April 30, 2018
ARTICLE:

Toddler Tantrums

By Dr Megan Yap - Paediatrician

Okay, I admit it.  This week’s post was borne completely out of selfishness.  Our 2-and-a-half year old son has been a complete horror-head of late, his “normal Terrible 2’s” tantrums escalating in the last few weeks into some kind of crazy exhibition of madness that any freak show would be proud of.  He has quite literally been driving Troy and I nuts.  I have lost count of the number of times we have looked in each other in utter disbelief at the sheer magnitude of the kid’s outbursts, usually over him lying in a puddle of sweat, tears and vomit.

I have been asked multiple times before to blog about toddler tantrums and it has been on my list of “to-do” topics for ages.  This week though, in desperation, I justified its inclusion into the “Paeds & Feeds Hall of Fame” in the hope that through my “research” into the topic, I might accidentally stumble upon some pieces of previously unknown “gold nugget” advice for myself that I could promptly institute in our house to control our little monster.

Here are some examples of triggers for Mr 2’s tantrums in the last 24 hours:

  1. He didn’t want a bath
  2. He later didn’t want to get out of the bath
  3. He wanted to eat a whole (massive) Easter egg, and I just gave him one piece
  4. I told him not to hit his sister
  5. I later put him in time-out for hitting his sister
  6. He wanted Havarti cheese (not normal cheddar cheese, specifically Havarti cheese – and apparently not in a slice, in a chunk *eye roll* *face palm*)
  7. I cut his sandwich into quarters
  8. He wanted to take his truck book to bed with him (along with his 7 gazillion other toys he “must” have at bedtime)
  9. He didn’t want to sit at the table for dinner
  10. I flushed the toilet (he wanted to flush it)

Alas, I have not managed to find any new “gold nuggets,” asides from the ones I already knew about.  Blogging has served as a good refresher course however, reminding me of a few little tidbits I had more recently forgotten about.  Here’s what I’ve got – I hope you find something here that works for you…

 

Why do kids have tantrums?

Tantrums are (unfortunately) a normal part of child development.  They can occur when children are hungry, tired, uncomfortable or when they are told they can’t do/have something they want.

They are most common between 2 and 4 years of age (peaking at age 2) when children are still developing their language abilities but starting to assert a sense of independence.  They can also occur in older children who have not yet learned more mature ways of dealing with their emotions.

Tantrums can appear as whining, crying, kicking, running away, screaming, biting, hitting and/or falling down.  They can be almighty explosions of rage and if you’re “lucky” your child might even vomit, break things or breath hold until they pass out (yep… some kids really do this.  My youngest is a protest puker from wa-ay back… and still is at 2 and a half *face palm*).

 

Avoiding tantrums

As a parent of 2 VERY determined and stubborn little kids (aged 2 and 5) I can, hand-on-heart, tell you that the best way to deal with tantrums is to AVOID THEM.  It is not always easy (actually in truth, it is almost NEVER easy) but being consistent, clear and predictable around rules and routines is the most reliable way to do this.  It also helps to be realistic around your expectations of behaviour for your child given their age.

ANTICIPATE THE TRIGGERS AND PLAN AHEAD

  • Make sure they aren’t hungry – pack snacks, keep regular meal times
  • Don’t push your luck – if you know your child is tired/coming up to nap time, don’t try to squeeze in more jobs!
  • If you know your child gets overwhelmed in busy environments (eg a supermarket), then (a) don’t spend too long in there (b) don’t take them – do your shopping online!

MAKE SURE YOUR CHILD IS GETTING ENOUGH SLEEP

I know how cranky and irritable I get when I haven’t had enough sleep, i.e. SOOOOPER cranky.  Kids are no different, in fact probably worse, because they lack self-regulation abilities to keep their emotions in check.  They will often initially start to escalate and become hyperactive, which can progress to being oppositional, defiant and unreasonable… before they throw a doozy tantrum.  Make sure your child is getting enough sleep.  Check out my past blog about normal sleep in children – http://www.kids-health.guru/children-and-normal-sleep-patterns/

KEEP OFF LIMITS ITEMS OUT OF SIGHT AND REACH

If you don’t want a screaming match with your toddler about not allowing them on your smart phone or iPad, then put it where they can’t see it!! I have heaps of parents tell me that it is a massive fight to get their child OFF an electronic device.  My advice to them is simple (a) don’t give it to them in the first place (b) if they can’t see it or don’t know where it is, they can’t (and won’t) demand it.

