Do good manners make a difference to a child’s health? Writing in Tuesday’s Science Times, pediatrician Dr. Perri Klass believes they do.
The conversations that every pediatrician has, over and over, about “limit setting” and “consistently praising good behavior” are conversations about manners. And when you are in the exam room with a child who seems to have none, you begin to wonder what is going on at home and at school, and questions of family dysfunction or neurodevelopmental problems begin to cross your mind.
Dr. Barbara Howard, an assistant professor of pediatrics at the Johns Hopkins School of Medicine and an expert on behavior and development, told me that a child’s manners were a perfectly appropriate topic to raise at a pediatric visit.
“It has a huge impact on people’s lives — why wouldn’t you bring it up?” she said. “Do they look you in the eye? If you stick your hand out do they shake it? How do they interact with the parents; do they interrupt, do they ask for things, do they open Mommy’s purse and take things out?”
Dr. Howard suggested that the whole “manners” concept might seem a little out of date — until you recast it as “social skills,” a very hot term these days. Social skills are necessary for school success, she pointed out; they affect how you do on the playground, in the classroom, in the workplace.
To read more about what a child’s manners mean to the pediatrician, read the full article, “Making Room for Miss Manners Is a Parenting Basic.” And then join the discussion below.
What do you think? Should a pediatrician comment on a child’s manners?
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I find cheeky, inconsiderate children incredibly obnoxious (never one bit cute), and I know, when I see one (as I often do these days), that this child will grow into a person with problems, or who causes problems for others.
Yesterday, I watched a prime example. A very active and verbal 3 or 4-year old, under the supervision of his adoring mother, stepped out and tripped a woman trying to walk through a crowded restaurant. He shouted over and over, again, with glee, “Mommy, did you see me trip that woman? I tripped her!” Not once, did Mommy tell him “that’s not nice,” or “sit down and stop getting in everyone’s way.”
No question in my mind: this is a phenomenon that is getting worse with every generation. I get the feeling that few parents really care what anyone thinks about their bratty little kids, and I guess that’s the whole problem.
— WesleyIf a kid is a real monster, and the parents aren’t doing anything about it, MAYBE they might listen to the pediatrician.
— CharityI agree with this article-manners are a sign that a child is being cared for properly. Spoiling a child, letting him/her run roughshod over others does the child no favors in the long run. Manners are critical to academic and social sucess. Parents that fail to teach manners are failing their children.
— KJGI think pediatricians should definitely comment to the parents on the manners, or “social skills,”" of their patients. Using the term “social skills” makes courtesy a developmental issue, not a classist “seen but not heard” mantra.
— VirginiaShould a pediatrician comment on a child’s manners? Absolutely, but only in the context of medicine. A cranky child may be in pain. A timid child may be fearful of the doctor (like getting a shot). An angry or violent child may be showing signs of mental illness. These are all important.
Children are not at their best when visiting a doctor, no more than adults, because visits imply a problem to be addressed. It is no surprise that children may “act out” when in an intimidating cold office, usually undressed and vulnerable. A child shouldn’t bite the doctor (or dentist for that matter) or scream and yell, but occasionally it does happen. It’s actually up to the parent to cooperate with the doctor (as a team) to get the child calmed down, but again, if the child is sick, it may not work. And this is probably as distressing to the parent as it is to the doctor.
Sick people are often not quite rational. As such, manners displayed in the doctor’s office may not be reflective of manners in the classroom or in the grocery store.
— LynneMy partner and I spend a lot of time and effort working with our 3-year-old on her manners (or “social skills,” if you will). As we do this, three main points have been foremost in my mind and in my actions toward her:
— Saskia1) Expectations should be age-appropriate. Despite what one’s in-laws or child-free neighbors may think, proper manners for a 3-year-old are different than for a 10-year-old.
2) You really can’t be your child’s friend. A loving mentor, guide, teacher, yes. Friend, no.
