Case #1: 2-Year-Old With Difficult Adjustment to New Child Care Setting
A mother of a toddler scheduled a telemedicine appointment to request a referral to a behavior specialist for her daughter. She recently started daycare after spending the first 2 years of her life at home with her mother. Almost daily since starting daycare, she received incident reports detailing her “bad behavior” including hitting and biting.
Entering the Provider’s World
What might the provider be thinking and feeling?
- Tired by too many visits
- Overwhelmed by the concern and uncertain about what to do
- Relieved that the mother just wants a referral
- This is not my problem or area of expertise
Understanding the Behavior Concern
Provider: Start by listening and learning more about what is concerning the parent or caregiver.
Example questions to learn more:
- Quality – Describe what your child does that is a concern for you.
- Duration – Is this behavior new or has this been happening for a while?
- Triggers – Have you noticed are there any circumstances under which the behaviors occur?
- Alleviating – What have you and other caregivers tried to help the child? How has that worked?
After asking these questions, the provider paused and asked the mother, “How does this situation at daycare make you feel?”
The mother responded, “I’m worried she is going to be a bully when she grows up. I’m embarrassed and ashamed that I didn’t teach her not to be mean to other kids. I feel sad because she was so well-behaved with me at home, but she had to go to daycare so I can work. I miss her too.”
The provider asked next, “How do you think your daughter feels at daycare?”
Entering the Child’s World
What might the child be thinking and feeling?
Provider: Ask reflective questions to learn more about the child’s experience.
His mother shared, “It’s been a really big change for her. We had so much fun together one-on-one at home. Now she’s with many other kids of different ages – it’s very loud and chaotic. She doesn’t know the adults yet and the staff changes frequently throughout the week. She comes home with bite marks, so I know other kids are biting her too.”
“What do you think you need during this time?” “What do you think your daughter needs?” the provider next asked.
Identifying Parent/Child Needs
What might the parent and child be needing?
Provider: Now that you’ve learned about the parent and child’s underlying feelings, ask the parent to reflect on their own needs and the needs of their child.
The mother shared, “She needs a quieter and calmer environment. She needs more comfort and attention. When I pick her up at the end of the day, the daycare staff has too many expectations of what she should do and speaks to her harshly sometimes. I can tell she is frustrated and sad because the older kids can do those things, but she’s still so young. The bite marks on her body let me know she might feel afraid of other kids or isn’t being watched closely since no one even told me anything happened.”
The provider was able to connect with the mother about how hard this situation must be for her and her daughter. The provider commented on what a wonderful job she was doing putting herself in her child’s shoes and thinking about what it must be like for her little girl to be at this strange new place all day. The provider supported her in already knowing what her daughter needs and recognizing that there is nothing “wrong” with her and that many things are underlying her biting and hitting at daycare.
Observations and Strengths Based Positive and Positive Instructive Feedback
Provider: Notice what the provider is doing well in their relationship with their child. Provide positive feedback contingent upon what you observed or heard during the visit. Share why this is important for the child’s social emotional development.
At the end of the visit, the mother had shifted from thinking something was wrong with her child and that she needed a referral to a behavioral specialist to realizing that she would like to find a childcare that was a better fit for both of them.