Time Out Rules

Bench picture source: many online retailers

My last blog on Toddler Rules begs for a blog on Time Out Rules.  I have seen Time Out work effectively, but it fails often because of inconsistent use, interactions with the child during Time Out, and sometimes simply the personality of the child.


Learn the procedures below, teach the procedures to all caregivers, and practice with your child before beginning to enforce time outs.  Any form of discipline works best when all caregivers are consistent.

Children need to know what to expect, so practicing is important. Review sessions might be needed if the child has trouble staying in time out. All practices should be at a time when the child is being good! Remember that the practice is for the parents too!  Siblings who are old enough need to know to ignore children in time out-- practice with them too.

Expect that behavior will worsen before it gets better. (Sorry, no one said parenting was easy...)  Plan on getting to work late.  Attempt to start bedtime routines a little early, because Time Outs will extend the total time. When children know that parents are trying to affect their behavior, they may resist and act out even more. After a time they learn that parents are winning and they (often abruptly) begin to behave. If parents don't continue to discipline, the undesired behaviors resurface, so you must persist on Time Outs for bad behaviors when they do occur.  They catch you by surprise after the child is usually good, but you can't ignore bad behaviors or the child learns they can get away with them!

Time Out works best when certain "rules" are followed. There are rules for the child as well as the adult!

Rules for child: 

• The child must stay in time out until the timer goes off. 
• If the child leaves early, the timer will be re-set. 
• If the child cries or tries to get attention, the timer will be re-set. This will happen as many times as needed until time out is complete. 
• In general, 1 minute per year of age is a good amount of time.

Rules for adult: 

• Remain calm.  It's hard, but don't yell or raise your voice.
• Be specific about why the child has a time out.
• Limit physical contact and limit eye contact.  (This is Time Out from human contact!) 
• Except when giving the time out, don't talk about the event.
• Be consistent with all behaviors and situations. (Give a time out even when you're late for work - it will pay back in the end!)

Things to do before and during Time Outs:

• Discuss desired behaviors and behaviors that will earn a time out (hitting, yelling, etc.) during your "practice" sessions.
• Resist any contact with the child in time out (no talking to child, avoid looking at child - other than discretely to be sure he/she is in time out).  Be covert to be sure the child is staying put safely.
• You should continue to do what you were doing before: Talking with others in room, dishes, etc.
• Quietly remind others that the child is in time out and cannot play/talk.
• Set the stage for success: Be sure kids get enough sleep, eat on schedule, and have supervision.  
• Praise good behaviors!

Things to remember after a Time Out:

The problem of over-discussing a behavior is a common mistake.  It is natural that a parent wants to be sure the child understands, but excessive talking tends to make kids more angry.  

• After time out is complete, the crime has been punished. 
• Leave it. 
• Do not re-live the past. 
• Do not keep "reminding" the child what he/she did wrong. 
• Kids will learn best if they are left to think about issues on their own. 
• The consequence already happened, you do not need to explain it to your child. 
• Trust that your child is smart enough to "get it". 
• It may take reinforcement (another Time Out) with the next behavior, but do not harp or nag about the behaviors. 
• If I keep making my point with another bullet point, do you start to ignore me? That is what tends to happen when things are overdone.  Just drop it.  

Where and How to do Time Out?

The location of Time Out can vary depending on where the behavior occurred, but do not put the child where he/she can see television or do anything fun.  Put your child where he can be covertly monitored for safety.  It can be as simple as moving the chair away from the dinner table.  The child can see the rest of the family enjoying dinner, but is completely ignored. This is very hard for the child, but very effective. When Time Out is complete, the child can re-join the dinner as if nothing happened, but will remember the isolation of Time Out. It works well if they can see the fun going on but can't participate. Isolating to a bedroom loses some of this benefit, because they can't see others having fun.


When placing child in time out, use brief directions, such as "Time Out for yelling". Be sure to state why the time out is happening, but keep it simple. The more you explain, the less effective it becomes.


After you tell the child to go to Time Out, direct where you want her to go. If the child refuses after 30 seconds, put the child there. Be quiet during the 30 seconds, don't yell, don't give the instructions again. (Yelling shows the child you are losing control-- don't go there!)

