Skip to content
  • About
  • Contact
  • Contribute
  • My Book
  • Careers
  • Podcast
  • Transcripts
  • Speaking
KevinMD
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • My Book
    • Careers
    • Podcast
    • Transcripts
    • Speaking
KevinMD
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • My Book
    • Careers
    • Podcast
    • Transcripts
    • Speaking
  • About Kevin Pho, MD, Founder of KevinMD
  • Be heard on social media’s leading physician voice
  • Contact Kevin
  • Custom enhanced author page pricing
  • DMCA Policy
  • Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices
  • KevinMD influencer opportunities
  • Opinion and commentary by KevinMD
  • Physician burnout speakers to keynote your conference
  • Physician Coaching by KevinMD
  • Physician keynote speaker: Kevin Pho, MD
  • Physician Speaking by KevinMD: a boutique speakers bureau
  • Primary care physician in Nashua, NH | Kevin Pho, MD
  • Privacy Policy
  • Recommended services by KevinMD
  • Terms of Use Agreement
  • Thank you for subscribing to KevinMD
  • Thank you for upgrading to the KevinMD enhanced author page
  • Upgrade to the KevinMD enhanced author page

Why setting consistent boundaries is important

Alex Lickerman, MD
Conditions and Diseases
June 9, 2013
Share
Tweet
Share

A few weeks ago my wife, my son, and I went out for dinner. My son, though usually well-behaved and pleasant, was boisterous and disruptive, alternately leaping off his seat to crawl under the table and banging his silverware on his water glass to see what different volume of sound he could make it produce. Our tolerance for disciplining him patiently having been exhausted in us both by our respective challenging days, we decided to do something we almost never do while eating a meal: allow him to play a game on my smartphone.

My wife and I both feel strongly not only that the amount of time we allow him to do that should be limited in general, but also that during a family meal we’re all careful to remain present with one another and aren’t allowed to disappear into our electronic devices (including she and I!). Yet that night we gave in to him.

Though the games immediately took over his attention and allowed my wife and I to enjoy the peaceful meal we craved, at almost every meal since he’s asked to play a game on my phone. When we say no, he pouts and acts out, continuing to cite that one time we said yes. “I did it then!” he cries. “Why can’t I do it now?”

My son is just five. He’s only beginning to learn how to regulate his emotions. Reasoning with him works only when he’s in a certain mood—that is, not activated by boredom, hunger, or a strong desire (which is to say, rarely). He usually respects the boundaries we set for him not because they’re (mostly) reasonable but because we set them (mostly) calmly and firmly. He sometimes tests them, of course, but he usually backs off quickly when we refuse to change our minds having learned over time that we rarely give in to whining.

This is because every time we have, we inevitably face days afterward of increased reluctance to respect the limits we set. Like almost all children, he’s a master of probing his parents’ weaknesses, searching for and taking advantage of any openings that lie exposed. This isn’t malicious on his part, of course. It’s how children learn to get what they want—to fulfill their desires—as their parents typically represent the main obstacles in the way of their doing so. As parents, we must constantly make judgments about those desires—about their safety, the message that allowing them to be fulfilled communicates, and so on. It may seem mean—or, at the very least, arbitrary—to anyone observing a parent-child interaction in which a child is being denied something he wants, but wise parents understand the importance of placing limits on their children. That, after all, is how you teach them appropriate behaviors and attitudes.

The challenge here isn’t figuring out what boundaries are appropriate to set. It’s setting those boundaries consistently. Because when you set them inconsistently, you create not only a more difficult child but also a more confused one. How can you justify to a child, who after a certain age not only understands fairness but demands it, why he can play a game on a smartphone at one meal but not at another? You can tell the truth—that you’re a flawed human being who’s sometimes just too tired to be consistent—which is what my wife and I ended up doing in the week that followed our misstep, but that rarely satisfies either parent or child.

The reasons for parents finding themselves lacking the will to set boundaries consistently are many. But the reason they must strive to do so anyway has to do with only one: the difference between psychological reinforcement schedules. Positive reinforcement is generally accepted to be superior to negative reinforcement in changing behavior as it leads to more lasting behavioral modification. In a positive reinforcement schedule, a reward is given after a desired behavior occurs (e.g., a dog gets praise after pooping outside). The most powerful positive reinforcement schedule is called the variable ratio schedule where rewards are given after a random number of responses (meaning a rat will get food after pressing a bar once, then five times, then seven times, then three times, then eight times, etc.).

This, then, is exactly the reinforcement schedule that giving in to a child’s demands on an occasional basis yields. You are in effect priming your child to continue to challenge what you’ve already set as appropriate boundaries. On the other hand, if you were to schedule exceptions on a regular basis, it would reinforce his challenging behavior far less. (In fact, my wife and I do just that by allowing our son to watch cartoons on weekend mornings only and half an hour of iPad “movies” on weeknights, limiting his total number of hours in front of a screen to 7.5/week. By scheduling exceptions to our basic rule of “no television” we limit his screen time to reasonable levels and he feels like he’s getting what he wants.)

The same is true of setting boundaries with adults. Many of us, of course, have great difficulty doing so for a variety of reasons. But what we may not realize is how we set ourselves up to have our boundaries tested more often in the future when we allow random exceptions in the present. This isn’t to say such exceptions shouldn’t sometimes be made. But even when they’re appropriate to make, the effect is the same. The point here isn’t that we should never make exceptions. It’s that we should be prepared, when we do, to have our boundaries challenged even more. Because when we are prepared, we’re better able to return to setting them consistently.