3) Exercising proper manners should make a child feel good about themselves, about relationships, about their place in the world. “Manners” aren’t chores or empty rituals.
It constantly amazes me how rude and undisciplined some children can be. I would think it would be only in familar cases that I should try to interfere, however.
In a lot of cases, it is the parents’ philosophy on discipline and I am not going to change that in an office visit.
— James Hubbard M.D. M.P.H.“What do you think? Should a pediatrician comment on a child’s manners?”
Yes. Children’s minds are (usually) malleable…the interventions that grownups can make when children are young make a real impact. Just look at our current prison or gang population and the unfortunate ways in which some of these individuals handle the problems of everyday life. If they don’t get something they want, instead of earning it, they take it. If they don’t like somebody, instead of talking to or avoiding that person, they attack them. If they feel bored, instead of involving themselves in productive activities, they turn to alcohol/drugs, unsafe sex, or other high-risk activities. What is crime other than maladaptive responses to usual human needs and wants? If we could help kids get that, and help their parents realize that they may need some help, we should do so. Pediatricians (and teachers) are in a unique position to make a tangible difference in the lives of the next generation - for all of us.
— GregSure, it’s OK. Sometimes probably necessary. I read on the internet the other day that King Henry VIII said “the one thing that impressed me most about America was the manner in which parents listened to their children.” I would tend to think that the average pediatrician would have a wealth of knowledge they could impart to a parent who is willing to take advantage of the opportunity to avail themselves of that knowledge.
— RichardI agree that a child’s behavior is a window into their home life.
However, there is one caveat: Many kids like to “show off” when they are at the doctor’s! A kid who is well-mannered elsewhere might begin to misbehave at the doctor’s because they don’t feel well, or they are uncomfortable having a semi-stranger undress them, touch their tummy, look at their private parts, and poke them with tongue depressors, throat swabs, and shots. They might just have had their patience tried by all of the waiting: waiting in the waiting room, and waiting in the exam room and not being allowed to touch all of the fun and interesting scales, bandaids, giant Q-tips, blood pressure cuffs, rubber gloves, and the doctor’s wheeled chair.
As a kid, my favorites were wheeling the doctor’s stool around the room, inflating the blood pressure cuff, and making hand-balloons out of the rubber gloves. And I turned out fine!
Perri Klass responds: A number of people (see comment 5 above, for example, or comment 64, below) have commented, very fairly, that children find visits to the doctor stressful, and that fear of shots, or even of being examined, may contribute to difficult behavior in the exam room. That’s absolutely true, but it’s a given for every pediatrician — we see child after child, always in that context (see comment 35, for example), and I suppose many of us think we do our best to mitigate some of the anxiety, and to help the parent cope with the child’s fear — and also that we’re pretty good at recognizing those emotions, and the ways they are commonly manifested at different ages (see comment 57). But for that very reason, when there’s a child whose behavior strikes a pediatrician as unusually problematic, it’s probably at least worth raising the question of whether this is everyday behavior for that child or not. After all, a 7-year-old whose response to stress or anxiety is rudeness, anger, and aggression, may be running into troubles outside of the doctor’s office as well.
— APAbsolutely not! The limits of what falls under the medical field have already been dangerously pushed beyond the traditional boundaries by psychiatry in this country, in particular with regards to kids and the school environment.
The last thing we need is pediatricians trying to medicalize behavior and open another minefield for big-pharma.
— DiogoOf course.
Can a kid have good manners and also ADHD, (not to be confused with learning disability or other co-morbidities)?
— CBI find this extremely interesting because my daughter has the best manners while at school and other public settings. She always makes good eye contact, smiles, and always says please and thank you. In school, she has been described as being exceptionally quiet and a pleasure to have in class. At home she is the complete opposite. She is impatient, loud, and full of attitude. I feel this disparity in her behavior has worked against me. For years I have felt she has ADD based on her behaviors at home. When meeting with teachers and her pediatrician I got the sense they did not believe me because she was well-behaved at school and at the doctor’s office. It took a great amount of persistence on my part to finally get a clear diagnosis because she is such a different child when out in the world.
