EPC Children's Health Q&A

Question: My 7 month old has had severe stopped up nose, mainly at night of course, and now she is starting to cough a little. What is the best treament or over the counter med for her nasal congestion?

Evansville Primary Care Answer:  I don't like to give medicines to infants unless I really have to.  If your  child has a runny nose at night and some cough, it sounds suspicious for budding allergies.  I would recommend this first:  control her environment.   Keep her sleeping area fastidiously clean.  Remove stuffed animals, heavy  curtains, and other dust-bearing things from her room.  Keep pets and smokers out of her room.  A Hepa air purifier in the room may help.  See if these things help.  If they don't, I would take her to see her doctor for evaluation of allergies.  There may be prescription medicines that can help.  Dr. Honnigford

Question:  I recently took my daughter to day care for the first time(she is 18 months old).  She stood at the door and cried from 7:30 that morning until 4:00 when I picked her up.  The only break she had was for an hour
nap.  She didn't eat or drink anything the whole time she was there she just cried. Ever since then she has had trouble sleeping through the night.  She wakes up screaming and I try to let her cry herself back to sleep but she just won't go.  Do you think the day care experience could have something to do with her sleeping patterns?  If so how do I convince her I'm not taking her back to day care?

Evansville Primary Care Answer:  What you are witnessing is "seperation anxiety".  It is a classic stage of  growing up.  The need to be with a parent (usually only one), becomes very  strong in this age.  Don't worry, even though this is an intensely strong  emotion for the child, it is also a phase that she will grow out of.  Usually by age 2.
Here are some survival tips.  If you need to take her to daycare or other  places, let her "test the water".  Go to daycare for an hour and play with her  there.  Then make it two.  Then leave her for an hour, two hours, four hours.   She will learn that her environment is safe and her natural curiousity will  take over.  The works just about the same for Grandma's House, the  Babysitter's, and just about any time when you will be away from the baby.
As far as bedtime, I would get a bedtime ritual.  Books, bath, story.  Once  this ritual is established, don't change it for a thing.  Drop everything and  tend to bedtime.  This helps children deal with stress and hardships they  encounter during the day, to have an unchanging routine at night.
Dr. Honnigford

Question:  My 3 month granddaughter's head is getting flat on the back where she lays on it so much. Will her head stay this shape or will it become round as she gets older?  Thank you for your time in answering this for me.

Evansville Primary Care Answer:   I get this question frequently.  But it's a good question.
A baby's head is soft and malleable, because the bones of the skull have not  grown together.  I would not worry about flattening of the occiput (the back of  the head).  Some of this is normal, some will be rounded out as her skull bones  fuse together. . .
Dr. Honngiford

Question:   If a child is seizure free for two years do you recomend they not take medication anymore and what are the chances that they will remain seizure free if they are taken off medicine?

Evansville Primary Care Answer: Once a child has been seizure free for one year, I consider weaning the medication.  However, this depends on the child's age, the types of seizures,  and the frequency of attacks before he was medicated.  If a child had seizures  many times per day or week prior to medication, I may continue it throughout  childhood.
However, if a child is well controlled for one year, a trial off the medication
is a good idea.  He may not need it anymore.  Or, if he has seizures, he may
need it at a lower dose. Good luck, Dr. Honnigford

Question:  What is good for teething?My nephew's boy is 6 months old and they can't give him the usual infant gel,because it irratates his throat.What else can they do to help his pain.

Evansville Primary Care Answer:   Teething tips:
Put chew toys in the refridgerator (not freezer) and then let baby suck on  them.  The coolness is soothing.  Give the baby many choices of teething  objects.  When you are teething, chewing on things *feels good*.  Teething  foods are also good.  My personal favorite are "Tell City Pretzels".  They are  just the right size and consistency.  And they don't stain.  Just rub the salt  off and away you go--inexpensive teether!
Don't underestimate the power of motrin and tylenol for teething pain.  These
are great especially around bedtime, because they last a long time.
Dr. Honnigford

Question:  My nephew's wife read somewhere that it was better not to change an infant at night when he gets up for feeding.Is this true? I find it hard to believe that being wet all night is good for anyone.Thanks

Evansville Primary Care Answer:  You got two pieces of advice tangled into one. . .
Please change that wet diaper at night when the baby gets up!  Prolonged  exposure to wet diapers promotes diaper rash. Instead, don't feed the baby much when he wakes up at night (in an effort to  reduce the need to wake to eat).  I think adage is the one they meant--at least  I hope so.
Dr. Honnigford

Question: My daughter is 18 and moved out. she has a job, that doesn't pay very well and doesn't have health care insurance. what is out there that she can get on for health care? somekind of aid.? finical aid? here in vincennes is where she lives. could you give me some answers to where she can go for help on what she makes on her income? thanks.

