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Cribsheet Page 27

by Emily Oster


  A common piece of advice to address this issue is that the child be given a diaper to poop in, perhaps in the bathroom. Although it may seem like a step backward, the theory is that it lowers the chance of constipation and subsequent negative feedback. There is not much evidence on this in either direction. In at least one small prospective study, children who were put back in diapers were virtually all trained within three months. But again, with time, everyone uses the toilet, and without a control group, it is difficult to learn much.14

  Nighttime Dryness

  Staying dry at night—or effectively waking up to use the bathroom—is a skill fundamentally different from using the toilet during the day. Manychildren will remain in a pull-up or diaper at night (and maybe when napping) long after they are fully trained during the day.

  In contrast to the day, staying dry at night basically requires that your body wakes you up if and when you need to pee. This ability develops at different ages in different children. By the age of five, 80 to 85 percent of children are dry at night (meaning not that they do not pee, but that if they do, they wake to use the bathroom).15

  Doctors generally do not worry about lack of nighttime dryness until a child is six years old. Older than that, it is common to begin to consider some interventions—waking the child to pee, limiting fluids before bed, a wetting alarm. These continued issues affect perhaps 10 percent of children (mostly boys) and nearly all of them eventually resolve.

  ELIMINATION COMMUNICATION

  Most people take for granted that their child will spend some time in diapers. Elimination communication, however, is a method in which parents train—perhaps from birth—to recognize the signs that their child is going to pee or poop and then quickly put them on the potty. Obviously with a baby that cannot sit up yet, you cannot put them on a toilet—the idea here is to hold them in your lap over a bowl or similar so they get the association.

  There are very few studies about elimination communication. One early report surveyed parents engaging this strategy and showed that, indeed, many parents reported their child did give signs of needing to use the toilet, even at a very young age.16 The children in the study were trained very early—by seventeen months, on average—with no adverse effects.

  It is worth noting that elimination communication is billed not as an explicit potty-training method, but as a system designed to encourage toilet use. It is hard to know what is meant by this distinction, but I think it is that in doing formal “potty training,” you are aiming to accomplish your goal in a relatively short time, whereas starting at infancy means this will necessarily take more time.

  Other studies are anecdotal reports of success, or summary articles that note that in cultures without diapers, moms seem to learn earlier how to figure out a child is about to go.

  If you think this is appealing, there is no reason not to do it, although it is probably worth noting that it is a reasonably impactful lifestyle choice and not one you are likely to get much support on from, say, your day care.

  The Bottom Line

  Age at toilet training has increased over time, very likely as a result of parents choosing to train later.

  Starting training earlier leads to earlier completion on average, although it generally takes longer; starting intensive training before twenty-seven months does not seem to lead to earlier completion.

  There is little evidence on the efficacy of child-led training versus more intensive, goal-oriented methods.

  Refusal to poop on the toilet is a common complication with some limited solutions.

  17

  Toddler Discipline

  When I misbehaved as a small child, my mother’s solution was to ask me to “sit on the stairs and think about it.” I would toddle off to the stairs, sit for a while and contemplate my wrongs, and then return to explain what I did wrong and that I would not do it again. My mother congratulated herself on being an amazing parent who was deeply in touch with her child and didn’t need to resort to the kind of “Go to your room!” discipline that others practiced.

  Then my brother, Stephen, arrived.

  He did not want to sit on the stairs and think about it when he misbehaved. In fact, he loudly refused. Things escalated to his being sent to his room. Also refused. My mother found herself physically carrying him to his room, shutting the door, and holding the door closed with all her strength while he screamed and tried to get out.

  Which goes to show, again, that parenting is much more about the child than about the parent. (Sidenote: Stephen is a wonderful and successful adult who was and remains a great brother.)

  When my own kids were born, I repeated a similar pattern. Penelope never had a tantrum. When Finn had one, I couldn’t believe it. There was so much yelling! I asked Jesse, “Do you think he’s sick? Should we take him to the doctor?” Jesse looked at me like I was a crazy person. “He’s not sick. He’s two.”

  Tantrums are at the more extreme end of toddler acting out, and nearly everyone has a story about one, usually one that occurred in public. When I talked to my friend Jenna about this chapter, she said her mom is still angry about a tantrum Jenna had at age four in a Kmart. My nephew once had one in a crowded mall, leaving his mother to walk away (the correct response) while he screamed on the floor and people stopped to try to help. Of course, once a child is in a tantrum, there is really no helping.

  Toddlers act out in other ways as well. They can almost seem like scientists—experimenting with what is possible. If I throw this half-eaten cauliflower stem at Mom and say, “I don’t LIKE IT!,” what will happen? If I hit my sister on the head with a book, will she hit back? Will an adult stop me?

