How to Handle Tantrums: Strategies for Parents and Children

Episode Transcript

Dr Nicole Beurkens:

Hi everyone, welcome to the show. I’m Dr. Nicole, and today I’m answering a question from one of you. This is a question about behavioral outbursts, tantrums — lots of these kinds of questions come in. So today we’re going to talk about this in the context of a developmentally-young child who suddenly seems to be falling apart about everything. This specific question comes from Nicole, who writes: “I have an almost four-year-old daughter who has started having major tantrums. She hasn’t had behavior issues like this previously, or at least outbursts to this level in frequency. I understand this can be a part of her age, but it feels out of hand and I’m at a loss. It seems like any little thing can set her off, and it can be up to 1-2 hours of rage and screaming. There seems to be nothing that can get her to move through it until she just comes down by herself. We’ve tried everything we can think of: Gotten angry, tried consequences, been patient, given opportunities, we’ve tried ignoring, separating from the situation. She’s currently an only child and I’m pregnant with my second, so I wonder if that could have something to do with the massive behavior shift. My question is: What can cause a huge behavior shift at this age, and what are the strategies for handling this?” Great question. Something that I think all of us as parents can relate to on some level, whether you have a child who’s going through this stage right now, or you have an older child, and you remember what it was like. Some of you may have chronologically older kids who developmentally are still operating at sort of this preschool phase of development or stage of development in terms of how they’re able to regulate their emotions and behaviors, so I think the ideas that I’m going to talk about and the strategies will be relevant to everybody.

So as always, let’s start with the big picture. Few things to think about here in the big picture: First, I totally hear the frustration, the distress, the angst in this parent. It certainly is understandable. We can relate to how that feels, right? I can empathize, and at the same time, I recognize that this level of distress and anxiety on the parents part is probably a component of what’s going on with the intensity and frequency of the child’s dysregulated behavior. It’s just a fact that kids can only handle their emotions and behaviors to the extent that the adults around them can. And so if we’re not able to manage ourselves well, even if we mean to and we’re trying to, but we’re sort of exuding this feeling of being really angsty, really distressed, feeling really overwhelmed ourselves, kids pick up on that they sense it, and that will just feed this cycle of really intense dysregulation. So the big picture, we need to be thinking about how we as adults are feeling, what our emotions are, and how that might be impacting what’s going on with the child. The other big picture thing here is that this age, this developmental stage is prime time for these kinds of issues. Kids are asserting their independence more, they’re more aware of things within them and around them. They’re having more thoughts, more feelings, more opinions, but they don’t yet have a lot of control over their lives. They also don’t have really good communication skills yet. Most kids at that age, three, almost four, aren’t really able to articulate exactly what’s going on for them, why they’re upset, what’s happening, how they’re feeling, and they may not even be aware of really what’s going on, they just know how they’re feeling about it. So the communication skills aren’t there, and those regulation capabilities, the skills for handling and soothing yourself through uncomfortable feelings, they’re not at a level where they can independently do that yet. So that’s part of what’s going on at this stage. And again, kids at this developmental stage, even if they’re chronologically older, they’re going to struggle with this more. Some of you have kids with neurodevelopmental issues or other kinds of challenges, where they have uneven development, where they might be chronologically and developmentally at a much older age for certain kinds of skills and issues, but when it comes to regulating their emotions and behaviors may still be at this younger level. So recognizing the developmental piece of what’s going on here is important.

Then we also need to think about, in the big picture here, that this child is going from a situation of being an only child in the family to having a sibling. And this is happening at a time in her development when she’s very aware of what’s going on. An almost four-year-old understands that there’s talk about the baby, sees mommy’s belly growing, sees changes happening around the house to prepare for the baby. So she’s aware of these changes and these things that are being talked about and these things that are happening, but doesn’t really have a way to put all that together and make sense of it yet, and is maybe having a lot of distress or just tension or unresolved things in her own mind about what this is going to mean for her. So this is likely playing a role as well. Recognizing that she’s going to have to share attention even more once the baby’s born, and even now, the focus of attention isn’t all on her. I’m sure there’s talk and things happening around the baby, and she’s realizing, “Hmm, wait a second, everything’s not about me anymore, what’s going on here?” So that’s a lot for a little person to handle. And while we’re talking specifically about the issue of change around a new baby coming into the family, this really applies for any change, any major life event, family change, stressor, anything that might be going on for a child, that’s something that we need to keep in mind when we’re seeing these changes in behavior. Also, in the big picture, I want to point out that it’s possible that there are some physiological things that are driving the behaviors as well. That’s difficult for me to say without more details about how sudden the onset was, what the child’s diet is like, what their lifestyle habits are like, but it is very possible when you see really sudden shifts in behavior or really a big increase in intensity and frequency in these things, there’s always the possibility that we need to be looking at things like food and nutrition, things like sleep, infections, that kind of stuff. So I’ll talk a little bit more about that in a little bit. So those are the big picture, things to keep in mind.