Evansville Primary Care Answer: Great Question. Now, more than ever, people are looking for assistance with rising health care costs. The government is aware of the problem. One solution was the introduction of HMO sponsored medicaid programs. These programs have less strict requirements than straight Medicaid, but have more limited benefits. Still, most teenagers out on their own for the first time will qualify for this program. You can apply at the local Department of Health Office. In Evansville, ours is located downtown in the Civic Building on the first floor. This program costs nothing and can only be taken away if you earn too much money or get insurance from another source. Dr. Honnigford

Question: My daughter is 2 years old and she drinks constantly. She always has to have something to drink. As soon as she wakes up she has to have something. Diabetes runs in my family. Should I take her in and have her tested?

Evansville Primary Care Answer: Nope. We rarely find diabetes in two year old who is growing appropriately. My suggestiong is this: take the juice out of her cup. Your daughter is drinking her calories instead of eating them. Use low fat or skim milk and low sugar or watered down juices. No bottles. Many parents use bottles like pacifiers and children carry them around all day and learn this bad habit. Break it early. If you do this, you may be surprised how much she will eat when it comes to mealtime.

Question: My twelve year old daughter was diagnosed with shingles on Friday (1-24-03) and my son has been sick now for two days, can there be any relationship between these two illnesses?

Evansville Primary Care Answer: Hmm. I don't see shingles in 12 year olds very often, but it can happen. Shingles is a skin manifestation of the Chicken Pox Virus -- Varicella. The child must have had chicken pox earlier in childhood in order to have Shingles. While your other child will not contract "Shingles", he can get the chicken pox virus from your daughter, just as if she had chicken pox. If he breaks out in a rash, I would talk to your doctor. Many children are immunized against varicella these days. Your son probably received this vaccine.

Question: Several years ago while practicing before his little league game, my son was hit in the head, just above the temple by a baseball that had been batted. It was extremely painful, yet he continued to play. I was not told about the accident until long after the game was over. I took him to urgent care where the doctor checked his ear, eyes, and did a short exam. We were told he was fine. Over the next couple of days, my son felt poorly and threw up once. My friend, a nurse, was very concerned. I made an appointment with our pediatrician. At the appointment, the doctor did another eye check, reflexes, etc., and ordered an x-ray of my son's skull. The x-ray showed no fractures, so again, we were told he was o.k. Since no image of the brain was ever taken, I'm wondering if there is any danger of problems in the future. Could this serious of a blow cause weakening of blood vessels or any other complications? My son has not had any symptoms (that I know of) that suggest problems. Thanks.

Evansville Primary Care Answer: Certainly the most severe problems that occur with head trauma will occur right around the time of the injury. Bleeding is the number one concern, because it is associated with the worst outcomes. Concusions can result in local brain injury and even predispose a child to seizures and headaches in the future. All that said, children respond very well to even massive head trauma. Young brains are plastic, that is, they can rewire and relearn to do tasks in new ways. There are stories about children with 50% brain loss, who grow up with no detectable deficeits. Dr. Honnigford

Question: I am a preschool teacher and have a student with down syndrome. She sneaks away from her mother as well as school staff. After researching her mother discovered this is a typical behavior for downs children and that she may not grow out of this until age 10 or 11. We are both worried about this dangerous behavior. Can you give me some strategies that work?

Evansville Primary Care Answer: Elopement (sneaking off to be alone) is a common problem with children with Down's Syndrome and Autism. They may not understand the dynamic social situations other children are accustomed to. They also may not recognize dangers in the environment, such as a busy street or tall staircase. Some things can help. Simple re-orienting activities such as one on one games and supervised play help greatly. A set of concrete rules is also very important. Here's an example: "Don't go past the yellow line on the curb" will be much easier to follow than "Don't go into the street". A yellow line is definitive. A street is more abstract. Stick to the very basics. Rules and re-orienting are the basis of discipline. There are no medications that can substitute for this. Down's Children can be taught what's allowed, even when they want to elope.
Good Luck,  Dr. Honnigford

Question:  My question is. My son is 6 years old and has been seen by a mental health dr since he was 2 1/2 he is now taking wellburtin twice a day and ritlan once a day for about 3weeks and i still don't see a change his behaviors at school are no better his dr believes he might be adhd with some add he will be tested on 2-14-03 but if he his should he be taking these two meds together?

