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The Basics: Pediatric Behavioral Issues

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The Basics: Pediatric Behavioral Issues

Apr 27, 2023

Facing challenges with your child's behavior? Pediatrician Cindy Gellner, MD, provides expert guidance on how to differentiate between normal childhood misbehavior and genuine behavioral concerns. Learn when to seek professional help from a mental health specialist and when the issue may actually be a result of parenting approaches. Equip yourself with the knowledge to better understand and support your child's emotional well-being.

Episode Transcript

I am having parents schedule appointments every day to talk about their child's behavior issues. While pediatricians often are the first place to start, I think some parents think that pediatricians can do more than what we actually can, like we have some sort of magical powers to be able to help their child. Trust me, I wish I had those magical powers, especially in my own house some days.

Pediatricians' Limitations in Addressing Child Behavior Issues

A good example of these requests is that some parents are asking me to evaluate their 3- and 4-year-olds for ADHD, which I cannot do at their age because many ADHD behaviors are totally normal in preschoolers.

Parents want me to give "medical diagnoses" for kids' bad behavior, so then I can give their kids medicine to make their kids behave. Not all behavior issues are due to medical problems.

Parents are wanting me to "treat" their kids and do behavior therapy for them, as in for the parent, so they don't have to. I'm not a behavioral pediatrician, nor am I a therapist, so this request is also out of my scope of practice.

Differentiating Child Behavioral Issues from Parenting Challenges

I think parents need to understand that a lot of what they want pediatricians to address lately are parenting issues, not medical issues. And pediatricians, one, can't teach parenting skills and, two, can't make their kids behave. There's no special pill for that, although as a parent, I too wish that was possible sometimes.

But that's what parenting classes and therapy are for, and often your pediatrician can give you a list of places for those types of resources.

Parents need to understand that while we can give general advice on childhood behaviors as pediatricians, we can't go in-depth into your child's specific issues. Again, we're not parenting experts, we're not behavior experts in the same way that someone with specific degrees in child development or child psychology is.

Please don't ask me to diagnose your 3-year-old with bipolar because they have temper tantrums, or treat your 7-year-old who acts up in school because according to the child "it's boring" and the parent wants ADHD medications. These are not medical behavior issues.

Recognizing the Need for Specialized Care from Child Psychology and Psychiatry

If there is a true medical behavior problem, then we get child psychology or child psychiatry involved. They are so much better trained to help with these types of situations.

What I have seen is that the kids who are having a lot of behavior issues are due to a variety of issues, including home life situations, the pandemic, struggles in school, and parents giving in to their kids because they don't want to hear them cry and then it backfires.

One good example is the parent who the minute their baby cries, even as young as 6 months old, instantly reaches for their phone and puts a video on. Then they have concerns when the child is 2 or 3 that their child won't calm down unless they give them an electronic device. They don't understand that they have actually programmed their child from infancy that crying equals video time, that their child will just ramp up their behavior until they get what they want.

In fact, a recent study showed that kids who are given electronics at such a young age end up having issues with executive function. Executive function is responsible for emotional regulation, learning, academic achievement, and mental health. Executive function enables us to plan, focus our attention, remember instructions, and handle multiple tasks successfully. So while electronics may calm your little one down in the moment, long term this isn't something you want them to keep doing.

Other behavior issues, like oppositional defiant disorder, are often triggered by family dysfunctions. And face it, we are all dysfunctional on some level right now. Parents are wanting me to fix their kids talking back or rolling their eyes or rudeness. And trust me, raising two teenage boys, I wish it was that easy, but it's not. It requires consistency, boundaries, and sometimes outside help.

I am by no means anywhere close to the perfect parent myself, but I have been that mean mom who puts restrictions on my kids, makes them do chores, and gives them consequences when they don't follow through with expectations. And now that they're getting older, they actually have thanked me for putting those boundaries on them and trying to encourage them to make good choices, because they see some of their classmates having free rein with no limitations and they realize now that while I was being the mean mom, I was actually trying to teach them life skills.

Pediatricians' Role in Behavior Management

So while pediatricians often have a lot of resources about where you can go to get behavioral help for your child, please understand that we cannot do the behavioral management ourselves. We can give you referrals to the people who really can help much better than we can. We can give you handouts on ways to help with behaviors, and we can talk to you and your child.

If your child's old enough, we can talk to them about ways they can control their behaviors and do it in a positive manner, so they understand that, yes, their parent might seem like they're being mean with restrictions and rules, but it's part of growing up and helping them make good choices.

We cannot prescribe unnecessary medications or give inappropriate diagnoses. Also, if we give you a referral, please follow through with it.

We want your child to get the help they need, but sometimes we aren't the people who can best help them. We understand that there is quite the wait for all mental health providers out there, but we just want your child to see someone who is actually qualified to help them and can do what your child and your family need on an individual basis to help them in the long run. Hang in there.