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Aggression—Behavioral Issues in Child Care and Schools

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ICD10

  • F91

  • R45.4

  • R45.6

  • Z55

How can children with aggression be identified?

  • All children display some aggressive behaviors throughout their development. For example, some biting and hitting is normal for toddlers before they develop language skills.

  • Children with aggressive behaviors are quickly identified by parents and caregivers because they often cause harm to others.

  • Aggression is reactionary and impulsive behavior that can be violent and unpredictable.

  • Aggression can cause physical or emotional harm to others, and behaviors may range from verbal attacks to physical harm.

  • Differences occur in rates of aggression. Boys generally display more aggressive behaviors than girls. Larger children are often more aggressive than smaller children. Active children are also usually more aggressive than passive or reserved ones.

  • Aggressive behaviors may be intentional or unintentional. Many children who are hyperactive and/or clumsy are accidentally aggressive, but their intentions are not malicious. It is important to distinguish between intentional and unintentional aggressiveness.

How common is it?

  • Aggression is a normal part of early childhood development. Children quickly learn that aggressive behavior is a powerful way to communicate their feelings, wants, and needs.

  • Infants can become aggressive when they are hungry, uncomfortable, fearful, angry, or in pain. Parents can learn how to tell what babies need by the sound of the cry and the flailing of arms and legs.

  • Toddlers between 2 and 4 years of age commonly show aggressive outbursts, such as tantrums or hurting others, as a way of expressing their frustration. Usually the aggression in this age group is expressed toward parents, in an effort to get compliance with the child’s wishes. Verbal aggression can increase as vocabulary increases.

  • Children between 4 and 5 years of age can be aggressive toward their siblings and peers. As children engage in more social interactions, they develop more independence and have plentiful opportunities to stand up for themselves.

  • Consistently aggressive children, particularly boys, between 3 and 6 years of age may carry their behavior style into adolescence. This can turn into more extreme acts of aggression, such as bullying, fighting, and theft.

What are the behaviors usually seen?

Examples of aggressive behavior in childhood can include

  • Hitting

  • Biting

  • Scratching

  • Pushing

  • Kicking

  • Pulling hair

  • Teasing

  • Taunting

  • Screaming

When should a more concerning issue be suspected?

  • Many children display developmentally appropriate aggression periodically, but caregivers should suspect a more concerning issue if aggressive behaviors are frequent and/or not easily managed with redirection or positive discipline.

  • When parents, teachers, and other caregivers see a pattern of aggressive behavior that causes impairment in social functioning (eg, difficulty making friends or participating in developmentally appropriate activities), it is time to discuss concerns with a doctor or mental health professional.

  • Parents and teachers should be careful not to minimize aggressive behaviors in children. Certain factors may increase the risk of violent behaviors, and if a child has experienced one or more of the following factors, professional support may be needed:

    • Experiencing physical or sexual abuse

    • Exposure to violence in the home and community

    • Exposure to violence in the media

    • Use of drugs and alcohol

    • Presence of firearms in the home

    • Stressful family socioeconomic factors (eg, poverty, separation or divorce, single parenting, unemployment, incarceration, lack of support)

    • Brain injury

What are typical management strategies in the behavioral support plan?

  • Watch for clues or triggers. Watch the child and learn as much as possible about the child’s aggressive behavior.

    • Whom does the child display aggression toward— caregivers, one particular friend, many peers?

    • What emotion causes the child to become aggressive—frustration, anger, jealousy, excitement?

    • How does the child act aggressively—with words or through aggressive behaviors?

    • When does the aggressive behavior usually happen—during group play with peers, when the child is hungry or tired, during transitions?

    • Is anything else going on in the child’s world—a move, a new baby at home, conflict or separation between parents, loss of a pet? Stressors can make a child feel less secure and less able to control impulses.

  • Set limits. Once you know what triggers the child, caregivers can proactively prevent aggressive behaviors by avoiding those triggers. For example, if the child tends to throw blocks at friends, the blocks might be off-limits for a while, until the aggressive behavior has decreased. Alternatively, if the aggressive behavior happens right before nap time, the child might be overtired and could benefit from an earlier bedtime.