Evansville Primary Care Answer: Yes. I commonly see antidepressants and ADHD medications, such as Ritalin, used together in refractory cases. However, I am surprised to see them being used prior to the formal testing for the disease.

Question:  I have a niece that is 4 years old. I have noticed this year her hair looks like it thinned out alot especially on one side of her head. I brought it up to her Dad her he seems to think its because her older sister pulls her hair sometimes. They both pull each others hair when they get mad at each other but, the older one doesn't have hair loss. It doesn't appear to be any new hair growth either. If I look a picture of her the year before she has alot of hair. I'm really worried about this adn so is some others in her family. Can you please tell me what else could cause hair loss in kids?

Evansville Primary Care Answer: There are several conditions that can cause hair loss in children. Yes, extensive twisting or pulling at hair (some kids have a bad habit of doing this) can cause hair loss, but it is usually in one discrete area where the child usually tugs. There are several scalp conditions that cause hair loss: Alopecia Areata and Tinea Capitis. The first is an autoimmune disease of the scalp that causes progressive destruction of hair follicles. It can lead to complete baldness, but there are ways to treat it. The second is a fungal type infection of the scalp that leads to brittle hair that breaks easily. There are a few other, rarer conditions that cause hair loss: poor nutrition, thyroid and other endocrine problems. However, usually these conditions cause many other symptoms other than hair loss. My advice, show it to your doctor.

Question:  My father was diagnosed with Hepites C he may have had this for 30 years. If he has do I and my children need to be tested for this?

Evansville Primary Care Answer: If a family member has been diagnosed with Chronic Hepatitis it is not a bad idea to get the older family members tested. All children these days are already immunized against Hepatitis B, but most teenagers and adults have not been. It would be a good idea to get the vaccine after testing. Dr. Honnigford

Question:  My grandson is almost 5 and the doctor thinks he has ADD or ADHD. He is waiting to be tested. In the meantime, he gave him Concerta. He cannot swallow the pill. So he gave him a capsule that they can break apart and put in food. They have given it twice and both times he became zombie like. Even wetting his pants. My husband read where there is a patch out that can work on this. Do you know anything about this or do you have any suggestions? He is so bad he was kicked out of pre-school. Please help. Thank You
Evansville Primary Care Answer:   Giving psychoactive agents before establishing a diagnosis is like giving out antibiotics over the phone. Some doctors do it, but it is not a good habit to get into. I'd really recommend getting that testing done first, before embarking on any new medication trials. You may be looking at behavior problems because of a depression or other condition which would not respond appropriately to ADHD medications. As for the patch, that information has not come across my desk. If there is a patch, it is not in widespread use yet. There are options to the pills, but they are few and far between. Get the testing, then let your doctor worry about administering routes of medication that's appropriate. Dr. Honnigford
Question:  I have a sort of private question. I bleed from my penis when i ejaculate. I don't want to tell my mom. I thought you might be able to help me with my problem. I was just wondering what it could be. I would really appreciate it if you could help me with my problem.
Evansville Primary Care Answer:   A very private question. Penile bleeding in teenagers is rarely something terrible. If ejaculation is painful and you see bleeding, you might have 'urethritis'. Cut down on any sexual activity for one week. A little motrin would help. If you have any discharge or redness around your penis, I'd see a doctor--especially if you are sexually active (these can be signs of a sexually transmitted disease). If you are having burning when you pee or see blood in your urine, again see a doctor, these could be signs of a urinary tract infection. Hope this helps. Dr. Honnigford

Question: My daughter has been running a low grade tempature off and on for about 2 weeks. She has no outward symptoms other than complaining about a crick in her neck a few times or her limbs (arms& legs)aching occasionally. She is 10 1/2, could this be growing pains?

