Introduction: Behavioral and Developmental Problems in Young Children: Merck Manual Home Edition


	Section		Children's Health Issues

	Subject		Behavioral and Developmental Problems in Young Children

Introduction

Children acquire many skills as they grow. Some skills, such as controlling urine and stool, depend mainly on the level of maturity of the child's nerves and brain. Others, such as behaving appropriately at home and in school, are the result of a complicated interaction between the child's physical and intellectual (cognitive) development, health, temperament, and relationship with parents, teachers, and caregivers.

Behavioral and developmental problems can become so troublesome that they threaten normal relationships between the child and others. Some behavioral problems, such as bed-wetting, can be mild and resolve quickly. Other behavioral problems, such as those that arise in children with attention deficit/hyperactivity disorder (ADHD), can require ongoing treatment. Most of the problems described in this chapter arise out of developmentally normal bad habits that children easily acquire. The goal of treatment is to change the bad habits by getting the child to want to change his behavior. This goal often takes persistent changes in actions by the parents, which in turn result in improved behaviors by the child.

Behavioral Problems due to Parenting Problems

A number of relatively minor problems of behavior may be due to parenting problems.

Child-parent interactional problems are difficulties in the relationship between a child and his parents, which may begin during the first few months of life. The relationship may be strained because of a difficult pregnancy or delivery or due to the mother suffering from depression after delivery or receiving inadequate support from the father, relatives, or friends. Contributing to the strain are a baby's unpredictable feeding and sleeping schedules. Most babies do not sleep through the night until 3 to 4 months of age. Poor relationships may slow the child's development of mental and social skills and cause failure to thrive.

A doctor or nurse can discuss the temperament of an individual baby and offer the parents information on the development of infants and helpful tips for coping. The parents may then be able to develop more realistic expectations, accept their feelings of guilt and conflict as normal, and try to rebuild a healthy relationship. If the relationship is not repaired, the child may continue to have problems later.

A vicious circle pattern is a cycle of negative (naughty) behavior by the child that causes a negative (angry) response from the parent or caregiver, followed by further negative behavior by the child, leading to a further negative response from the parent. Vicious circles usually begin when a child is aggressive and resistant. The parents or caregivers respond by scolding, yelling, and spanking. Vicious circles may also result when parents react to a fearful, clinging, or manipulative child with overprotection and overpermissiveness.

The vicious circle pattern may be broken if parents learn to ignore bad behavior that does not affect the rights of others, such as temper tantrums or refusals to eat. For behavior that cannot be ignored, distraction or a timeout procedure can be tried. Parents should also praise the child for good behavior.

Discipline problems are inappropriate behaviors that develop when discipline is ineffective. Efforts to control a child's behavior through scolding or physical punishments such as spanking may work briefly if used sparingly. However, these approaches generally tend not to alter the bad behavior sufficiently and may reduce the child's sense of security and self-esteem. Moreover, spanking can get out of hand when the parent is angry. A timeout procedure can be helpful. However, punishments become ineffective when overused. Furthermore, threats that the parents will leave or send the child away can be psychologically damaging.

Praise and reward can reinforce good behavior. Because most children prefer attention for inappropriate behavior to no attention at all, the parents should create special times each day for pleasant interactions with the child.

Last full review/revision February 2003