At the beginning, you may have to physically place your child in Time Out. You can pick her up from the back (not too much physical contact ... no "hugs"). This may happen several times in one event if the child keeps running away.  Don't set the timer until he/she sits quietly. You also can help her get to Time Out with hand-holding or gently guiding from the back. Once children are pros at Time Out just naming the place and telling them "Time Out for hitting, sit on that chair" is sufficient.

Put your Time Out clock in view of the child, but out of reach. Practice with 10-15 seconds. For real Time Out, use one minute per year age.

Re-set the timer each time your child cries, gets up or tries to stop the timer early. Do not look at or talk to your child at this time.

After time out, simply say, "you are out of Time Out" and continue your activities. DO NOT continue to scold. DO NOT give a hug or congratulate on finishing Time Out.

DO give POSITIVE feedback often! When a child does a good thing or makes a good decision, be sure to smile, hug, say "good job" or "way to go". Kids love to get noticed and love attention. Give it for good behavior and the child is rewarded and will strive for those rewards again!

Always remember:  Behavior worsens when children (and adults) are tired, sick, hungry, or out of normal routines. Try to ensure regular routines, adequate sleep, healthy meals, and let children know if their routine will be different in advance. But don't use these as excuses for bad behavior! Schools, law enforcement, friends, etc. don't care if you "were just tired" and couldn't help yourself.

In a nutshell:  Patience is most important when re-directing behaviors. Yelling only fuels the fire and invites kids to yell back. Too much talking also backfires.  After the Time Out, resume normal activities. Be consistent with giving time out for all the bad behaviors you are trying to change, or the child will feel like he's getting away with it sometimes and will push the limits as much as possible.  Remember to be consistent with all providers, all behaviors and in all situations. Don't make excuses for the child (he's hungry/tired, it's the other kid's fault). If you give in once, the child will try for more leeway!

Toddler Rules

The toddler rules of possession have been published on many social media sites in various forms (see above, left column).   They have me thinking: why do toddlers do what they do, and how can parents use that reasoning to help parent?

I firmly believe that young kids don't misbehave on purpose in most instances. They are exploring limitations, learning new things, and learning to work with others.  They don't have the coordination to avoid all spills and falls. They lack the understanding of natural consequences.  Rules of life haven't all been explained to them yet... and even if they have been explained, they are hard to understand!

If you've ever read any of the Junie B. Jones books, you will see that although the adults in her life are frustrated with her actions, Junie B. has a very innocent and well-intentioned reason behind every wrongdoing.  Parents just don't see it that way.  So how do we find the reasons behind the actions?  Kids can't express the "why" of their actions. They are often confused when they get in trouble, then act out even more in anger or frustration.

Toddlers are experiencing a rapid growth, both physically and emotionally. They learn new skills, become better coordinated, and are able to experience many new things.  They say "No!" often and can be very independent. This independence causes rifts between them and their parents, much like the growing independence of teenagers.  Teens and toddlers are very similar. Learning to break away from parents is natural at both of these life stages, and it is difficult for many at both times.

Some important points: 

• New environment or toys encourage exploration, so give clear directions and set limits.
• Tantrums can be from frustration. Try to figure out your child's intent and use that to help modify the tantrum. Sometimes a time out helps all involved calm down!
• Tired, sick, and hungry trigger us all to be more irritable, impatient, and confused. Avoid these at all costs!
• Change to routine throws toddlers off. Try to keep the same routine daily, and if it will vary, give kids a head's up in advance.
• Kids crave atttention. Even negative attention (such as yelling at them) is attention. They will do what they need to get your attention, so try to fill them will praise and attention when being good and avoid attention when they are misbehaving (without allowing safety to suffer). Time Out is the perfect time to avoid talking to kids and physical contact with them.  
• Fill them with confidence and praise when they're being good! It's sometimes hard to remember, but praise quiet voices, independent play, saying kind words, or other "good" behaviors.  You can praise with words, a hug, and more.

Even many adults have yet to learn about anger management, patience, sharing, and manners, so we must expect that toddlers and young kids have not mastered those skills.  You don't want your child to be one of those adults who never masters those skills, so model good behaviors and encourage/reward them in your kids!

Injuries from pacifiers, bottles and sippy cups?

Just last month I saw an article about a child who was nearly scalped by his sippy cup during a car accident. The article was about the dangers of projectile objects in the car.  (For the full article, see the link.)