Evansville Primary Care Answer:  Sounds more like the flu. Myalgias (intermittant muscle cramping often associated with fever) are a common complaint with the flu virus. Treat them with Motrin or Tylenol, fluids, and plenty of rest. Growing pains usually happen in the long bones, such as the legs and arms, because these are the places that grow the most quickly. I can't say I've ever encountered growing pains in the neck.  Dr. Honnigford

Question: My son went for his 5 year check up and it was determined that he had ketones in his urine. They were not concerned because he had a cold at the time. Is it possible that the ketones were related to that? Can ketones in urine be related to things other than diabetes? Thanks!

Evansville Primary Care Answer:   Ketones in urine by themselves tell us very little. But ketones can give clues to other things. Ketones are the breakdown product of sugar, but they usually are metabolized quite quickly. In a urine with very high sugar and positive ketones, yes, diabetes would be a concern (but not a definiive diagnosis). Another case, a child with concentrated urine and positive ketones most likely represents dehydration. The body has very little fluid to work with and some metabolites are seen in the urine. If your child was sick, this may be the case, especially if he wasn't eating or drinking well. All said, Ketones by themselves do not tell us anything.  Dr. Honnigford

Question: This a hard question to talk about I have a 14 year old boy who takes womens panties, and was caught stealing tampons from a store is this something i should be worried about? I don't know how to deal with this can you help

Evansville Primary Care Answer:   The problem is not difficult to understand, but the solution can be a tricky one. Teenagers are *always* fascinated by the opposite sex. Up to this time, very little differentiated their friends and schoolmates. But now, kids who they once played with are no longer kids, they are boys and girls. I am never surprised to see boys skulking in their older sister's closets. (Note: it is almost always the older, more mature sister than a younger one). Stealing, however, is a much more difficult problem. Teenagers who steal should be dealt with very firmly, or the behavior will continue. It does not matter what is stolen. Teenagers may try to steal things they could not acquire normally, like cigarettes and playboy magazines. This and all other stealing behavior should be snuffed out once it is detected.  Best of Luck, Dr. Honnigford

Question: My eight year old daughter has had unexplainable fever on two seperate occasion. These fevers lasted one week and then went away. She has no other symptoms. On the last episode of this unknown temperature, she had some lab work done. Her WBC and platelets were very low. We repeated the labs two days later. The WBC and platelets had gone up slightly. Her doctor felt that it was caused by a virus. Is there such a thing? And to occur on two occasions?

Evansville Primary Care Answer:  Your doctor is absolutely correct. Viruses may cause fevers, even very high fevers. Certain viral infections can slow down your bodies production of bone marrow products (like platelets and red blood cells). Actually, your bone marrow puts so much energy into making the cells that can eliminate the viral infection that the other cells are temporarily forgotten about (this is a disputed belief--others feel a viral particle inhibits cellular production, truth is we're not sure). And yes, viral fevers may come in waves. Your doctor did the right thing by following the blood count. In the majority of cases, this situation resolves rapidly.
Dr. Honnigford

Question: We have two cildren- ages 4 and 16months. They have had a night time cough and round-the-clock runny noses for 9 days now. Should we see our pediatrician now or continue to let it run its course?

Evansville Primary Care Answer:   Two kids, both sick. Sounds like a upper respiratory infection to me, but here are a few guidelines. If your cold symptoms are accompanied by a fever and lasting more than two days, see the doctor. If there are other associated symptoms, such as sore throat, ear pain, nausea or diarrhea, again I'd see the doctor. If you can control the cough and congestion with over the counter medications, I'd do just that. Sometimes colds can last the better part of two weeks, but if the child is running around during the day, eating well, and otherwise healthy, I'd just tough it out. All that said, kids with repetitive nighttime cough, may be showing some signs of asthma. If I were you, I'd get some good cough medicine over the counter. If these symptoms are still there by the end of the weekend, I'd be ready to see my doctor Monday.
Dr. Honnigford

Question: I am currently 7 months pregnant and plan to supplement baby formula and breast milk. Is there a particular formula you would recommend? Thanks.

