The main point of this brochure is to let children and parents know that violence is a choice, not inevitable. Developed for parents of pre- and early adolescents, the brochure describes the physiology of anger and offers strategies for children to avoid fighting when angry. Helping children understand their feelings and how to translate those feelings into appropriate actions is an important part of clinician involvement in violence prevention.

Anger, like conflict, is an inevitable part of life. As peer relationships become more important and children become more independent, fights have the potential to escalate. Research has shown that children involved in fights often lack a repertoire of appropriate responses to complex situations. This brochure provides parents with the information they need to coach their child in ways to avoid fighting.

Although some children may need a more concentrated intervention, this parent brochure serves as a foundation for discussion. Children who report having been in multiple fights need effective intervention. (Note that this brochure does not apply to a situation of bullying, in which bullies pick on children who are smaller and weaker.) While it is important to note that the concepts in this brochure are relevant across multiple cultural and socioeconomic groups, older teenagers, particularly those living in urban areas, may be less likely to find this sort of general advice useful.

Several effective school curricula deal with the issues of conflict resolution and anger management. For patients who participate in those programs, this material may reinforce the messages received at school. However, this approach may be new to parents and they may need to be counseled about the risks of escalating violence. Parents need to teach their children how to avoid letting conflicts escalate into physical fights.

How to Use This Tool

• This topic can be introduced with parents and children in many ways. Some clinicians begin with a benign question for parents, such as, "Are there a lot of fights at your child's school?" or for children, such as, "What happens when you get angry?"
• Pediatricians are in a unique position to describe the physiology of anger, particularly its effect on judgment and decision making. Use this as a springboard to discuss techniques to stay calm. For example, suggest that the child wait a few moments for the feeling to pass instead of engaging in violence.
  

• A common concern among patients, particularly boys, is that they will be in more danger if they refuse to fight; a 1996 study identified that young men were afraid of being labeled as a "sucker," although the precise term will vary by region and over time. The brochure describes techniques that avoid fighting but still allow the youth to "save face." Most patients will know of others who manage to avoid getting in fights, yet maintain high peer status. For those patients who avoid fighting, it is helpful to ask them what they do when they are angry. Some clinicians say, "I know a lot of kids get in fights. It's terrific that you're able to avoid them. When I talk with kids who seem to have trouble with getting into fights, what would you suggest I tell them" "What hints do you have for kids in your community to avoid fighting?" Children learn by exposure. Be alert to the possibility of abuse, domestic violence, or witnessing severe brutality in patients who appear to be getting into a lot of fights at a young age. Further assessment may be required.
• Children with ADHD or a history of minimal brain trauma may be more impulsive and more prone to fighting. It is helpful to keep these diagnoses in mind when confronted with a child having difficulty controlling aggressive impulses.

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