Now an article is released in Pediatrics on the numbers of injuries associated with bottles, pacifiers, and sippy cups during the past nearly 20 years.  The authors studied ER visits after children under 3 years of age were injured by one of these items designed for infants through preschoolers.  They did not include children who went to their own doctor or whose injuries were more minor and did not require medical attention, but the numbers were much higher than expected.  Nearly 200 young children a month visit an ER for injuries due to one of these items.  Lacerations were the most common injuries, especially to the mouth.  Injuries occurred mostly from falling, not product malfunctions.  They were most common in the 1-2 year age group, when kids are starting to walk around (and run!)

Take home message: use these items wisely.

Pacifiers are a great soothing tool to help infants and young children fall to sleep.  Limit them to sleep.  When kids are up playing, they don't need them.   This has been my advice for years due to the fact that keeping the paci in the bed also decreases risk of infections and aides in getting rid of it at an earlier age.  Now I have another reason!

Bottles are an essential source of nutrition for most infants.  Feeding time is also a comfort time.  Infants should be held for all feedings initially, then older infants can be seated if they are not still held. They do not need to walk around with a bottle in their mouth ever!  Eating on the go is unhealthy for us all.  We should sit at the table and eat.  (This might also decrease choking, as kids running around with food in their mouth are more likely to choke than those seated at a table.)  Toddlers should learn this habit young as well.  Once they are a year of age they should transition away from a bottle. 

Sippy cups also do not need to be carried around throughout the day. I often see kids with drinks other than water being carried around much of the day.  They simply don't need to do this: it is bad for their teeth and it increases overall calorie intake, contributing to obesity. Toddlers and older children can be offered drinks with meals, while seated at the table.  If thirsty between meals, have them sit and relax with their drink.  That is a good habit for us all, but our on-the-go society easily helps us forget the basics. 

Our kids teach us many things about life.  Maybe we can learn from them with these simple rules.  We can all sit to enjoy our meals and snacks and stop eating on the run!  We'll be healthier in many ways!

Toddler Talk

Any parent knows that raising toddlers takes a special kind of patience and can lead to parental exhaustion. There are challenges to all ages, but toddler moments tend to be memorable!  Tantrums can explode and totally change the look of your little angel.


Some kids are mild mannered and people pleasers by nature and are relatively easy to discipline.  Strong willed kids can be among the most challenging, but with proper guidance can grow up to be great leaders.  So how do you guide them?


The basics of discipline are similar regardless of a child's age or temperament.  Consistency among all caregivers is important. Consistency with routines, especially meal times and sleeping, is also very important.  Never underestimate how much damage being tired, sick, or hungry can do to any person's behavior~ especially toddlers!


Praising the positive is a great way to improve the odds that they will want to get that positive attention again.  Catch kids being good.  As they grow and mature, make the stakes higher, but early on praise every small good deed.  

Remember when your rambunctious toddler was a newborn and you were so proud when he simply peed or pooped? Slept 3 hours straight? Very little expectations from a newborn.  As they grow you expect more, but don't expect a toddler to sit still for an hour like you would a school aged child.  Set age appropriate goals and work on a few new behaviors at a time.  Praise when they do a good job with patience or make a good choice to use a quiet voice.  Find the good in things they do throughout the day.  Sometimes it's hard, but you have to find good things to praise!  This does not mean that all is rosy. You must still be firm when they are not being good. Let them know what they did wrong with a short phrase. Set a consequence as appropriate. 

Many parents worry that their child is out of control.  I disagree.  Kids always want control.  Parents simply (ha ha) have to remain in control of the important things and give kids the control they can own.  This enables the parent to be in charge of the important things but allows the child to make decisions about things that won't affect his health or safety, which helps him develop a sense of well being, confidence and decision making capabilities.  


When a parent wants to change a behavior of a child, do NOT show anger.  Raising your voice shows the child that you are losing control and a child feeds on that to elevate the situation to a battle. 

Try to repeat the SAME short phrase of what you want the child to do.  It is very important that you don't say what you DON'T want...give the child clear directions of what you DO want.  If the child argues or ignores, simply repeat the SAME instructions of what you want them to do.  

An example of a clear statement of what you want: 

• I want you to pick up the bear and put him in the toy box.  