— RunningI think that the development of manners is very much a part of a child’s well-being and therefore should be a component of the doctor’s visit. A lack of manners is found at the source of the many social difficulties encountered as a child - difficulties that manifest themselves in a myriad of physical ailments.
For instance, I have a younger cousin who is a perfectionist, painfully shy, and has trouble with some of her schoolwork even though she is very bright and capable. She has learned to be incompetent and to act very childishly (albeit in a shy, well-behaved, timid way) - as if she were 5 even though she is 9 - in terms of her interests and hobbies, her relationship with her peers and her teacher, and within her family (she’s the youngest). She only eats about 900 calories per day because she doesn’t think she is a big girl with a growing appetite, and is unable to participate in school activities because she “doesn’t know how”. She will be in the 5th grade next year, and although her grades are high enough to pass, her social skills aren’t. (She can’t even tell a waitress at a casual restaurant what item she would like to order, nor have a five minute conversation with a close relative on the phone).
Even though her parents are well-meaning and very educated, she is being crippled by this lack of social skills, and it has affected her health. I wish a doctor would talk to my aunt and uncle, because they don’t listen to our advice! A doctor knows what a child should be reasonably expected to do socially, and can be an important wake-up call for the parents.
— MelissaSure. Just refer to it as Social Aptitude or Emotional Intelligence or something and it can be discussed as easily as ADD or whatever else ails the child.
I think it’s cruel to send a child out into the world without manners. He’ll never know why people don’t really enjoy his company….
— JennaRunning: Your description of your daughter sounds like me as a child: “Delightful,” “an angel,” & “a pleasure to have in my class/home.” At home, an impatient, disagreeable, & tantrum-prone devil emerged. Home was the only setting that prompted my bad behavior, which troubled me as a child because I couldn’t reconcile it with my easy good behavior in all other situations.
My former (and often despised) stepfather forced me to practice good manners & respect for others at home. It was hard for me at first, but I’m now all grown up and nearly done with medical school. Interestingly, my mother somehow misremembers me as an angelic, “easy,” child as noted on every report card. My well-practiced manners/social skills (along with genuine interest in others’ stories & well being) seem to endear me to patients. Even my generally well-mannered classmates have complimented/admired these qualities that never leave me.
Rest assured, it’s quite possible your daughter will mature beyond her difficult home behavior . Unfortunately for society-at-large, excellent manners & social skills will set your daughter far apart from many of her peers.
— MGGang members, manners? Bad manners should be addressed but gang members, criminals and con men, (especially) often have impeccable manners. It’s their morals that are questionable.
— LoriAs long as pediatricians have been properly trained in psychological and behavioral assessments, sure, let them comment on manners. This includes training about cultural nuances in how respect and courtesy are paid.
For example, many cultures, including U.S. subcultures, view looking adults directly in the eye as disrespectful. A direct gaze is not well-mannered but downright rude, especially for someone of lower status interacting with a superior (e.g., children and adults).
I would guess, though she mentions looking an adult in the eye as an indicator of possessing manners, Dr. Howard understands the importance of looking holistically, not simply at particular behaviors but the tone of the interaction.
Another example. I was outside the US and greeted someone with what I considered a polite gesture, prefacing my greeting with a friendly “hi!” and continued to comment on some pleasantry. I was told how rude that was instead of saying a more proper “hello.” I honestly didn’t intend to be rude, but this underscored the cultural differences. And perhaps, the importance of training both adults and young people alike; just because I didn’t intend to be rude doesn’t mean I was not!
Perri Klass responds: That’s an excellent point about cultural nuances, though I think that generally, a child who is making an effort to behave well is perceived as such, even across some cultural and linguistic barriers. I think I’m trying to discuss a consistent pattern of behavior, not any one omission or commission.