Now let’s talk about our in-the-moment strategies. What do we do when the child is having one of these really intense, sudden kinds of prolonged meltdowns or tantrums? The first thing, as I often talk about in so many of these episodes is that we as the adults need to focus on our own emotional and behavioral regulation. Easier said than done, but our child can only be as regulated as we are in that moment. So we need to use our tools, mantras, things like reminding ourselves over and over in our mind, “This too shall pass” or “She’s a good kid having a hard time”, or “I’m a good mom, this isn’t my fault.” Whatever kinds of mantras keep us thinking about the right things that keep our nervous system regulated and calm, that’s what we want to be doing. We want to be focusing on our breathing, calming breathing, we tend to get very escalated, and notice that we’re having shallow breathing, which just fuels our anxiety, our distress about it. So we want to focus on keeping our breathing slow and calm. Also, noticing what’s happening in our body. Are we super tense? Is our jaw clenched? Our shoulders tight? Our fists kind of clenched? Are we sending these signals from our body that whoa, we are really stressed, really upset, really anxious, really feeling out of control here? We want to be mindful of that and relax our body. Also, reining in our thoughts. This is where the mantras come in, because as humans, our brain has the amazing capacity to conduct mental time travel. Going way into the future and thinking things like “Oh my goodness, what’s going to happen if she is an adult and still behaving this way?” or “What am I going to do when she’s a teenager, and she’s too big for me to physically pick her up and move her?”, and we get ourselves all wrapped up in this future thinking. And that prevents us from focusing on what’s actually happening in the here and now. So we want to ground ourselves and our thoughts in what’s happening now. “This is my three, almost four-year-old child who is mad about this thing that happened, she’s having difficulty managing that. I’m here, I can handle this, we’re going get through it.” So that’s the first thing.

Second thing is to focus on our own sense of feeling calm, but also firm and confident. Now, this takes practice, but it’s super important for us to be confident in our approach to these situations. Kids need to know that we can handle their big feelings and their behaviors. If they sense that we are overwhelmed by what’s happening for them, that’s even more dysregulated for them because they’re like, “Oh, great, I’ve lost it. I can’t steer the ship. I’m totally out of sorts and out of control, and so is the adult that’s here with me”. It’s actually really scary for them. So we need to portray that we are confidently steering the ship, or as an eight-year-old at our clinic once said to his mom, “Who is driving the bus?” We need to be driving the bus, especially in these difficult moments. letting kids know that we’ve got this. You’re having a hard time. I’m going to help you through this. We can handle this.

The third thing that we want to do is acknowledge the feelings. Kids may be able to articulate what’s going on, “I’m really mad”, or “That hurt”, or “I didn’t like that.” Sometimes they’re not able to communicate their feelings. We can take a good guess as to what’s going on for them. So we want to acknowledge that and empathize with that. Not using a lot of words, but something simple like, “I know you’re mad. I said it’s time to clean up the toys. I get it. You wanted to keep playing.” We’re acknowledging and empathizing with the underlying emotions here and saying, “Yeah, I get it, I see you, I understand what’s happening.” And that’s important because it helps them to feel seen and heard, and helps them to know that we get what’s happening for them. You want to be careful about not doing too much talking or too much verbal around that. When kids are really dysregulated, kind of falling apart like this, sometimes the more language or the more verbal communication we use can be even more overwhelming. It’s like pouring fuel on the fire. So for some kids, it’s best not to say anything, and just sort of communicate through our calm, empathic, and confident body language, facial expressions, especially if you have a child with significant processing difficulties, putting a lot of language or verbal in there isn’t going to be helpful. But if you do, just keep it simple, acknowledge and empathize.

