat; add some cheese and baby carrots, and then add a fun treat or small sugar-sweetened beverage."
Don't eat sugar on an empty stomach. Doing so can lead to a surge in blood sugar, and that itself may alter a child's behavior, according to Castle.
Make sure that your child is drinking plenty of water. Also, avoid sugar-sweetened beverages on top of eating sugary foods, King advised.
Don't hype up sugar. If you don't have sugar and candies in your house often, and you bring sweets home and make a big deal about it, your child may pick up on it and become excited, King explained.
The latest parenting advice from Canada's pediatricians is to shift away from shaming, blaming and any other types of negative discipline to what they call positive parenting.
Positive parenting is a set of principles to correct children's misbehaviour with greater empathy and communication and less punishment — and sticking with it at the times when it's most challenging. Experts say positive parenting fosters loving, predictable and secure relationships between a child and their parent or guardian.
The Canadian Paediatric Society (CPS) said in its latest position statement, released Thursday, that this is the first time it is asking all primary care practitioners to encourage positive parenting. Doing so, the society says, buffers against the effects of stressors and traumatic events.
Gold-standard randomized trials have demonstrated how positive parenting techniques are more effective at reducing negative behaviour in children, said Jenny Jenkins, the Atkinson Chair of Early Child Development and Education at the University of Toronto. Jenkins, a clinical and developmental psychologist, wasn't involved in the position statement.
"Negative comments, negativity or harshness towards children has been shown to be much more problematic developmentally for kids," Jenkins said.
'Pick their battles'
Positive parenting techniques provide a better relationship between parents and children."Rather than parents getting mad at kids and being irritable with them and negative with them, the interaction becomes a more positive one," she said.
If parents ignore the low-level problematic things that kids often do and intervene only when there's a safety concern or really bad behaviour, then their interactions with a child can shift in a more positive direction.
"The parents are trying to pick their battles," Jenkins said.
But today's parents may be at a loss on how to practise positive parenting since many of their parents didn't use it with them, said Dr. Andrea Feller, a member of the CPS's early years task force that wrote the position statement.
Past parenting advice was well intentioned and based on what was known at the time, she said. But experts in child brain development no longer recommend discipline that includes punishments like shaming and blaming.
Experts say positive parenting fosters loving, predictable and secure relationships between a child and their parent or guardian. the Canadian Paediatric Society, in a new position statement, is for first time asking all primary care practitioners to encourage positive parenting.
Feller encourages parents who feel conflicted between the way they were raised and adopting positive parenting to trust themselves.
"Parents are a child's first, best and most important teacher," said Feller,a pediatrician in the Niagara Region and a mother of two children under 12.
In fact, the CPS said the reason behind the new statement is that while there are many factors that can put kids at risk for developmental problems, parenting is one that can be easily changed. The focus is on children aged zero to six years.
Time outs 'have a place' but should not be used to discipline children under the age of three, who only understand that a parent or caregiver has turned them away, says Dr. Andrea Feller of the Canadian Paediatric Society.
Recommendations to doctors
One way parents can get guidance is at the doctor's office. The CPS is encouraging pediatricians and family doctors to be comfortable asking parents about their relationship with a child and how well the family is coping.At every visit, clinicians should ask questions about a child's behaviours and family routines, such as "What is your child's bedtime routine?"
Parents of young children commonly ask doctors for advice on crying, sleep and challenging behaviours, so that could serve as an opening for those types of conversations.
Clinicians are also encouraged to broach difficult and sometimes uncomfortable topics, such as trauma, and ask questions like "Has anything stressful happened to you or your family since I last saw you?"
To promote positive parenting behaviours, the society's other recommendations to clinicians include:
- Ask if there is a consistent caregiver, since that is a protective factor.
- Model communication skills by being open, predictable, kind and curious.
- Promote shared reading by families.
- Incorporate family-friendly hours and proactive scheduling into their practice (e.g. "Let's make an appointment for early next month" versus "Come back if you're having difficulties.")