— Ben*Somebody* needs to address children’s poor manners with parents, that’s for sure!
As a teacher, I’d often like to, but it is difficult-to-impossible to bring up without alienating families. (I find I have more success heading directly to the kids. You’d be amazed at how easily young children will just accept a statement like, “I know you don’t have to say ‘please’ and ‘thank you’ at home, but at school we do because so many people like to hear those words.”)
But honestly, I’m not sure how much talking to parents about these things will help. What I’ve found is that a lot of the time the problem is that the parents don’t have any manners, either!
— TinaAs a High School teacher, I have to say that SOMEONE needs to talk to these kids when there is still time to change the behavior. Many of the behavior issues I see in High School could have been fixed years ago when the child was younger, but at 14, or 15, it is a more difficult battle!
Please, parents, remember. While your child is the center of your world, he is not the center of everyone’s world, and he needs to learn that.
— Brenna in MinnesotaI know I am turning into a cranky old lady, my children are both in college, but I am shocked when I see parents who allow their children to pinch their cheeks or yank on their hair. Mothers can’t keep their children from digging into their purses. One little boy at church kicked or head butted his mother when ever she tried to have a conversation with anyone after church and the mother did nothing!
— ElizabethAs noted already, anyone who is sick or feeling anxious about having blood drawn or getting a shot is not going to be on his or her best behavior. However if a doctor takes the time, and has the ability, to observe a child carefully, taking into account the setting and the child’s age, he or she may be able to save a parent (and child!) years of misunderstanding and grief by suggesting a child might benefit by being tested, for example, for central processing disorder or ADHD. However. Far too many adults — especially those without children — are unable to differentiate between a child who is undergoing a stressful but passing situation, such as visiting a doctor, from a child who needs help. When thoughtless adults make swift and careless judgments, such as a teacher I heard about who, on the 2nd or 3rd day of school, asked a parent what “meds” her Kindergarten son was on, they do more harm than good. Such grownups should, themselves, seek counseling for “social skills.”
Perri Klass responds: You make an excellent point, and one which should be a big part of this discussion: to make unsolicited and critical remarks to other people about their children generally falls under the heading of nosiness, minding-other-people’s business or, let’s just say it, plain old rudeness. I certainly didn’t mean this column in any way as a license to tell the person whose child is melting down in the supermarket or falling apart at a soccer game that this is clearly the result of lax parenting techniques, and will probably result in juvenile delinquency — that is truly uncharitable and unconscionable behavior. On the other hand, as a pediatrician, I am often obliged to discuss certain difficult issues with my patients and their parents (you know, childhood obesity, puberty, head lice, constipation, that kind of thing), and I think there should be a way to discuss off-the-scale bad behavior as well.
— A HaTo Richard:
— Susan de ResendizKing Henry VIII of England made no comments about the parents or children in “America.” Henry was born in 1491, Columbus “discovered” American in 1492, and England did not send exploration parties to the North American Continent until the reign of Queen Elizabeth I, daughter of Henry. King George was on the throne when the English in the future United State of America revolted in the late 1700s.
No parent likes to be told that his/her child is impolite, rude or misbehaved. The doctor would probably accomplish nothing but having the parents pick another doctor. Besides - rude and misbehaved children tend to have rude and misbehaved parents.
— AnneMy brother, today a perfectly well-mannered commercial airline pilot, once broke our family doctor’s ribs when he fought him over having to be vaccinated. (He was probably 7 or so and this was over 4 decades ago).
Children can have meltdowns anywhere. My daughter, who barely cried as a baby, once had a (fairly mild) meltdown in an airport, mostly because she was tired from having missed a nap. (She was 2). These events have nothing to do with “manners.” She was simply crying, but I’m sure it looked like she was “spoiled” to observers.
My brother? He’s an attractive, intelligent man who has great social skills.
My daughter? Now a very polite tween young lady.
— Kate