  • Respond quickly and calmly. When you see a child act aggressively, respond immediately. Remind the child that aggressive behavior is hurtful and unacceptable. If aggressive behaviors continue, institute a time-out or cool-off period or take away a privilege. Caregivers should focus on preventing the child from hurting another child, while also teaching the child that aggressive behavior is wrong. Caregivers should always label the aggressive behavior with a firm tone: “I don’t like it when you hit me or anyone else. Hitting hurts.”

  • Consistency is key. It is essential that consequences for aggressive behaviors are consistently enforced. Predictability teaches children that there will be negative consequences for negative behaviors.

  • Teach that words can solve problems. Explain to the child that words are much better for solving problems or conflicts than aggression. A frustrated preschooler can ask for a turn, rather than snatching a toy from a friend. If a child has a limited vocabulary, teach the child to use gestures to communicate what is desired or needed.

  • Help the child to understand his or her feelings and behavior. Often, children display aggressiveness out of frustration or anger. While it is normal and acceptable for children to get angry, it is not acceptable to bite, hit, kick, or fight. Validate the child’s emotion while teaching positive ways to deal with frustration. Examples include kicking a ball, listening to music, coloring a picture, finding an adult to help, or simply saying, “I’m mad.

  • Reward positive behavior. While it is important to address the negative aggressive behavior, it is also important to notice when a child successfully manages difficult emotions well. Acknowledge the child when he or she displays cooperative behavior with peers or siblings, such as sharing, taking turns, or walking away from a dispute. Behavior that is rewarded tends to be repeated, so praising a child’s self-control and conflict resolution is an effective strategy for managing behavior.

  • Set an example. Remember that children learn from their caregivers’ behaviors, so it is imperative that caregivers do not model the behavior they are trying to eliminate. No matter how angry a caregiver becomes, it is important to stay calm and refrain from acting aggressively. Caregivers should work to set a good example by managing their own tempers and solving problems with words, rather than actions. This teaches children to act responsibly, instead of aggressively.

When should I ask for additional support?

  • If a child’s aggressive behavior does not decrease with strategies to manage the behavior, it is time to discuss these concerns with a mental health professional and/or the child’s pediatrician.

  • Many developmental and/or mental health conditions can contribute to aggressive behavior, including

    • Autism spectrum disorder

    • Attention-deficit/hyperactivity disorder

    • Conduct disorder

    • Intermittent explosive disorder

    • Posttraumatic stress disorder

  • Additionally, brain injury and brain damage can also contribute to aggressive behaviors. If a child’s aggressive behavior is related to one of these issues, further treatment and interventions are required. Treatments can include behavioral modification, psychotherapy, and/or medication.

What training and/or policies may be needed?

  • Clear discipline policies should be established in the child care or school classroom setting to address aggressive behaviors, with the understanding that incorporating positive praise in the classroom for all children will serve to reduce concerning behaviors such as aggression.

  • When a child acts aggressively toward others, the child should be offered an opportunity to express his or her feelings in a healthy and acceptable way. It might be beneficial to have the child take a break and calm down in a safe and quiet place. This should not be considered punishment. It is important that children learn how to self-regulate and regain control, so caregivers can promote this by allowing a child time to cool off in a cozy corner or another quiet spot.

  • Teachers and caregivers should have adequate training in child development and age-appropriate expectations. They should understand that aggression is a normal part of development, but they should also recognize when a child’s aggressive behaviors warrants a referral to a medical professional.

  • Support parents in understanding the importance of limiting screen time. Young children tend to display more aggressive behaviors after watching violence on television or playing aggressive games on video game consoles or tablets. Monitor and limit the amount of time a child is exposed to programs or video games that portray violence as a way of solving problems or winning the game. The American Academy of Pediatrics encourages parents to select high-quality, age-appropriate media for children and suggests limiting screen time to 1 hour per day.

Where can I find additional resources?

  • Encyclopedia of Children’s Health (www.healthofchildren.com)

  • Zero to Three (www.zerotothree.org)

  • Center on the Social and Emotional Foundations for Early Learning (http://csefel.vanderbilt.edu)

  • Conscious Discipline (https://consciousdiscipline.com)

Adapted from Managing Behavioral Issues in Child Care and Schools: A Quick Reference Guide.

Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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