Primary care providers can also direct parents to positive parenting books or free community supports such as local early years centres.
Shift to time ins
The document also included a section on time outs and time ins.A time out creates a brief break in the child's behaviours, even if it's a positive one such as expressing curiosity or reaching for a hug. In a time in, on the other hand, the caregiver invites the child to sit and talk about feelings and behaviour in an age-appropriate way.
Parenting throughout history could be weird, and downright dangerous: author
SECOND OPINION'Helicopter parents' may hinder kids' emotional well-being
A time in focuses on connecting with the child, acknowledging his or her feelings and redirecting them in positive direction.
"Time outs have a place," Feller said, but should be considered a "last resort," since time outs can drift inappropriately into punishment.
What's more, time outs have no place in disciplining children under the age of three, who only understand that a parent or caregiver has turned them away. Often, Feller added, it is the parent who needs a break.
Feller noted social workers and early childhood educators already encourage positive discipline.
Now medical professionals are making the shift toward helping parents recognize that a young child's misbehaviour is often a way for them to communicate: "I can't handle things right now. I need your help."
Pediatrician Daniel Flanders, founder and director of Kindercare Pediatrics in Toronto, said the position statement is reasonable.
"It's a positive step in right direction, but it's a really small one," Flanders said. What's missing is practical ways to help parents implement it.
"It's all fair and good to say this is how parents should parent, but it's a whole other ball game when a single mom is trying to make it through the day, and she doesn't really have any resources or any support to really help her parent in all the ways this position statement is encouraging."
Amina Zafar · CBC News April 14
Amina Zafar has covered health, medical and science news at CBC since 2000. She has a degree in environmental science and a master's in journalism.
source: www.cbc.ca
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Does sugar make kids hyper? That's largely a myth
Does sugar make kids hyper? Maybe.
"If you look at the peer-reviewed evidence, we cannot say sugar absolutely makes kids hyper; however, you can't discount that sugar may have a slight effect" on behavior, said Kristi L. King, senior pediatric dietitian at Texas Children's Hospital and spokeswoman for the Academy of Nutrition and Dietetics.
In the mid-1990s, a meta-analysis reviewed 16 studies on sugar's effects in children. The research, published in the medical journal JAMA, concluded that sugar does not affect behavior or cognitive performance in children. "However, a small effect of sugar or effects on subsets of children cannot be ruled out," the article said.
Like adults, some children may be more sensitive to blood sugar spikes than others. This may mean they are more likely to become aroused when consuming sugar.
Notably, a small percentage of children with attention-deficit hyperactivity disorder may be extra sensitive to sugar, and their behavior changes when they eat it, according to Jill Castle, a registered dietitian and childhood nutrition expert who teaches a parenting course called the ADHD Diet for Kids. "They may become more aggressive or hyperactive or difficult to parent," Castle explained. Minimizing sugar in the diet can be beneficial for these children.
According to Castle, lots of sugary foods can also equate to elevated amounts of food dyes, artificial flavors or other additives that could be problematic for a child with ADHD, often making it difficult to tease out whether sugar is the culprit.
Complicating the issue is the fact that we don't have a way to determine whether there is a link. "Is there a biomarker? A hormone level?" King asked. "It's disheartening for parents. ... They want answers. And unfortunately, nutrition is such an individual thing."
Sugar and hyperactivity: Positive link or parent perception?
The idea of a link between sugar and hyperactivity in children dates to the 1970s, when the Feingold diet was prescribed by a pediatrician with the same name as an eating plan to alleviate symptoms of ADHD."His diet eliminated artificial flavorings, sweeteners and preservatives -- and so sugar kind of got lumped in, as well," King said.
This diet may have led parents to perceive that sugar is a culprit when it comes to kids' excitable behavior - even if it is not the true cause of one's hyperactivity.