  The constant experimentation can be exhausting and confusing, especially as your kid gets to the point where it is harder to physically restrain them. When your son insists on repeatedly taking his shirt off in a museum, what do you do? Do you physically put the shirt back on? Do you just give up and let him run around without a shirt? (Why does he want to take the shirt off anyway? He repeatedly emphasized his intense desire to wear that very shirt in the morning.)

  The somewhat good news is that there are evidence-based approaches to dealing with discipline. I say “somewhat good” since there is no magic bullet that will completely stop tantrums and turn your two-year-old into a seven-year-old. Instead, parenting interventions focus on how to respond to bad behavior when it starts and limit recurrence.

  Before even getting into evidence, though, it’s worth stepping back and thinking about why we want to discipline our kids. What are we trying to accomplish? I think the answer is the same as what we are trying to do with all our other parenting choices: we are trying to raise happy, nice, productive adults. When my kid refuses to clean up a mess and I discipline that behavior, it is not really that I want some help cleaning up. Actually, it would be faster to clean up myself than get her to do it. It’s more that I’m trying to teach her to be someone who takes responsibility for her messes, both the LEGO messes now and the inevitable non-LEGO messes she’ll create in the future.

  This is the discipline-as-education philosophy espoused by French parenting (thanks, Bringing Up Bébé!). Discipline is not the same as punishment. Yes, there is a punishment component. But it’s in the service of raising better humans, not punishment for its own sake.

  With this scaffolding, we can turn to the data. There are a number of evidence-based parenting interventions. These include 1-2-3 Magic, the Incredible Years, Triple P—Positive Parenting Program, and so on. Many schools—including those that have children with serious behavioral issues—use a similar program called Positive Behavior Interventions and Supports, which has a similar set of goals and structures.

  Broadly, all these emphasize a few key elements.

  First, recognize that children are not adults, and you usually cannot improve their behavior with a discussion. If your four-year-
old is taking their shirt off in the museum, they will not respond to a reasoned discussion about how you actually do need to wear a shirt in public places. The flip side of this—more important—is that you shouldn’t expect them to respond to adult reasoning. And as a result, you should not get angry the way you would if, say, your spouse was stripping in the museum and didn’t stop after you explained why they shouldn’t.

  All these interventions emphasize not getting angry. Don’t yell, don’t escalate, and definitely don’t hit. Controlling parental anger is the first central part of the intervention.

  This is so easy to say, but it is often so hard to do. It takes practice on your part. Most of us do not want to get angry with our kids, but we have all found ourselves furious in various moments. Toddler discipline is, really, parental discipline. Breathe. Take a second. I once told my children, “I’m so mad right now, I’m going to the bathroom for a while to calm down.” (It’s the only door in the house that locks.) And I did, only coming out when I thought I could handle not only them, but myself.

  An extension of this your-child-is-not-an-adult observation is that it is probably not a good use of your time to think a lot about why your small child is having a tantrum. There is a strong temptation to try to figure out what exactly is the issue—to try to get them to articulate the precise problems they are having. Even if they can talk, this is likely to be fruitless, since they probably do not know. Tantrums happen for all kinds of reasons. Working on disciplining the tantrum behavior is the goal. If they do not think of a tantrum as a way to react, they can work on developing other, more productive ways to communicate their problems.

  Second, these approaches all emphasize setting up a clear system of rewards and punishments and following through on them every time. For example, 1-2-3 Magic develops a system of counting (to three, obviously) in the face of disruptive behavior, and if three is reached, there is a defined consequence (a time-out, loss of a privilege, etc.).

  Finally, there is a strong emphasis on consistency. Whatever the system you use, use it every time. If the consequence of counting to three is a time-out, then there needs to be a time-out every time, including, say, in the grocery store. (The book suggests you find a corner of the store, or bring a “time-out mat” with you.)

  As an extension, if you say no to something, you stick to no. If your kid asks for dessert and you say no, you cannot then later say yes if they whine for long enough. This basically makes sense—what do they learn from that? That whining will sometimes work. Let’s do more of it! And similarly, do not make threats you cannot carry out.

  Let’s say you are on an airplane and your child keeps kicking the seat in front of them. Telling them, “If you do that one more time, I’m going to leave you on the airplane” is not a good threat. Why? Because you are not going to leave them on the airplane. When they then kick again to test this, and they find they are not, in fact, left on the airplane, they’ll file this away for later. The same logic goes for the common parent car trip threat, “I’m going to turn this car around if you kids do not stop fighting!” Fine to say this, but you’d better be prepared to turn around.

  These are the broad parameters. Like sleep training, the specifics differ across programs. If you are hoping to use this kind of discipline, you’ll probably want to pick a particular program and stick to it. One may not be better than the other, but given the importance of consistency, it is necessary to adopt one approach among everyone who is with your kid, not five similar but not identical approaches.

  These approaches are helpful through older ages, but can be used as early as two. The books have some specific guidelines for time-outs—for example, they should be shorter at younger ages and do not start until after a tantrum has ended. And they do outline some key components that are useful for very small children. For example, do not let your child use a tantrum to get what they want.

