Behavior: Ask the experts


Girl who hits older brother punishes herself



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Q The parents of a 3-year-old girl wonder how they can discipline her. She habitually hits her 4-year-old brother in the head while they are playing. They have tried time-outs and limiting TV time. Sometimes, after hitting her brother, the child automatically takes her own time-out, by standing in a corner of the living room. Big brother doesn't hit back. What should the family do?

Achilles Litao, MD
Bronx, N.Y.

A This is an unusual example of sibling rivalry and aggression. Usually, a 4-year-old boy would have little trouble controlling the aggression of his 3-year-old sister. But this child not only hits her older brother; rather than ignoring or denying her actions afterward she has the self-awareness to give herself a time-out!

A situation like this raises many questions: How does this little girl behave in other social situations? Does she hit other children—at the day-care center, in the park, when visiting others' homes? How often does she hit her brother at home? Hitting that occurs once every few days is much less worrisome than hitting daily or several times a day, and hitting that takes place only at home is less troubling than hitting in a variety of settings. Is the blow somewhat controlled, or truly dangerous—such as pushing her older brother on the stairs, or using sticks or other weapons?

Is the child's overall development healthy? Are her language skills advanced enough to allow her to express herself? Or is she frustrated by language, motor, or developmental delay? Does she have the temperamental characteristics of the "difficult child" who requires specialized parenting techniques? Alternatively, is her brother subtly provocative, using his relative maturity to get his sister in trouble?

Are both parents clear, forceful, and united in their response? When both parents come down firmly, clearly, and consistently, most 3-year-olds comply. Is marital tension or family stress making it difficult to be consistent? Or is this behavior the only way to get attention in a busy, stressed family? Are grandparents or caretakers sabotaging the parents' disciplinary efforts?

Does this child show any other psychiatric symptoms that may underlie her aggression, such as consistent misbehavior, attention deficit hyperactivity disorder, or an inability to read social cues? When complex disorders such as these present this early, they require referral to a child psychiatrist.

If this child's behavior is within the range of normal and if it carries no true danger or accompanies no other worrisome symptoms, temperamental characteristics, or developmental delay, then reinforcing the parents' consistency and making sure they are clear about what they expect from their daughter is a good way to begin. If that does not work, the next step— if the behavior continues—is referral to a behavioral pediatrician or psychologist.

I also wonder about the brother's response to his sister's behavior. Parents should not encourage violence, of course, but a greater degree of assertiveness would come in handy for this boy not only in this situation but in preschool and on the elementary school playground. Although this was not the point of your question, I should say that I would be a bit concerned about this young girl's brother if, after some encouragement, he could not be moved to help her learn the consequences of her aggressive behavior.

Michael S. Jellinek, MD
Boston, Mass.

DR. JELLINEK is senior vice president for administration and chief, Child Psychiatry Service, Massachusetts General Hospital, and professor of psychiatry and of pediatrics, Harvard Medical School.


Behavior: Ask the experts. Contemporary Pediatrics 2001;10:29.

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