THE terrible twos can be a daunting prospect for even the most experienced parent.

Tantrums in the supermarket, hostilities at bedtime and battles at the dinner table can sap confidence and leave you wondering who's meant to be in control.

It's a situation every parent can relate to and even leads some to question if their child needs to be assessed for a more serious problem, such as Attention Deficit Hyperactivity Disorder (ADHD).

But while a small percentage of children may well need to be assessed for underlying conditions, parents should rest assured that a certain level of challenging behaviour is normal in pre-schoolers.

Monica Williams, manager of the health visiting service in Lancaster, explained: "Tantrums, scratching, hitting and biting are common and it doesn't necessarily mean something is wrong.

"However, each parent will have different ideas about what is good or bad behaviour and will naturally become concerned when they don't know how to deal with it.

"That's where your health visitor can be invaluable. They are able to assess your child in their home environment, look at what triggers the bad behaviour and identify whether or not there is a genuine problem.

Ignoring
"Often it's just a case of trying some behavioural management techniques, such as having the child sit at the bottom of the stairs to take time out, or in certain cases ignoring the bad behaviour if the child is seeking attention.

"We encourage positive praise whenever possible, telling the child if they've had a good day or done something right, giving them lots of hugs and kisses."

Mum Sharon Morris says her son Alfie, who is three in September, is generally good but will sometimes throw a tantrum.

"It can involve throwing things, kicking or punching," she said. "But he knows when he's done something wrong and he has time out on his bed to calm down and then he will say sorry."

Kerry Farish agrees. Her two-year-old daughter Maisie's behaviour changed not long after her younger sister Poppy came along.

"We had some advice from the health visitor about her behaviour, because I didn't really know what was happening to her all of a sudden," Kerry said.

"She definitely knows when she's done something wrong. We will warn her, and if she gets really bad we will sit her on the step and leave her to it and she will calm herself down.

"It sounds really basic but it's just about teaching her what she can and can't do."

Jo Lamb has her hands full making sure Ellie, three, and Sam, two, don't cause her double trouble.

"It's hard work but I think if you make the effort and try to keep them amused, life is a lot easier," she said. "If you are lazy they just get irritable and that's when the tantrums start. They want stimulating and you have got to give them that.

"Ellie and Sam are really close but that also means when they argue, all hell breaks loose, so it's good to stop the argument before it really gets going.

"The tantrums started at about 18 months. I think girls are the worst, boys are far more laid back. All of a sudden Ellie will just lay down and sometimes there's nothing you can do.

"I just try to sit her calmly and leave her to it, and often she will bring herself out of it. She knows she's doing it, and you just can't rise to it or pamper her."

Clare Benson agrees that keeping two-year-old Olivia entertained is the key to a peaceful life.

"She's generally very good, but she can be a bit of a madam at times," she said. "If she starts to get a bit stroppy it can be best to ignore her, it depends what she's doing.

"They just get bored easily so you just have to entertain them. Olivia goes to nursery two mornings a week which I thought would do her good. It gives her a bit of independence."

Meanwhile, Victoria Gorst is thankful for having boys. Mackenzie, who is three next month, hasn't caused the family any serious problems, despite the arrival of brother Harvey three months ago.

"He's really easy," she said. "He just gets on with things. He wants to touch Harvey all the time and so we have to tell him to be gentle, but he doesn't really push us to limits."

With many grandparents having responsibility for youngsters nowadays, it's also vital the whole family is singing from the same hymn sheet.

"The main thing is for all the carers to be consistent so the child knows the same boundaries whether they're with mum and dad, grandparents or a childminder," Monica said.

Grandma Velma Keating agrees. Looking after Nathaniel, two, while his mum works means the family has to work together for a positive result.

"You have to follow the same ground rules otherwise it won't work," she said. "The child has to know when they've gone too far, and that they can't get away with things just because they're with their grandparents rather than their parents."

Any parent worried about their child's behaviour or development can contact their health visitor via child health clinics, GP surgery, or children's centres.

There's also a free six-week course for Lancaster parents looking for support and confidence to cope with troublesome toddlers.

Handling Children's Behaviour is run by health visitor Jo Stretch, who offers her experience of dealing with challenging behaviour among pre-schoolers and regaining control.

Jo said: "It can get to the point where two and three-year-olds rule the roost and parents dread taking them out in public because they know their child will kick off. Nobody wants to have to deal with that in the middle of a supermarket.

Ignoring
"It can leave them feeling like they're not a good parent, which is not true. They just need to know how to set boundaries and take a firm hand to get back in control, all of which they can learn on the course.

"Sometimes just being with other people who are going through the same thing is enough to help parents realise they are not alone. The group members can help support each other and exchange ideas that have worked for them."

Much of the course focuses on positive parenting, such as establishing reward systems, as Jo feels there can be too much emphasis on what a child does wrong and not enough when they do something well.

Group work and exercises help parents put these techniques into context and they are then encouraged to practice these at home.

"Those who see it through feel much more in control and confident in managing challenging behaviour," Jo said.

Places are still available on the next course, which starts on November 6. Anyone interested can contact Jo Stretch on 01524 387415 or speak to their health visitor, who can also advise on any aspect of your child's development.

A course run by Surestart in conjunction with children's charity NCH also aims to support parents of young children.

The COPE parenting course is a series of nine two-hour sessions designed to help parents increase their self-esteem and knowledge by reinforcing and developing their own parenting skills.

Identifying ADHD
n ADHD is a persistent and severe impairment, which mainly involves a high level of inattentive, restless and impulsive behaviour.

n As there is a wide range of acceptable behaviour in young children and many different reasons for it, diagnosis can be an involved process and is carried out when there is a real cause for concern.

n A health visitor would consider the child as an individual in the context of society, home and school to get the full picture, working with colleagues from other services or agencies where necessary. Other possible reasons for the behaviour are taken into account first and parents would be urged to try behavioural management techniques.

n If these do not bring about a change in behaviour, a referral for assessment would then be made to a community paediatrician.

n For further information or support, contact ADHD North West on 01524 822887 or email worrall@ecosse.net

Further information
n Surestart: 382818

n Mental Health Foundation:
020 7803 1101 or www.mhf.org.uk

n The Royal College of Psychiatrists: 020 7235 2351 or www.rcpsych.ac.uk

n Attention Deficit Disorder Information and Support Service: 020 8906 9068 or www.addiss.co.uk

n North Lancashire Primary Care Trust: 01253 306305 or
www.northlancshealth.nhs.uk

n The 'Birth to 5' book given to all first-time parents, which has a
chapter on behaviour management as well as useful contacts, can be downloaded from www.dh.gov.uk

Next month's feature in on changing schools, e-mail your views to gayle.rouncivell@lancasterguardian.co.uk