Now, the next thing is what we’re going to do about this actual physical behavior that’s going on. So a couple directions to go with this, depending on what’s happening. If the child’s just throwing herself down on the floor, crying, maybe kicking, just kind of having a classic tantrum right there on the floor, it’s fine to leave her where she is. As long as it’s not disrupting anybody, she’s not harming anything, leave her where she is, and stay by her with your calm, quiet presence. Don’t do a lot of talking, just quietly and calmly stay there with her. At some point, maybe she’ll crawl into your lap, maybe she won’t. Whatever might happen, you’re staying near her as a support, you’re not leaving her alone to handle it. You’re not saying “Get out of here, go somewhere by yourself until you can settle down.” That is not what we want to be doing here. That doesn’t help kids’ nervous systems co-regulate with ours, which is what needs to happen for them to calm down. So we want to stay there, calm, quiet presence. If it is disrupting other things in the area, then it’s appropriate to bring the child to another room, a quiet, not overstimulating space where we can stay with her until she comes down from this. Now, the other path is if she’s doing something unsafe or potentially unsafe or harmful to herself, to another person, to property, that could be you hitting and kicking people, it could be trying to run away to a space where she could get hurt, it could be throwing toys at something that could break or harm someone, any of those kinds of things, then we need to calmly but firmly create physical boundaries there. If the child is small enough — in this case, this is a three, almost four year old, if the child is small enough, you can physically contain her with your body, pull her firmly on your lap, hold her arms firmly and say, “I’m going to help you. I won’t let you hurt somebody”. Sometimes it’s important to bring the child to another space where there aren’t maybe things that they can be throwing or creating problems with, or where there isn’t another person that they can harm. So you have to look at this point, how do you contain the situation so that physical harm isn’t a possibility? If it’s an older or bigger child, and you’re not able to physically move the child to another space, then you need to look at perhaps standing away from where they can kick or hit you but firmly holding on to their hand, so you have this physical connection so they can’t run away, they can’t be grabbing things and harming themselves or properties. You’re creating a physical boundary that way. You may need to leave them in that space and quickly remove things that could be dangerous or damaging out of the area. So you’re looking here at what do you need to do to create safety here? To remove things that could be potential dangers, to not allow the child to hurt themselves or you? Physical container, physical boundaries. And the message here is “Your feelings are welcome. You are allowed to have whatever feelings you have, but your behavior is not welcome. Your feelings are welcome. Your behavior is not.” And so that can sound like “It’s okay to be upset, I won’t let you hurt yourself”, or “I understand you’re mad, that’s okay, I won’t let you break the window.” So that’s the message we’re sending here.

Now, some of you may have a child where it’s better to actually give them some space alone. This is definitely the case for some kids who get really overwhelmed by other people or things in the environment. You know your kid best, you can experiment with both. But some kids truly do better if we stay in the area, or maybe have them in a room, but we stay outside the door and check on them periodically, “I’ll be right outside.” So you’re not leaving them. It’s not like “You stay here, I’m not going to be anywhere near you.” It’s no, “I’m here, but I’m recognizing that your sensory system, your brain, you need some separation right now in order to get yourself together, so I’m going to stand on the other side of the door,” or “I’m going to stand a little further away in the room”, and that can be important for some kids. So that’s a tip for those of you with kids who really need that space. And throughout this, you’re focused on staying calm, and in control of yourself in the situation. Here are the kinds of thoughts that you want to hold on to, and you can write these down, put them on an index card, memorize them, whatever you want to do, but here are some thoughts that are helpful while you are with your child waiting for them to settle and their nervous system to re-regulate. You think to yourself: “These things are normal, they’re to be expected. She’s having a hard time, this will pass. She’s learning how to manage her feelings, she’s not good at that yet. I’m capable of helping her through. There’s nothing I have to fix in this moment. My calm, confident presence is enough.” These are the things you want to ground yourself in. This helps prevent that future time travel in your mind that gets us all wrapped up in our own emotions and our own anxieties, and doesn’t allow us to stay in the situation as a calm, confident, regulating presence for our child. Now, when the child finally does calm down — and actually, let me say one more thing about that in the moment, because this mom mentioned that the child can sometimes go on and on with the screaming and the dysregulation for an hour or two hours. If that’s happening, you want to stay with the child or near the child through the real initial escalation of that, but you do not need to stay right there and engage with it for an hour or two hours. Kids can sometimes go in and out of some sort of escalations with that. They may still sort of be hanging on and still kind of throwing a little bit of a fit or still screaming, but once you’re through that initial surge, it’s okay then to leave them in that space by themselves and say, “Oh, I’m going to go do this, I’ll be back.” You don’t need to spend two hours standing outside the door or right there in the room with them once they’ve gone through that initial surge of dysregulation. The exception is if they’re going on and on like that, and potentially going to harm themselves, then you do need to stay with them and create that physical container and safety for them.

