Time out for time outs: Why pediatricians now promote 'positive parenting'

The latest parenting advice from Canada's pediatricians is to shift away from shaming, blaming and any other types of negative discipline to what they call positive parenting.

Positive parenting is a set of principles to correct children's misbehaviour with greater empathy and communication and less punishment — and sticking with it at the times when it's most challenging. Experts say positive parenting fosters loving, predictable and secure relationships between a child and their parent or guardian.

The Canadian Paediatric Society (CPS) said in its latest position statement, released Thursday, that this is the first time it is asking all primary care practitioners to encourage positive parenting. Doing so, the society says, buffers against the effects of stressors and traumatic events.

Gold-standard randomized trials have demonstrated how positive parenting techniques are more effective at reducing negative behaviour in children, said Jenny Jenkins, the Atkinson Chair of Early Child Development and Education at the University of Toronto. Jenkins, a clinical and developmental psychologist, wasn't involved in the position statement.

"Negative comments, negativity or harshness towards children has been shown to be much more problematic developmentally for kids," Jenkins said.

'Pick their battles'

Positive parenting techniques provide a better relationship between parents and children.

"Rather than parents getting mad at kids and being irritable with them and negative with them, the interaction becomes a more positive one," she said.

If parents ignore the low-level problematic things that kids often do and intervene only when there's a safety concern or really bad behaviour, then their interactions with a child can shift in a more positive direction.

"The parents are trying to pick their battles," Jenkins said.

But today's parents may be at a loss on how to practise positive parenting since many of their parents didn't use it with them, said Dr. Andrea Feller, a member of the CPS's early years task force that wrote the position statement.

Past parenting advice was well intentioned and based on what was known at the time, she said. But experts in child brain development no longer recommend discipline that includes punishments like shaming and blaming.

Feller encourages parents who feel conflicted between the way they were raised and adopting positive parenting to trust themselves.

"Parents are a child's first, best and most important teacher," said Feller, a pediatrician in the Niagara Region and a mother of two children under 12.

In fact, the CPS said the reason behind the new statement is that while there are many factors that can put kids at risk for developmental problems, parenting is one that can be easily changed. The focus is on children aged zero to six years.

Recommendations to doctors

One way parents can get guidance is at the doctor's office. The CPS is encouraging pediatricians and family doctors to be comfortable asking parents about their relationship with a child and how well the family is coping.

At every visit, clinicians should ask questions about a child's behaviours and family routines, such as "What is your child's bedtime routine?"

Parents of young children commonly ask doctors for advice on crying, sleep and challenging behaviours, so that could serve as an opening for those types of conversations.

Clinicians are also encouraged to broach difficult and sometimes uncomfortable topics, such as trauma, and ask questions like "Has anything stressful happened to you or your family since I last saw you?"

To promote positive parenting behaviours, the society's other recommendations to clinicians include:

• Ask if there is a consistent caregiver, since that is a protective factor.

• Model communication skills by being open, predictable, kind and curious.

• Promote shared reading by families.

• Incorporate family-friendly hours and proactive scheduling into their practice (e.g. "Let's make an appointment for early next month" versus "Come back if you're having difficulties.")

Primary care providers can also direct parents to positive parenting books or free community supports such as local early years centres.

Shift to time ins

The document also included a section on time outs and time ins.

A time out creates a brief break in the child's behaviours, even if it's a positive one such as expressing curiosity or reaching for a hug. In a time in, on the other hand, the caregiver invites the child to sit and talk about feelings and behaviour in an age-appropriate way.

A time in focuses on connecting with the child, acknowledging his or her feelings and redirecting them in positive direction.

"Time outs have a place," Feller said, but should be considered a "last resort," since time outs can drift inappropriately into punishment.

What's more, time outs have no place in disciplining children under the age of three, who only understand that a parent or caregiver has turned them away. Often, Feller added, it is the parent who needs a break.

Feller noted social workers and early childhood educators already encourage positive discipline.

Now medical professionals are making the shift toward helping parents recognize that a young child's misbehaviour is often a way for them to communicate: "I can't handle things right now. I need your help."

Pediatrician Daniel Flanders, founder and director of Kindercare Pediatrics in Toronto, said the position statement is reasonable.

"It's a positive step in right direction, but it's a really small one," Flanders said. What's missing is practical ways to help parents implement it.

"It's all fair and good to say this is how parents should parent, but it's a whole other ball game when a single mom is trying to make it through the day, and she doesn't really have any resources or any support to really help her parent in all the ways this position statement is encouraging."