Alex Lickerman is an internal medicine physician at the University of Chicago who blogs at Happiness in this World.  He is the author of The Undefeated Mind: On the Science of Constructing an Indestructible Self.

Prev

How to know if your baby has autism

June 8, 2013 Kevin 0
…
Next

HPV and oral sex: Is Michael Douglas correct?

June 9, 2013 Kevin 22
…

Tagged as: Pediatrics

< Previous Post
How to know if your baby has autism
Next Post >
HPV and oral sex: Is Michael Douglas correct?

ADVERTISEMENT

More by Alex Lickerman, MD

  • The main difference between functional medicine and evidence-based medicine

    Alex Lickerman, MD
  • Is too much care as harmful as too little?

    Alex Lickerman, MD
  • a desk with keyboard and ipad with the kevinmd logo

    The art of compromising is the key to a healthy relationship

    Alex Lickerman, MD

More in Conditions and Diseases

  • Fear of cancer recurrence is a human response, not a flaw

    Jae L. Ross, PsyD
  • Mental health ghost networks are badly hurting patients

    Steve Cohen, JD
  • The opioid crackdown is harming chronic pain patients

    Bill Bauer, MD, PhD
  • ED boarding fails patients before treatment begins

    Sarah Whaley
  • Insurance denial after transplant: Approval isn’t access

    Payton Herres
  • Prenatal testing for Down syndrome is not a verdict

    Laurel A. Coons, PhD
  • Most Popular

  • Past Week

    • The MCAT requirement persists as a norm, not as a tool

      Aniruth Ananthanarayanan | Medical Education
    • DEA fear is reshaping how doctors prescribe

      Ronald L. Lindsay, MD | Physician
    • The double standard at the heart of chronic pain treatment

      Joshua Saylor | Conditions and Diseases
    • Your sinus infection may not be an infection

      Franklyn R. Gergits, DO, MBA | Conditions and Diseases
    • Why scientific medicine alone is not making us healthier

      Narinder Singh Parhar, MD | Physician
    • 20 years inside a Medicare Advantage insurer, and who actually pays [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Primary care crisis requires new training and skills

      Justin Oldfield, MD | Physician
    • The MCAT requirement persists as a norm, not as a tool

      Aniruth Ananthanarayanan | Medical Education
    • Polycystic ovary syndrome is more than ovarian

      Oluyemisi Famuyiwa, MD | Conditions and Diseases
    • DEA fear is reshaping how doctors prescribe

      Ronald L. Lindsay, MD | Physician
    • Physician retirement is a myth for the ripening doctor

      Farid Sabet-Sharghi, MD | Physician
    • Primary care access is the real problem, not the system

      Payam Zamani, MD | Physician
  • Recent Posts

    • 20 years inside a Medicare Advantage insurer, and who actually pays [PODCAST]

      The Podcast by KevinMD | Podcast
    • Fear of cancer recurrence is a human response, not a flaw

      Jae L. Ross, PsyD | Conditions and Diseases
    • The attention economy is starving public health

      Paul Dranichnikov, MD, PhD | Physician
    • Mental health ghost networks are badly hurting patients

      Steve Cohen, JD | Conditions and Diseases
    • 3 changes physicians on social media need from institutions

      Trisha Majumdar | Social Media in Medicine
    • Why your overhead percentage is the wrong benchmark

      GetPracticeHelp | Physician Finance

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The MCAT requirement persists as a norm, not as a tool

      Aniruth Ananthanarayanan | Medical Education
    • DEA fear is reshaping how doctors prescribe

      Ronald L. Lindsay, MD | Physician
    • The double standard at the heart of chronic pain treatment

      Joshua Saylor | Conditions and Diseases
    • Your sinus infection may not be an infection

      Franklyn R. Gergits, DO, MBA | Conditions and Diseases
    • Why scientific medicine alone is not making us healthier

      Narinder Singh Parhar, MD | Physician
    • 20 years inside a Medicare Advantage insurer, and who actually pays [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Primary care crisis requires new training and skills

      Justin Oldfield, MD | Physician
    • The MCAT requirement persists as a norm, not as a tool

      Aniruth Ananthanarayanan | Medical Education
    • Polycystic ovary syndrome is more than ovarian

      Oluyemisi Famuyiwa, MD | Conditions and Diseases
    • DEA fear is reshaping how doctors prescribe

      Ronald L. Lindsay, MD | Physician
    • Physician retirement is a myth for the ripening doctor

      Farid Sabet-Sharghi, MD | Physician
    • Primary care access is the real problem, not the system

      Payam Zamani, MD | Physician
  • Recent Posts

    • 20 years inside a Medicare Advantage insurer, and who actually pays [PODCAST]

      The Podcast by KevinMD | Podcast
    • Fear of cancer recurrence is a human response, not a flaw

      Jae L. Ross, PsyD | Conditions and Diseases
    • The attention economy is starving public health

      Paul Dranichnikov, MD, PhD | Physician
    • Mental health ghost networks are badly hurting patients

      Steve Cohen, JD | Conditions and Diseases
    • 3 changes physicians on social media need from institutions

      Trisha Majumdar | Social Media in Medicine
    • Why your overhead percentage is the wrong benchmark

      GetPracticeHelp | Physician Finance

MedPage Today Professional

An Everyday Health Property Medpage Today

Copyright © 2026 KevinMD.com | Powered by Astra WordPress Theme

  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...