TODDLER TROUBLE - Full extract 

Some months ago I called into the supermarket near our surgery. In front of me at the check-out counter was a young mother with her daughter of about three.  

As each shopping item was pulled out of the trolley, the child took delight in picking it up and trying to open it. After numerous pleas and threats, the mother was getting a bit frazzled. The last straw came when she looked up to see her daughter chomping into a chocolate bar that she had taken from a nearby display. 

The mother took the chocolate from the little girl and asked the cashier to add it to the bill. The toddler immediately threw herself onto the floor crying. When the mother bent down to pick her up she kicked and fought and then sprawled on the floor in a way that seemed to increase her weight several times over. 

The mother was starting to lose it altogether at this stage. A few smacks later she stormed out of the supermarket with the girl dangling under her arm. The groceries remained unpacked in the trolley. 

A lot of parents ask their family doctor for advice about their young children. This could be about temper tantrums, sibling rivalry, problems settling down to bed at night, punching or biting other children, or just driving their parents to distraction. Although as a medical student and trainee GP you learn a little about paediatric behaviour problems, it is rather theoretical until you have a child or two of your own. 

I am not an expert on surviving early parenthood. However, a lot has been written on the subject, and over the years I have spoken to many frantic parents and witnessed innumerable confrontations in my waiting room and office. Here are a few suggestions that might be of use:- 

Minor behavioural problems are so common that they can be regarded as the norm. Difficulties arise when there is a difference between the child's behaviour and the parent's expectations. Some children can be behaving very normally and yet their parents can be greatly worried that they have a real problem on their hands. As parents, we need to have realistic expectations of our children at each age. It helps to talk things through with other parents, friends or your family doctor. And if there are two parents at home, talk about your child, so there can be some uniformity in the way the child is managed. 

Parenting is very much a learn as you go experience. It is okay to make a few mistakes along the way. We all do. Fortunately, children are very resilient. 

No matter what anyone says, there are easy toddlers and difficult toddlers. Some parents seem to get an easy run with a very placid child. Others are not so lucky and bring home a volatile little bundle that really tests them out. However, if a child ever behaves totally out of character, it is a good idea to see your family doctor to make sure there is no underlying medical problem, such as an ear infection. 

The terrible two's do exist. After 18 months or so, children are learning to control their environment. This includes their parents, siblings, the family dog, relatives and anyone else in their way. So it is normal for children to get quite assertive from this age, and confrontations are inevitable. 

For any household to function there has to be limits on what the parents regard as unacceptable behaviour. There should also be an agreed method of handling situations when a child goes beyond those limits. If for instance a child keeps hitting other children, it is better to remove the child for a period of time-out in his or her room. After five or ten minutes, the child should be allowed to re-enter the group with dignity intact, and not subjected to a lengthy rehash of the whole incident. The general approach is to reward good behaviour and ignore unacceptable behaviour, unless there is a risk of damage to person or property. 

The supermarket is not the best place to discuss for the first time a particular limit on a child's behaviour; nor is three o'clock in the morning the best time. These issues are best discussed at a quiet time and from a position of strength. It is better to avoid major confrontations if possible, especially those you cannot win. With experience we gradually learn how to get across the message, without painting ourselves into a corner. 

Children learn a great deal from parents by just observing their behaviour, in particular the way they treat other people. This may be more important than the amount we read about childrearing. Another important aspect is the nurturing of a strong self-esteem in our children. Our whole approach to parenting should be with this in mind. 

Sometimes it becomes clear that a child and it's parents have continuing problems and need specialist advice. In this situation, a referral to a paediatrician or a child psychologist can often be very helpful. 

Health Tips:
* Before getting too worried about your child's behaviour, find out what's normal first. Ask your doctor to recommend some further information on the subject, and speak to other parents.

* Although limitations on behaviour are necessary, it is better to avoid confrontations over issues that don't matter.

Recommended reading:  Dr Christopher Green   Toddler Taming.  Doubleday,
                                     Sydney  1990.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: December 11, 2004