Parents frequently ask their primary care physician about discipline. Discipline should be a priority topic for anticipatory guidance at 15 months and 18 months (Hagan et al., 2008). Effective discipline requires three essential components: (1) a positive, loving relationship between the parent(s) and child, (2) positive reinforcement strategies to increase desired behaviors, and (3) punishment or removal of reinforcement to reduce or eliminate undesired behaviors (AAP Committee on Psychosocial Aspects, 1998). Although often confused with punishment, discipline actually means to teach. All children benefit from guidance and structure, and most children require occasional discipline. The best discipline is consistent and considers the child's developmental level as well as the child's point of view. Effective strategies include environmental modifications (e.g., child-proofing the house), distraction, redirection, giving appropriate choices, and time-out. Although many parents spank (Regalado et al., 2004), corporal punishment is controversial and has potential long-term negative effects (Smith, 2006). Other methods of discipline are more effective over time and should be used. Some families may require more intensive assistance, and clinicians should be aware of local resources for teaching parents.

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