In one study from the mid-'90s, researchers gave children a drink containing a sugar substitute. One group of moms was told that their kids were drinking a high-sugar drink; the other group was told the truth, that their kids were consuming a sugar substitute. Mothers who were told that their kids consumed sugar rated their kids as more hyperactive, even though they didn't consume any sugar.
"Just thinking their children were consuming sugar caused moms to perceive their children as being more hyperactive," King said.
"When children consume sugar, it's usually around something fun: holidays, birthdays, celebrations; there's already that excitement there," she said. "I don't think you can say the sugar made them run around and play with friends. ... That would be very hard to separate out."
Instead, a release of the hormone adrenaline might explain a child's overly energetic behavior. "It's a flight or flight hormone; when you are excited or fearful, it increases heart rate and directs blood flow to the muscles, which may make children more antsy and have the urge to keep moving, so you may be perceiving that as hyperactivity," King said.
To try to determine whether your child is truly sugar-sensitive or just excited about a celebration, Castle recommends eliminating sugary foods from the diet for a few weeks and then testing the child with a sugary food like soda, frosted cake or a tablespoon of sugar in 100% juice, and watching the child's response. "It may be a quick way to determine how sugar may be affecting the child," Castle said.
Then again, like the parents in that study, you may just think they're being hyper just because you know that they consumed sugar.
Tips for parents
Even though most kids don't have a sugar sensitivity, that doesn't mean sugar is good for their health. Sugary foods and beverages deliver calories without any nutrients. What's more, eating foods high in added sugars throughout childhood is linked to the development of risk factors for heart disease, such as an increased risk of obesity and elevated blood pressure in children and young adults.To keep kids healthy, the American Heart Association recommends that children ages 2 to 18 consume less than 6 teaspoons - or 24 grams - of added sugars daily. To put that number in perspective, consider that 24 grams is the amount of sugar in just one 1.55-ounce chocolate bar. A 12-ounce can of regular soda contains about 40 grams of sugar, well over a day's worth.
If you are looking for ways to cut back on sweets for your children, here are some tips to get started:
Gradually reduce the amount of sweets in your child's diet. This is good advice for all kids, with and without ADHD. "I teach the 90/10 Rule for the appropriate balance of nourishing foods and sweets and treats, which equates to one to two normal-sized portions of sweets or treats each day, on average," Castle said. If there seems to be a strong sensitivity to sweets, Castle recommends removing sweets and added sugar from the diet as best as you can.Establish routine meals and snacks on a predictable schedule. "Anecdotally, this is one of the main things I work on with families, and they tell me they feel their child is calmer and better-behaved. There is something to be said for nourishing the brain and body on predictable, consistent intervals of three to four hours," Castle said.
When introducing foods with added sugars, pair them with protein, healthy fat or fiber. This helps to blunt the effects of blood sugar surges and drops, and it optimizes satiety.
Castle and King suggest the following combinations:
- Cookies with milk
- Candy or chocolate with nut butter on crackers
- Ice cream with nuts or oatmeal crumble topping
- Cake with milk or milk alternative
Experts say you can also include your treat as part of a snack or meal. "If you're at a party, try veggies and hummus and then having some dessert!" King said. "Or eat a small, sensible meal with lean protein, like turkey meat; add some cheese and baby carrots, and then add a fun treat or small sugar-sweetened beverage."
Don't eat sugar on an empty stomach. Doing so can lead to a surge in blood sugar, and that itself may alter a child's behavior, according to Castle.
Make sure that your child is drinking plenty of water. Also, avoid sugar-sweetened beverages on top of eating sugary foods, King advised.
Don't hype up sugar. If you don't have sugar and candies in your house often, and you bring sweets home and make a big deal about it, your child may pick up on it and become excited, King explained.
By Lisa Drayer, CNN Thu April 18, 2019
Lisa Drayer is a nutritionist, an author and a CNN health and nutrition contributor.
source: www.cnn.com
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