Examples of unclear statements or negative statements include:

• You made such a mess! Can't this place ever be clean?

•  Don't leave a mess on the floor.

If your instructions aren't followed the child will get a consequence.  Consequences depend on age.  Toddlers may have to sit on a step, towel or special chair for time out.  Sometimes putting the toys in time out helps... simply put them away for a time if the toy is causing problems, such as kids fighting over it or if it is not put away.


When choosing consequences remember not to take away things that in general HELP behavior (such as outdoor play, which overall releases energy so the child will act better indoors).  The consequences have to mean something to the child or else he won't care if they are taken away. (I've never heard a parent say, "No broccoli for dinner if you don't clean your room!")


The way we tend to phrase consequences is just like that unfortunately:

 no *special treat* if you don't *do desired behavior*

This sounds like a threat and many children (and adults) take it as such.  Rephrasing the sentence to a more positive expression usually gets better results:

you can have *special treat* if you *do desired behavior*

The intention is the same, but the feel of the sentence is much more positive, and people tend to react better to positive statements.

This would sound like, "We will go to the park if you clean your room," instead of "we won't go to the park unless you clean your room."  

The second sentence sounds like a challenge to the child.  Hmmm... how can I get to the park without cleaning my room?  Throw a fit?  Run out the door?  Throw around all my toys?



What if you lose your temper and you see the situation is elevating?  You are yelling, the child is screaming, nothing good is coming from the situation.  How do you get back in control?

Time outs work well.  It gives the toddler a consequence.  The most important part of time out in this situation is not being a consequence, it is the calming effect of time.  

Parents may need the time out as much as the child.  This gives you a chance to collect your thoughts and come up with a game plan of what to say and do.  For more on Time Out, click here.

Another way to turn this out of control situation around is humor.  Many parents think that when a child is in trouble, you shouldn't be "fun", but it can really help.

One night my daughter was throwing a fit about getting dressed.  I started yelling (yes, I'm human and make mistakes too!) but then realized it was (of course) feeding her anger.  She was unable to tell me what was wrong, she was so upset.  I picked up one of her dolls, made the doll "cry", and started talking to the doll to try to see what was wrong.  I said my thoughts out loud..."baby is too little to use words, maybe she is hurt"...moved all the arms and legs...now I had my daughter's attention..."no, no hurt spots"...."maybe she has a dirty diaper"... smelled the bottom..."pee yew, dirty diaper"... By now my daughter was laughing instead of crying. ..."I guess babies are too little to use words, that's why she had to cry, I'm so glad you're a big girl and can tell me what's wrong."  Once she was calmed down, things got much easier.  

The trick is thinking of something that helps the situation when you are frustrated.  The best plan is coming up with ideas for your most common arguments before the next argument starts.

  The arguments tend to be the same every day, whether it is brushing teeth, getting into the car seat, putting on sunscreen... whatever it is, you usually have an idea of what it will be.  Think of things ahead of time that you can use to help situations.

Always lead by example.  Children learn what they see, not what they are told.  If you say, "eat your veggies," but never eat your own, they won't like their veggies.  If you make them buckle up, but don't wear your seat belt, they will argue about wearing theirs.

Corporal punishment is not beneficial.  Studies show that kids who are spanked become more aggressive.  If a child bites, don't bite back.  If a child hits, don't hit back.  If you hit as a form of punishment, your child will learn to hit to get her way.



Keeping a routine helps children know what to expect next.  Be sure enough sleep is available because tired children (and adults) are testy.  Same with hungry and sick children.  If you think that a child's bad behavior stems from being tired or hungry, offer a nap or food.



If your child has major behavior problems, choose the few behaviors that bother you most and work on those.  You cannot expect a child to suddenly be perfect.  Reward the small steps toward good behavior.  When a child sees you noticing the good behavior, they often want to please more and give more good behaviors.



Children also like to be in control, so if you offer them choices (with either choice something that is ok with you), they feel in control and are more likely to do what you want.

A choice may be "do you want to get dressed or brush teeth first?"  The child then chooses one of the choices, so she is happy that she chose to brush teeth.  She doesn't realize that you have manipulated her.  If she says "watch TV", you say, "that wasn't a choice, the choices were getting dressed or brushing teeth first."  Give about 10 seconds for her to make a choice.  If she doesn't decide, then you decide for her.  

