Discipline techniques in the 12-month-old child

The terrible twos: "So soon?"

At each 12-month visit, I remind parents that this is the beginning of "the terrible twos." Invariably, first-time parents will gasp and respond that they thought this did not occur until the child was 2 years old. This response allows me an opportunity to explain that the "terrible twos" refers to the second year of life, particularly between 18 months and 2 years of age. One of the reasons this next year will be difficult is because the toddler will be trying to resolve many internal conflicts during this time. These conflicts include:

Because of these major areas of cognitive dissonance, the toddler will often rapidly decompensate, exhibiting outbursts or tantrums as a result. Parents are often startled by the drastic mood changes, and question whether there is something wrong with the child, or with their parenting, to cause such outbursts. Just knowing that during this next year their toddler will normally demonstrate strange and new behavior will help parents feel more prepared, and less overwhelmed when the tantrums begin.

Some battles can't be won

Another important concept that pediatricians can quickly convey to families at the 12-month visit is that children should view their parents as authority figures. Children feel more secure when they know that someone else is in charge, and that someone is there to make sure that they are kept safe. However, in order to do this in an effect-ive manner, parents should also be smart enough to only pick the battles they can win! This will assure that parents will be viewed with healthy respect, while not becoming overly controlling.

There are obviously some behaviors that should never be taken on as battles. Feeding, sleeping, and toileting are all areas in which parents should never resort to battles, since their toddlers can-and will always-win. Force-feeding a toddler, for example, will often result in vomiting, while forcing a child to sit on the toilet can result in stool withholding. Therefore, parents should be encouraged to set reasonable expectations for their particular child and use different methods, particularly positive encouragement and rewards, to teach appropriate behavior in these areas. It is also important for parents to only pick a few battles, and ignore much of the childish behavior.

Pay no mind, and the concept of gentle

When I mention to parents that hitting, kicking, biting, and pinching are normal behaviors for 1-year-olds, most parents will acknowledge that their 12-month-old has indeed been biting. The parent(s) will often then explain or excuse the behavior, saying the child is showing excitement, is trying to kiss the parent, or is teething. For most parents, however, the reason for the behavior is not actually important, since the behavior is often inappropriate and painful. So, parents will often appreciate learning a helpful way of teaching their child not to bite.

Kohlberg's laws of moral development teach that a child between 1 and 3 years of age learns what is right and wrong behavior by the immediate consequence that follows the behavior.¹ So, providers should instruct the parent(s) to state in a firm voice, "no biting," and to then place the child down on the floor (since most of the time the parent is holding the child when these activities are attempted). Then tell the parent(s) to turn his or her face away from the child, for just a few seconds. This effectively tells the child that he/she will not receive parental attention for that kind of behavior. Over time, this will help extinguish the unwanted behavior.

Psychologists use the term "extinction" to describe the elimination of behaviors that are not reinforced, and this teaching tool can continue to be used effectively as the child grows. Whining, for example, is easily eliminated when the parent refuses to acknowledge or respond unless the child reverts to a more pleasant voice.

Some parents have asked me whether their child will feel abandoned if they use this technique. Since the parents only need to turn their face away from the child for a few seconds, it is easy to reassure these concerned parents that their child-who has received so much parental attention and love during the first year of life-will not be adversely affected by this brief loss of attention.

I have also been surprised at how quickly toddlers learn the concept of "gentle." Many parents are able to show their young child how to touch their own faces, that of their siblings, and household pets. Holding the child's hand and moving it repeatedly in a soft, slow way shows the child how to touch "gently." Practicing this behavior when the parent and child are relaxed and enjoying each other's company makes learning more effective, and the positive reward of the parent's smile of approval, and words of encouragement, will reinforce the toddler's behavior.

Even the young 12-month-old will respond to these techniques-ignoring the child when inappropriate behavior is seen, and positively rewarding the appropriate behavior of gentle touching. You can also remind parents that the five "Ds" from the 9-month visit (Contemp Pediatr 2008;25(6):47) will continue to be important teaching tools during this second year of life. Distraction becomes an even more effective parenting tool during the second year of life, and most parents quickly realize how easily a toddler's attention can be diverted, thus avoiding a full-blown tantrum.

At their wit's end

Some children will by their nature pose greater challenges, and some parents will have a harder time being consistent and staying calm. The teaching tool of "time out" will be introduced at the 15-month-visit, but a modified version of time out may be initiated for younger children. Advise parents if these suggested techniques are not working, and if there are too many tantrums or too much anger in the house, to contact their pediatrician for additional help.

DR. ANDERSON is a clinical professor in the Department of Pediatrics at the University of California, San Francisco, School of Medicine. The author has nothing to disclose in regard to affiliations with, or financial interests in, any organization that may have an interest in any part of this article.

Reference

1. Dixon SD, Stein MT: Encounters with Children. Pediatric Behavior and Development, ed 2. Chicago, Yearbook Medical Publishers, p 24