Discipline in early childhood

As pediatricians we have an opportunity and a responsibility to guide parents in the structure of discipline they set up for their children. The major goals of this structure are to help children develop a sense of being both lovable and capable. To feel lovable a child needs an enduring responsive relationship that conveys positive regard. Attending to children promptly, giving individual time daily, acknowledging positive behaviors, and ignoring minor transgressions all help them feel valued. Active listening without judgment demonstrates acceptance of children's feelings. Talking to children without labels or generalizations but with specific feedback about their actions and with congruent emotional tone is respectful and promotes self-esteem. Children also deserve assistance with transitions, thanks, and apologies as appropriate. To feel (and become) capable, children need a consistent structure of routines, good models, respectful instruction, and progressive expectations so that they have an ongoing experience of success. To grow as individuals they need opportunities to make choices relevant to their interests and role-taking opportunities to gain perspective on social interaction. Praise and rewards motivate as well as instruct children, but they also need to experience consequences to their actions. Natural consequences are optimal but parents also need to design logical consequences that are graded, related, prompt, and reasonable for a child's misbehaviors. Consequences are most effective when given after only one request, exactly as clearly promised by the adult involved without interference by others. Time out is one of the most effective consequences for young children when used properly. Physical punishment has multiple negative effects on a child's development, especially if used noncontingently. Intrapersonal and family factors predispose parents to predictable problems in establishing healthy discipline. Pediatricians can play an important role in promoting the emotional development of children by anticipating, guiding, and counseling families about discipline as well as referring them effectively.     

Narcolepsy.

The symptom of excessive sleepiness in children and adolescents does not necessarily cause great concern to families and professionals involved in their care. Children may deny the symptom and minimise the adverse effects. These factors contribute to an underdiagnosis of narcolepsy in this age group when clinical diagnosis is difficult as associated symptoms may not have appeared or are hard to elicit. In this paper three children whose difficult behaviour contributed to the presentation of their sleep disorder are described.