Discussing different behavioral strategies is an important part of my patient visits, and I frequently recommend the use of time-out for children over the age of 2 years. However, conflicting information on the internet could easily lead any parent to question its use.

A loving and responsive connection between parents and children is a critical foundational piece of healthy child development. We, as adults, need to be mindful of what children are or are not developmentally capable of doing and maintain reasonable expectations for their behavior.

That being said, time-out strategies have a time and place when implemented in the correct or appropriate manner. I often hear from parents that time-outs simply don't work for their children. However, time-outs as a behavioral strategy can be very effective in reducing attention-seeking behaviors that are inappropriate, dangerous and injurious.

Young children, especially those with ADHD, are highly motivated by generating adult attention, whether positive ("Great job waiting your turn!") or negative ("Why did you take that from your sister? What did I tell you about that?"). We want to teach all children that appropriate behavior is more effective than inappropriate behavior to gain adult attention.

I recently talked to Patty Huang, MD, a developmental pediatrician at Children's, to talk about best practices.

Here are tips she shared on how to use time-outs:

  • Catch your child being good. Significantly increase your praise and attention for appropriate behavior. Set a goal of providing positive attention at least 50 times a day (about every five to 10 minutes). Parents (myself included) frequently pay a lot of attention when our children are acting inappropriately. After all, it's pretty easy to ignore a child when he is playing quietly and cooperatively. But that's actually sending the message that inappropriate attention-seeking behaviors are effective to gain our attention.
  • Be consistent. When trying to improve a behavior, we need to be consistent in using the strategy. That being said, putting a child in time-out multiple times a day is unpleasant for all involved and makes it harder to be consistent. Choose one to two of the most problematic behaviors that will lead to a time-out. Be specific. All other inappropriate attention-seeking behaviors (unless safety is at risk) should be ignored during this time. Examples of a specific behavior might be throwing a toy at a sibling or kicking the table. Note that "Not listening" is not a specific behavior and can be a confusing standard for a child and also for a parent to enforce.
  • Be on the same page. Parents and caregivers need to consistently enforce the strategy in order to be fully effective. Writing down the rules can help remind everyone when (and when not) to intervene.
  • Use the strategy to reduce attention seeking-behaviors. If a child is put in time-out for behaviors that are not attention-seeking (e.g., receiving a bad grade), it will not be effective and is therefore not appropriate.
  • Use a simple phrase. The time-out itself should start with a short sentence, "You threw a toy at your sister, time-out". Time-out means time out from parent attention, both positive and negative. A time-out should not involve negotiating, arguing, or chasing back and forth-- these are all forms of attention.
  • Make the duration age-appropriate. The duration of a time-out should be about a minute for each year of age, and your child should remain in time-out until he is able to calm-down and stay calm for at least 15 to 30 seconds. Don't push your child to apologize in order to be removed from time-out.
  • Know when to discuss the behavior. After the time-out, not during the time-out, is an appropriate time to calmly discuss the behavior with your child.
  • Expect that attention-seeking behaviors will increase at first. These behaviors will decrease once the child learns that you will no longer respond to these behaviors any more except with a time-out.

Many parents tell me that their kids "don't get it," don't seem sorry when in time-out, and therefore believe the strategy doesn't work. However, time-out is not designed to make your child think and apologize for certain behaviors.

By taking your child out of current activities and formally removing attention, the time-out is intended to send a message that an inappropriate, attention-seeking behavior will not receive attention.

For time-outs to be effective, children do need to have enough language skill and some understanding of action and consequence, which is why we do not recommend time-outs for children under 2 years of age.

Have a question for the Healthy Kids panel? Ask it here. Read more from the Healthy Kids blog »