Evansville Primary Care Answer:   Interesting question. Truth is, if you are going to breast feed, go full tilt. It is much easier to breast feed all the time than every now and then. If you breast feed occassionally, it may not be a strong enough signal for your milk to come in, and your baby will end up drinking formula only. I'd say try to breast feed only for the first few weeks, to get your feeding established. If you need bottles, pump. Thereafter, supplement with formula. There is a very good book on breastfeeding that is reasonable and does not preach glood and doom about formula. It's called "So That's What There For". But if you want my formula preference, it's Emfamil Lipil. But then I'm biased as to what my baby likes.  Dr. Honnigford

Question:  My 4 year old son has chronic eczema. He has been battling this atopic dermatitis since birth. We have tried everything, and nothing seems to work on a consistent basis. (protopic, cutivate, oat-meal baths, allergists, etc.) My question is two fold. #1 Should we be concerned about the dangers (if any) of his taking Hydroxyzine virtually every day as well as the constant use of these powerful topical ointments. #2 Is there a chance he will outgrow this as he continues to get older?? Thanks so much for your time.

Evansville Primary Care Answer:   Eczema is a very common condition in atopic children (kids predisposed to allergies and asthma). I like to think of it like acne. It's an annoying nuissance that affects alot of very young children, but it is nothing more than that. Most children will grow out of the eczema as they grow older. Topical steroids and oral antihistamines are the mainstay of treatment. However, if you are worried about the long term side effects of topical steroids (like skin lightening), ask you doctor about this: there is a new ezcema cream on the market that is not steroid based called Elidel. It's perfectly safe for kids and it works pretty well. But be assured that ezcema is just a nuissance, nothing more.. Good luck! Dr. Honnigford

Question:  I have a 3 1/2 year old son, that has problems sleeping at night. He didn't start even sleeping through a whole night until he was 18 months old. When he wakes up he's very combative, SHAKES, and screams wildly. He will not let you calm him down, we have to just let him wear himself down. Another concern I have with him is that he rarely eats anything. When we sit down to eat he might eat a few bites, but nothing significant. He only weighs in at 25 pounds and is very tall for his age. We have asked his own doctor but he blows it off and says that every child is different. This is realy a great concern of mine. Do I have a reason to be? Thank You!

Evansville Primary Care Answer:    It sounds like your child is suffering from Night Terrors. This is a benign condition that can happen in kids between the ages of 2-5 years old. We used to think that these were bad dreams, like nightmares, but research in brain waves has shown differently. To be truthful, we don't know what causes Night Terrors, but they can be seen in up to 5% of healthy children. It is a phase the chlild will outgrow. Here are a few survival tips: Children with Night Terrors typically have difficulty waking up. They can be very combative during their arousal state. While waking a child up may end the episode, it usually is best to leave an agitated child alone. Night Terrors are more common when a child is more tired. Do not interrupt daytime naps. Night Terrors can be familial, so ask if anyone else in your family has experienced them. As for eating, well, kids do go through cycles were they eat massive amounts and then what seems to be very little. This is in accordance with their growth patterns. Unfortunately, I have to agree with your doctor. This is pretty normal, especially for a tall growing child. Dr. Honnigford

Question:   My son is 6 months old. He is 20 lbs. and 28 in. long, so he is a big baby. I cannot get shoes to fit him. His feet are too wide. Does he need to wear shoes at this age, or should I wait until he starts walking to worry about it. I have heard that if I wait, his feet will continue to spread and it will make it harder. Thanks!

Evansville Primary Care Answer:    Ah, baby shoes. They're trendy, expensive, and difficult to keep on baby's feet. The truth is, most babies do not need to wear shoes. Look at the shoes on the market anyway, they don't offer much arch support, they are just fancy socks with rubber soles. I would not waste too much time trying to keep your baby in shoes. Now, occassionally we will see a baby with foot deformities, such as clubfeet, who can benefit from special shoes. But this is the exception. If your pediatrician says your child has good feet, let him run around barefoot. Now, about his weight . . . Dr. Honnigford

Question:  Is it wise to give infants and/or small children Benedryl for symtoms of collic?

Evansville Primary Care Answer:    Colic is truly a tough thing to endure during infancy. I know that benadryl can be used to quell the symptoms of nausea, but I don't use it routinely in children. Two reasons: 1) too much drowsiness. Colicky babies are colicky most of the time, and it is too easy to give three or four doses of benadryl a day. This leads to way too much in there system. Infants, even colicky infants need awake playtime so they can learn and grow. 2) paradoxical hyperkinesia. This happened to me once while I was working at Children's Hospital in Detroit Michigan. I gave a two year old give a dose of benadryl to calm her down prior to a procedure. Instead I got just the opposite! A wild, wound-up, screaming, flailing child! Now this doesn't happen often, but about 1-2% of children can have this paradoxical response to benadryl. Did I mention it takes four to six hours to wear off? Here's what I recommend: mylicon gas drops. Simethicone is exceptionally safe and can be used frequently without risk to the baby. That and a regular diet and you'll go pretty far.  Good Luck Dr. Honnigford

Question:  I have two children, a son 9 and a daughter 6. They always want to wear deodarent and I was wondering at what age children should start to wear it? Is it ok to let them wear it or could it hurt them? Please let me know as soon as you can. Thank you very much for your time.