So once they are calm, their nervous system is regulated, you want to move on to whatever is next. The mistake that many parents and adults make at this point in the process is they cycle right into trying to discuss what happened teaching a lesson, talking about it, giving some kind of consequence or punishment. That’s not going to be effective. Their nervous system at that point is still really vulnerable and sensitive after just coming through that. So you don’t want to dwell on it, you want to just calmly and confidently move on to what’s next. That could look like going back to the thing that you were trying to have done before the tantrum occurred. So it might sound like, “You were really upset about cleaning up, I get it. Tell you what? I’m going to help you put the puzzles on the shelf”, and then away you go. You just guide them right back to the puzzles, and you maybe hand them a box to put on the shelf, and then you move along. Done and done. Or it can be a smart strategy here for many kids to use what I call a buffer activity. So they’ve just come down from this intense dysregulated tantrum, and before we put any task demands on them, or go back to the thing that created the problem in the first place, we use a buffer like, “Let’s have a snack,” or “Let’s go play outside for a little bit.” We’re looking at some way to help them positively re-engage with us, with life.

Maybe a snack is needed, maybe their blood sugar is in the tank, and we really need to help regulate their blood sugar with a good snack. Or maybe the fresh air. Maybe they just need some regulating sensory input and movement by riding their bike or going for a walk, or whatever it might be. So those buffer activities can be really, really helpful there. And then, after that, then we can go back to cleaning up the games or whatever it was that needed to happen. So those are your in the moment tools.

Now, in the longer term, what are our strategies here that we need to be thinking about? My first suggestion is, with a child like this, make sure that you’ve got some non-demanding play and quality time together daily. Now, you may hear that and go, “No, definitely I already have that worked in the day. We have plenty of time together enjoying things and doing things”. Great, but if you look at it, and you’re like, “You know, actually I’ve been more busy lately, or schedules have changed, we haven’t had as much time together,” then that’s something to think about, to try to make sure that you’re having some quality engagement, some non-demanding, enjoyable time together, even for 10 minutes during the day to kind of fill that child’s cup up a little bit to let them know that they’re seeing, they’re valued, you want to be with them. The second thing is to make sure that your child’s behavior isn’t taking up too much space in your life. What do I mean by that? Well, lots of families when they come into my clinic, if their child is exhibiting really significant behaviors, major tantrums, intense behaviors, that can sort of take over the parents life or lives. It takes up space in their mind, constantly thinking about it, ruminating about it, trying to problem-solve it in their own heads. It can take over relationships. If you and your partner constantly, like every conversation you have is about your child and their behavior, what you’re going to do. It can take over your conversations with friends, with family members, your texts with your friends. It can take over your social media and internet use, where you just find yourself almost obsessively consuming content around kids’ behavior and all of that. So these things can kind of worm their way into our lives and takeover in a way that’s not helpful, because we don’t want to give these behaviors that much power and control. We just don’t. It’s not helpful to us, and it’s not helpful to them. So to kind of do a check for yourself of, “Okay, this is going on, this is a problem, this is something that I need to address,” but making sure that it’s not taking over your life, your brain, your relationships.

