Taking Control

Helping Children Follow Their Medical Treatment Program: Guidelines for Parents of Children with Rheumatic Diseases

Adapted and published with permission from Michael A. Rapoff, PhD of the University of Kansas Medical Center, author of "Helping Children Follow their Medical Treatment Program: Guidelines for Parents of Children with Rheumatic Diseases"

Discipline: When and How

In spite of parents’ best efforts to reward cooperation and ignore minor complaints, children occasionally refuse to cooperate. When this happens, you have few options but to discipline your child. This is always difficult for parents and particularly difficult for parents of children with chronic diseases. No one wants to add more negatives to a child’s life that at times has more negatives than needed.

What many parents begin to realize is that the best they can do for their child with a chronic illness is to treat them like any other child. All children need to develop self-discipline whether they have a chronic disease or not (it may actually be more important for a child with a chronic disease). Self-discipline does not just develop on its own but follows from the discipline that children receive from their parents over a period of years.

What does discipline involve? A good general definition is "setting rules and enforcing them in a way that is the least bothersome to the parent and child." Most parents have pleaded with, yelled at (raised their voices at least), and may have even spanked their children. These strategies are often not effective and have a way of generating guilt.

There are some better alternatives. With children from about 18 months to 10 years, the “time-out” procedure works well when children refuse to cooperate. This basically involves placing your child in a chair located in a boring place and requiring them to sit for a period of time (usually less than 5 minutes if they get quiet fast enough). After allowing the child to leave time-out, she is immediately asked to do what you asked her to do.

With older children, the most effective discipline procedure is to take away privileges. However, privileges should be taken away for a specific amount of time and opportunities should be available for earning them back. For example, if your child doesn’t take her medications, she could lose phone privileges for 24 hours but could earn them back by taking her medications the next day. If you are using a reward system, you can take a specified number of tokens away for not following the treatment program.

Although most parents would like to avoid disciplining their children, this can’t be avoided when raising children. When you have to discipline, it is most effective if you do it in a matter-of-fact way without arguing or yelling. Your child won’t like to be disciplined but children really do want limits and boundaries in their life. From an early age, they will begin to test the limits. Make sure you are clear about where the limits are and that you intend to enforce them when necessary, in a firm but loving way.

Preparation of this booklet was supported in part by a program project grant from the Department of Health and Human Services, Maternal and Child Health Division (MCJ 203483-02-0) to the Department of Pediatrics, University of Kansas Medical Center.  An earlier version of this booklet was supported in part by an Allied Health Professional grant awarded to the author by the Arthritis Foundation.  
Special thanks to the following colleagues for their critique of earlier drafts of this booklet:  Jan Black, Dr. Mark Purviance, Dr. Carol B. Lindsley, and Dr. Ed Christophersen.
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