A bit about vaccines and in defense of time outs

Today, I want to deviate from my last few posts about COVID to talk about discipline. Shaming parents is a real pet peeve of mine. I would much rather parents be informed and empowered to select from the full range of options at their disposal. But before I dive in to discuss time outs, a few details about vaccines.

Many people have asked me what I think about the COVID vaccine for breastfeeding mothers and pregnant women. I can’t imagine a way in which a breastfeeding child could be harmed by the mRNA vaccines currently available in the US. I discussed it in more detail here. I am not an OBGYN, but all of their major professional organizations (ACOG, SMFM, ASRM) are on board with vaccination and the concerns about fertility issues are unfounded. 10,000 pregnant women have been vaccinated with no untoward effects (though it’s early yet) and evidence suggests the immunity protects the newborn. I contributed to a summary article here.

As with everything decision, you should consider your specific exposures, risks and benefits and discuss it with your doctor, but generally speaking I am confident about these vaccines .

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During a pandemic, I am particularly sensitive towards shaming parents. And on instagram, where I spend far too much time, I am constantly seeing parents discouraged from using evidence-based strategies because they are out of vogue. I’ve seen this about sleep-training, which is by no means necessary for every child or a mandatory part of parenting, but is highly unlikely to cause any damage. Another Instagram influencer with hundreds of thousands of followers posted that any consequence is potentially harmful (which I remain confused about).

This kind of “cancel culture” is in my opinion harmful. There are rarely absolutes when it comes to interpreting scientific research. The devil is in the details and the nuance really matters.

So today, I want to share a summary of why I still support the use of time outs. Time outs have a lot of baggage. Many parents may remember a “mean” time out from their childhood. “Go to your room and don’t come out!” But the time out which I am discussing here may not be what you imagine or remember.

A time out is an interruption in unwanted or unsafe behavior up to a minute per year of age in a quiet boring space. Following the time out, you can discuss it with your child or just move on. 

Time outs can be used for bad behavior - biting, hitting, dangerous, or “red light” behavior. Timeouts can also be used for more moderate “yellow light” behavior that continues despite several warnings (this is effectively described in the book 1,2,3 magic). Time outs teach “no” well. Time outs can provide space and time for children to process big feelings.

Time outs do not work well to help a child learn productive play, stop whining or motivate good behavior. Time outs may not help some children who are very distressed being left alone particularly those with a history of trauma or adoption. Often when you start with time outs bad behavior increases, but within a week or so of a consistent new limit, the behavior should decrease. If it doesn’t and you are using time outs all the time, it’s time to consider a new strategy or whether there is an underlying issue (ie. sleep problems, speech delay or other diagnosis) that may warrant addressing. 

So where did the time-out hate come from?

Attachment theory and positive parenting have brought us a lot of good tools to help us raise children, but criticism of time outs started in 2014, in a Time magazine editorial promoting the parenting book the Whole Brain Child by Dan Siegel and Tina Payne Bryson (a book I really like by the way). The editorial was titled “Time-outs are hurting your child”. Later the authors essentially retracted this claim, but the damage had been done. No parent wants to use a harmful technique.

But there has been no evidence of harm from scientific studies on timeouts. Certainly we can imagine timeouts being misused - time outs could be too long, use a lot of yelling or used for purposes where they don’t work. But we don’t have a reason to trash the parenting technique as intended. In fact, we have evidence time outs are effective and safe.

A 2019 study followed 1400 children from age 3 to age 12 and found no differences in families who used time outs as compared to those who didn’t. These typical use time outs were intentionally defined by the parents and could have really ranged in frequency and intensity. The children’s attachment, the IQ, the emotional health and the creativity were all the same. Other studies have shown similar results in different populations. The American Academy of Pediatrics and the American Psychological Association still support time outs as an evidence based effective way to teach children.

Why am I all riled up about time outs being criticized? 

For one, I am an advocate for parents. Responding to tantrums and children who are misbehaving can be exhausting. While prevention and positive techniques are great, the time out is a tool that requires less from parents.

Particularly now during COVID when parents have other responsibilities to balance work or children to watch, managing our energy is crucial. Families who use more caregivers or children who move back and forth between households of separated parents may find that time outs provide more consistency for the children.

The consistency may be more important to the child than the choice of strategy in the end - we know consistency helps a child learn and feel safe. For parents of neurodiverse or “spirited” children or children with significant behavior problems sometimes related to a medical condition (e.g. ADHD), taking away time outs may be a particularly large ask. 

Individuals who are the most critical of timeouts are often speaking from a place of privilege and are often selling their own strategies. But I worry that the misrepresented danger of time outs will result in parents having fewer strategies to help their families and may at the extreme even cause more child abuse.

Part of what I love about pediatrics is how dedicated parents are to doing the best thing for their families, and if time outs were shown to be as dangerous as child abuse of course I’d agree we should trash them. But without evidence of this, let’s offer parents the variety of options and allow them to pick what fits best with their family and parenting preferences. 

Let me know what you think in the comments or send me an email. If you found this helpful, consider sharing with friends. Have a great weekend.