Kids will be upset if they don't get their un-offered choice, but try to limit discussion and let her think about it.  Most children are smart enough to figure out what to do.  They can learn from it.  If you try to rescue them by letting them chose their own option, they don't learn.  If you try to make sure they know what they did wrong and what they should have done, they get angry and don't learn.  Let them do the learning.  Don't keep harping on them... it will just make them angry and resentful!

Behavior is a challenge to most parents, but with love and guidance, consistency, and proper sleep and nutrition, you can improve the odds that kids will behave.

Got Milk? Cow, Coconut, Soy, or Almond?

A Facebook follower asked about how to choose a milk substitute recently. There is not a simple answer.

For many years it was easy:  The American Academy of Pediatrics recommended whole milk from 1 year to 2 years of age, then 2% until 4 years.  At 4 years it was recommended to switch to skim milk. If kids couldn't tolerate cow's milk they were given soy.

Then came questions about the estrogen like effects of soy and the problem that soy allergy is common in milk allergic kids.

The obesity rates climbing in kids has put into question whether whole milk is needed until 2 years and if lower fat milks should be given at younger ages.  The answer to this is probably not routinely, but toddlers who are overweight can benefit from a lower fat milk.

Grocery store shelves now offer not only whole, 2%, 1%, and skim cow milks (regular, hormone free and organic of each of these!) and soy milk, but they also sell lactose free milk (in several fat concentrations),  rice milk, almond milk, coconut milk, and goat milk.

How do you make the right choice for your child?  Below is a nice chart from MyHealthNewsDaily.com comparing calories, fat, protein, and calcium contents of various milks.  Taste is a very important consideration for the picky child.  If they don't like the taste, they will not drink it.  Even the textures of the milks can vary quite a bit and might require acclimation.  Food allergies and intolerances drive many of the choices.  Note: none of these are appropriate for infants under one year.  Breast milk or formula are the only healthy options for infants due to other nutrients needed in an infant's diet! 

Historically it has been felt that toddlers need more calories from milk, and should not regularly drink a low fat/low calorie milk.  Because of the rising obesity rates (even among toddlers and preschoolers) this recommendation is changing and kids can drink lower calorie products if their caloric intake from foods is sufficient.  Beware of high calories in milks like coconut milk, goat milk, rice, or soy milk.  They have nearly as many calories (or more!) than whole fat cow's milk.

One cup of coconut milk has over 50 grams of fat and over 460 calories!  A special treat: yes. A routine daily drink: no!  

(For comparison, a BK vanilla milkshake has 412 calories and 23 grams of fat in 227 grams (just 1/2 oz shy of a full cup).

Calcium levels vary widely in various milks and should be taken into consideration when choosing a milk for your child.  Other foods, such as calcium fortified orange juice, yogurt, tofu, leafy greens, cheese, and fortified cereals, can (and should) incorporate calcium into the diet.

Vitamin D is very difficult to get through diet alone and it is recommended that everyone take a Vitamin D supplement.  For more information, click here.

There is no consensus that organic milk offers any health benefit.  Due to it's high cost, it is prohibitive for many families to buy organic.  Hormone free milk is available for a mid-range cost without the potential (yet unproven) risks of hormones given to cows.  There isn't any nutritional benefit of the hormone free milk or organic milk compared to conventional milk, but if you are concerned about hormone exposure from milk, hormone free is less expensive than organic.


Lactose free milk: 160 calories, total fat 9g, protein 8 g, calcium 30%
Lactose free reduced fat milk: 130 calories, total fat 5g, protein 8 g, calcium 30%
Lactose free fat free milk: 80 calories, total fat 0g, protein 8g, calcium 30%
(Lactose milk nutrition facts based on one cup, from www.fatsecret.com)

Potty Training

I remember long ago when I was a relatively new mom I still had insecurities about what I was doing (despite the fact that I was a pediatrician with extra training with kids). Well, to be honest, I still have lots of great advice for parents, but with my own kids I often struggle to know what's best.  But my kids are way beyond the potty training years, so I feel like I have that hurdle down now...