Evansville Primary Care Answer:    Children want to be just like parents. You wear deodorant (I hope) and so do they. Next they will want to shave and wear make-up. Don't worry, it an okay habit to foster. Children can wear deodorant--but be careful. There is a big difference between "Deodorant" and "Antiperspirant". Mild deodorants, like Speed Stick and other stick types are safe, just check the label. If it says "Antiperspirant", it may contain chemicals such as aluminum and zinc that can cause rashes. Stick with very mild products that just deodorize, and, hey, you may have the best smelling kids in gym class. By the way, now is also a good time to let them see you brushing your teeth and eating vegetables, because maybe they will want to mimic that, too. Seriously!  Dr. Honnigford

Question: Recently a friend's child was hospitalized w/ fever, staggered walk etc and the doctor said his cold has settled in his hip. I have never heard of anything like this. Can you explain, or does this sound as crazy to you as it does to me ? Thanks !

Evansville Primary Care Answer:   Hmm.  I am a bit puzzled, also. Certainly there are infections that can involve the hips. Certain viral infections can cause myalgias (muscle and joing pains). But a joint injefection is usually quite severe, causing hospitalization and IV  antibiotics for many weeks. Here's how it usually happens: a skin infection  gets into the blood (usually staph or strep), this blood infection (bacteremia) then works its way to a joint and causes seeding of the joing with bacteria. The resulting infection is quite severe (osteomyelitis). My advice is this: have the parent talk to the doctor and ask, what exactly did he mean. Sometimes it is helpful to ask for the big fancy medical words that we use, because then you can use your own resources (such as the internet or medical libraries) to get better answers for yourself.

Question: My daughter got up this morning with a rash on her arms and on her legs. There was one spot on her stomach and one spot on her back. She feels fine and has no fever. Are there any virus going around that cause a rash. The rash does itch. Thank you.

Evansville Primary Care Answer:   While it is really impossible to diagnose a rash without seeing it, this rash sounds suspicious for dermatitis. This is a reaction skin makes when it is irritated. It occurs most commonly in the winter time, when the weather is dry and cold. Usually exposed areas of skin are involved: arms, legs, face, and belly near the beltline. Topical steroids like cortisone cream can help take the itch away. Most offen this is a mild reaction and goes away with time. If it persists for more than a week or is accompanied by other symptoms, see your doctor.

Question: My grandson is 4, and I am worried. He is in preschool and is always in trouble. When they try to get them to sit down and learn he won't sit. He tells them he can't do it. He is smart so I know he can do it. He doesn't have patience for anything. He will start something and be tired of it in 2 minutes. He does not mind. If you try to make him mind he hits and kicks. We try time outs and that doesn't work. Is there a way to test for ADHD or is he too young? I am worried because he has to go to kindergarten next year. His preschool teacher is at the end of her rope. I am afraid they are going to kick him out. Please help. Thank You.

Evansville Primary Care Answer:   ADHD is a popular diagnosis, but not always the correct one.  There could be many reasons behind your son's behavior. Acting out is one way a child can handle stress.  Is there a new baby at home?  Are you living in a different place?  Are there things going on that may be difficult for a child to understand?  There are ways to reduce stress for a child: 1)  Have a routine.  consistent mealtimes, strict bedtimes. 2)  Stimulate the child, give him several activities he may choose from. Impulsiveness is extremely common at this age, but so is curiosity. Don't be frustrated if he doesn't finish every activity;  maybe he just wanted to see if he would enjoy doing it. 3)  Have discipline.  The same punishment meted out in the same fashion. Never "threaten" children with discipline.  Do it, or don't do it.  If he deserves time out, give it.  And he may not leave before it's over. Period. Discipline that changes or is not acted upon confuses kids.  they test limits all the time and will only stop when they reach one.  Lastly, if his behavior continues to be a problem, especially at school, talk to his doctor.  There are ways for testing ADHD, even as young as 4 years old.