Another longer-term strategy is when your child is calm, so not in the heat of the moment with any of this, make sure that you’re doing some previewing and some talking about what life is going to be like when the baby comes, what your daughter can expect. Keep it casual as real-life situations come up. So let’s say you’re sitting down at dinner, you’ve got a family dinner routine, you’re sitting down together, and you might say something like, “You know? Once the baby comes, we’re still going to sit down and have dinner together at this table every night. Yeah, the baby will probably sleep on my lap, or maybe he’ll sleep in the swing, but we’re still going to have dinner together.” Or maybe you have a routine of reading with your child before bed. So you’re doing that one night, and you could say something like, “You know? We’re still going to read together before bed each night, even when the baby is here.” So those are just some examples. But what you want to do is start previewing what life is going to be like, to help soothe and ease her mind and her questions around what’s going to change and what that’s going to mean for her. So maybe involving her in some decisions about where things are going to be kept, or talking with her about “Oh, look, I’m washing all the baby clothes. Let’s think about where we’re going to keep these. You know? I’m still going to wash your clothes and put them away in your drawers even when the baby’s here.” So you’re doing that previewing to ease some of the questions and concerns that may be going through your child’s mind, and that’s going to reduce anxiety and distress. And this goes for whatever the family change might be. In this case, it’s a new baby, but you can use this strategy for whatever changes or transitions might be coming up. Another thing here to think about is on a regular basis, make sure that your child’s having time to engage in play, in drawing, in pretend play and these kinds of things around the baby coming, you being pregnant, what she’s thinking and feeling, even around some of the behavioral stuff. Play and these creative outlets are how kids communicate and process these things. So making sure that there’s ample time for those kinds of activities and that she’s able to work through some of these things in that play kind of way.

I would also say that there absolutely is a time and a place for seeking out some professional support around these challenges, whether that’s from a child development specialist, a parenting coach, a mental health professional who specializes in these kinds of issues for kids and families, if you need to do that. It doesn’t need to be a diagnosis or any level of particular severity for you to reach out and say, “I just want to find out if this is normal. Is there something wrong? I could use some support.” So that may be helpful just to ease your mind as a parent, and to know that you have a resource and support person to help you navigate this. That could be a great strategy to use.

The last thing in terms of longer-term issues or things to look at is identifying any of those underlying more physiological issues that I mentioned at the start of this episode. So is your child having blood sugar dysregulation? Are you noticing a pattern where a little while after she eats, sort of blood sugar spikes, and then crashes and irritability? What are her eating habits like? Is there consistent eating, or has that changed, and maybe she’s not eating as much, or she’s eating a lot more sugar? So anything that’s changed around dietary patterns. The potential that there’s a food maybe that she’s sensitive or allergic to that’s exacerbating this behavior? I commonly see that with milk and dairy for kids, but it can be any type of food. You want to think about that. Is my child craving a certain type of food all the time, or eating a lot of something? That could be an indicator that food might be triggering some things. You want to look at sleep. Is she getting enough good quality sleep? Have her sleep habits changed? Is it possible that disrupted sleep or just not getting enough sleep is playing a role? Was she napping and now she’s dropped her naps? And now there are more of these behaviors happening? So you want to think about sleep. Is she getting enough movement and play time? Has there been more screen time recently? Is screen time creating irritability or issues? So these are the kinds of things you want to be really just looking at. Are you seeing patterns? Are some of these things potentially driving the sudden increase in the intensity and the frequency of the behavior? The other thing is if this behavior truly was very, very sudden, like overnight, like within a 24 to 48 hour period, your child’s personality and behavior completely changed, then we need to really look at infections. Has this child been exposed to STREP, or does she have a STREP infection, or did she recently get over one? It could be the same for Epstein-Barr, it could be COVID. It could be any number of things, any kind of infection. If the child’s been ill recently, that’s a connection to make. Maybe the sudden extreme change in behavior is related to that. Sometimes kids don’t get the symptoms of an illness themselves, but they’ve been exposed to it. Someone else in the family has had it, or at school or at daycare. So you want to be connecting any of those dots if there’s been a recent infection, health status change, change in any kind of medication, anything like that definitely can be a clue as to what might be driving the very sudden extreme change in personality and behavior.

So those are the longer-term things to think about. I hope that these ways of thinking about this and these specific strategies are helpful for Nicole and all the rest of you dealing with kids who become very dysregulated, and even physically aggressive, if you are totally focused on them, and if there are challenges and things happening, and they’re getting really dysregulated.

Remember, if you have a question you’d like answered on a future show, feel free to email it to support@drbeurkens.com, and we will see about answering that In a future episode. Thank you as always for listening, for being here, for being a part of this community, and I will catch you back here next time.