My son's baby book's potty training page shows my naivety.  He started showing interest in the potty and even telling me appropriately when he needed to go about 18 months of age. I knew that he was on the early side of potty training (normally between 18 months and 3 years). This is especially unusual for boys, but he was a smart kid, was directing it all himself, and why not potty train him if he's interested?  I was so excited for him (and me!) that he was interested. We put out the potty chair. We clapped and praised. He was so happy to make pee in the potty.

Then he lost interest. Out of the blue. Done.

It is almost a year to the day later that the baby book says he was interested again. I actually tried to not let him train, since my 2nd baby was due soon, and I didn't want him to regress.

When the daycare teacher said, "he's been in the same diaper all day for 3 days in a row, he needs underwear!" I decided it was okay to break out the Buzz Lightyear underwear. When he did it this time, he did it well. He easily mastered the skill and didn't have accidents.

 

When my daughter started using the potty early (about 15 months) I thought it was a fleeting interest as well, but she continued to regularly use the toilet. Wow! Easy... she did it all on her own. (Her independent streak has it's negatives, but I liked this aspect of it.) She never had accidents. Ever. I stopped bringing extra clothes for her cubby at daycare, she was that good.

Then she lost interest. Out of the blue. Done. At 3 years!

One day she woke and said she was a baby and needed a diaper. By this time, we had no diapers. I told her she was a big girl, got her dressed, and sent her off to daycare as usual. When I picked her up there was a bag of other kid's wet clothes. She was on her 4th outfit of the day, but we had no extras at school because she was my never has accidents kid. I knew she wasn't sick. (UTI's can cause accidents.)  She had simply decided that she wanted to be treated like a baby. 

I had to go out and buy diapers. We stocked her cubby with extra clothes. She LOVED being treated like a baby. The daycare even moved her to the toddler room because the 3 year room didn't allow diapers. She loved being with the babies, so it suited her just fine.  The problem was the teachers made such a big deal about how she was a big girl and didn't need the diaper. When I finally convinced the teachers to just matter of factly change the diaper and ignore her behaviors, she decided it wasn't fun any more to be a baby. Suddenly she was potty trained again. No more accidents. Ever.

Kids develop at various stages.  My advice has always been to let them take the lead when to start potty training, which can happen anywhere from 15 months until 3 years of age.

Kids leading the way? They are ready to take the lead and potty train when they show interest (wanting to sit on a potty chair, wanting a wet diaper off, telling you when they are wet).  If you push, they will resist.  Teens and toddlers are one and the same: they both try to exert independence and do it their own way. The more you push, the more they pull.

If you think your child is aware of when he/she needs to urinate or have a bowel movement, put out a potty chair that is in full view when in the bathroom.

Buy potty training books geared toward toddlers.

Show excitement and give praise for interest and any steps in the right direction (sitting on potty, peeing in potty, washing hands, etc.).  You can do a potty dance, give stickers, call Grandma, and do whatever makes a big deal for each little step!

Praise others for using the bathroom.  Invite play dates who are similar ages and are potty trained over so your child can see them in action.  Praise older siblings for going to the bathroom.

You can put the idea in their head:  "I'm going to the potty.  Boy, do I feel good!  I went on the potty, didn't get my pants dirty, got to flush the toilet, got to use the foamy soap, etc." but don't tell them directly to go.  They resist being told anything!

Scoop on Poop: Many kids are ready to go pee in the potty, but are afraid to poop there.  That is okay.  Offer a diaper at the time of day they often have a bowel movement.  It is not good to try to force stooling in the toilet if they don't want to go there.  They will hold it and end up constipated. Don't go there!

You can take them to the bathroom after the bowel movement and drop the stool into the toilet, then have the child flush.  Then they associate the stool going down the toilet, which sometimes helps.  Encourage lots of fruits and water so the stool stays soft.  If it hurts to poop, they hold it longer, which then hurts again, which reinforces holding and then constipation.  (See also our website page on constipation for more hints to keep the stool soft.)

Don't worry about setbacks.  (See above!!!)

Many kids show a temporary interest in potty training, but then stop wanting to go completely.  Return to diapers, but leave the potty chair visible.  When the child starts to show interest again, give praises.

Remember: normal children do not go to kindergarten in diapers!  They will all potty train.  If your child isn't potty trained during the day by 3 1/2 years, talk to your doctor.

Nighttime accidents are actually normal much longer, see our bedwetting information.