  The evidence that these work is based on a number of randomized controlled trials.

  To give an example, a paper published in 2003 in the Journal of Child and Adolescent Psychiatry reported on an evaluation of 1-2-3 Magic among 222 families.1 All the parents involved were looking for help managing their children’s behavior, although none of the children had clinical behavior problems. That is to say, they were just engaging in the standard difficult behaviors.

  The intervention was fairly light—parents attended three two-hour meetings that discussed the 1-2-3 Magic approach, and were shown videos and given handouts about particular problem issues. There was a fourth two-hour meeting a month later to reinforce.

  The experimental group—the one that got the intervention—had improvements on all the variables measured. The parents scored better on measures of parenting—i.e., “Are you hostile and angry toward your child?”—and the children scored better on a variety of measures of behavior. Moreover, the parents reported that their children were better behaved and more compliant, and that their own stress had gone down. The authors noted the effect sizes were not enormous—it would be hard to expect huge effects, given how limited the intervention was—but they were large enough for parents to notice them and affect their time with their children.

  Smaller trials of 1-2-3 Magic with longer follow-ups have shown similar impacts, with authors arguing that the effects of these programs can be seen even two years later.2

  The evidence isn’t limited to 1-2-3 Magic. A number of studies—especially in the UK and Ireland—have seen similar impacts with the Incredible Years approach. The results there show improvements in parenting practices, reductions in child behavior problems, and lower parental stress.3 Reviews that pull together evidence on all programs of this type show similarly consistent findings across studies. The bottom line is, they just seem to work.4

  So, okay, these approaches work. But should you use one?

  One answer to this is that it depends on the alternative. I’ll talk about spanking in a bit, but the evidence suggests that it has negative consequences in both the short and long term. So if hitting is the alternative, then one of these programs is probably worth a try. And if you are tired and frustrated and feel you don’t like your kid very much, then, well, that’s also a reason to try.

  In this way, these programs are not unlike sleep training. Many of the benefits are to the parents: lower stress, better relationship with your child, etc. (In this case, there may be some benefits at school also.) If what you are doing is working for you, great. If not, this might be worth a try.

  These programs all focus on limiting disruptive behaviors—whining, fighting, tantrums, talking back—and encouraging broadly cooperative behavior like sitting at dinner and getting ready in the morning.

  What about the more annoying things? Like, say, your kid insisting on singing the same song fifty times in a row? Just as an example.

  You probably need to live with those. One of the main tenets of these parenting approaches is that discipline should be reserved for actual bad behavior, not for things that are merely annoying. At least one of the books I read on this suggested earplugs. It is worth noting that for an older kid, if they know you are annoyed, they’ll probably do whatever annoying thing they’re doing more.

  It would be remiss of me to close this chapter without mentioning spanking. Although this has become a less common punishment over time, a large share of American families (estimates suggest at least half)5 do use spanking or other forms of mild corporal punishment to address misbehavior. Some schools also still use corporal punishment.

  I try, throughout this book and in my own parenting, to be truly evidence based and let the data lead me. But in this case I want to be up-front about my biases: I do not believe in spanking. There is nothing I could read in the data that would lead me to think it is a good idea, either. My impression of the data—detailed below—is that it is not, in fact, a good idea. But I want to be clear that I am starting from a place of bias.

&nbs
p; Most studies of spanking focus on the impacts on behavior and school performance: Does spanking your child lead to more behavior problems later? Does it lead to lower school performance?

  There are at least two reasons why this is a difficult question to answer with data. First, parents who spank are different from those who do not. Since many of the factors that correlate with spanking also correlate with worse outcomes for other reasons, if you look at just the raw correlation between spanking and later outcomes, you’ll overstate the downside.

  Second, even within the group of parents who spank, it stands to reason that children who are more difficult may be spanked more. Let’s say you measure spanking behavior at age three and outcomes at age five. The data may well show (in fact, does show) that spanking at three implies more behavior problems at five. But behavior problems at three may lead to both spanking and behavior problems later. This is difficult, although perhaps not impossible, to address.

  The most careful studies of this try to follow children through early childhood and look at all the possible pathways of effect. An example is a paper in Child Development that uses samples of almost four thousand children observed from at least age one through age five.6 The authors looked at data on spanking at ages one, three, and five and on behavior at those ages. They tried to fully adjust for the possible pathways. For example, they correlated spanking at age one with behavior problems at age five and then asked whether that relationship goes away if you, say, control for spanking at age three.

  The authors argued that spanking does have negative long-term impacts, especially on behavior problems. Spanking at age one increased behavior problems at three, and spanking at three increased behavior problems at five. These results held even with controls for earlier behavior—spanking at three relates to behavior problems at five, even controlling for behavior problems at three.

 

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