Similarly, if you want your children to make healthy choices with respect to snacks and food, then only provide them with healthy choices.  Either don’t buy junk food at all, or put it where they can’t find it or see it.

PICK YOUR BATTLES

Face it, if you really think about it, sometimes your kid’s requests aren’t THAT bad.  If the request isn’t totes cray cray (ie totally crazy), then accommodating it might be better than starting WWIII.

GIVE THEM A CHOICE BETWEEN 2 OPTIONS

Asking your child, “Do you want cereal for breakfast?” Only to have them answer “NO!” – leaves you in a difficult position with a bowl of soggy cereal you don’t know what to do with.  Rookie error!  Often tantrums can be about a toddler wanting independence and control over their environment, even if they don’t yet possess the ability to handle it.  Giving them a limited choice (for example “Would you like to have toast OR cereal for breakfast?”) gives the child some control over the situation which is often enough to keep them happy.

GIVE THEM AMPLE WARNING

Transitioning a toddler out of an activity is about as easy as… cleaning vomit out of a car seat (and I have done that several times).  Even if it was just as hard to transition them INTO the activity in the first place!  I allow the 2-year-old 10 minutes of iPad time when he is sitting on the potty (it’s the only way I can get him to sit still long enough to do anything).  But getting the iPad back OFF him and getting him off the potty in the past was soooo difficult – resulting in screaming, tantrums and inevitably for him, a vomit.  I started giving him warnings, at 5 min, 2 min, 1 min… and then stumbled on the trick of setting a kitchen timer to go off when time is up. Gold.  Needless to say, it is (usually) no longer an issue.

BE AWARE AND TUNE INTO YOUR CHILD’S SIGNS

If you sense things are escalating, then intervene before the situation becomes irretrievable eg distract the child or remove them from the situation/remove the trigger.

 

What to do once the tantrum is in FULL SWING

There are HEAPS of different approaches to handling a tantrum, depending on who is giving you advice and what their approach is.  My thought on the differences in approach are:

  • Sometimes the approach needs to be tailored to the disposition of the child
    • Not all approaches suit all personalities
  • Your strategy should differ depending on why your child is upset
    • Sometimes you might need to comfort your child – eg if they have hurt themselves
    • Sometimes you might need to ignore you child – eg if the tantrum is because your toddler has been refused something
    • Sometimes you might need to institute or hold firm with a consequence – eg if the tantrum is about not being allowed to do something dangerous.

IGNORE & DISTRACT

Some sources suggest that ignoring is the best strategy for extinguishing undesirable behaviours in under 2’s.  Others say ignoring tantrums doesn’t help and instead makes a child feel frightened because the child doesn’t know what to do without your help. This is why I suggest pairing “ignore” with “distract.”  Ignoring shows the child that their undesirable behaviour does not achieve the reaction they want (so there is no point in doing it).  Distraction takes advantage of a toddler’s short attention span by offering something else instead of what they aren’t allowed to have. It might be an alternative snack (eg a strawberry in place of a chocolate), or even taking them outside to look at something different.

WAIT IT OUT

Stay where your child can see you so they know you have not left them but do not try to reason with them.  Once the tantrum is in full swing, reasoning will be about as useful as a chocolate teapot.

TIME OUT

“Time-out” is one of the first behavioural modification strategies I ever learnt about as a trainee paediatrician.  The terms and conditions of the time-out have to be negotiated and made absolutely clear to the child at a time when they are calm and level (that is, BEFORE a tantrum occurs and BEFORE you try to enforce it).

It can be used in a number of ways. One way is as a tool to teach children about unacceptable behaviour (eg if they have hurt someone) by using it as a consequence – revoking the privilege of being around people and interesting things for a short period of time, by removing them for a set time period to a previously arranged “time out area” which is both safe and boring.  It also provides the child with a chance to think about how they might behave better next time.

In younger children, I prefer not to use “time out” as a punishment or reprimand.  Rather I use it to give the child a break from a situation that has overwhelmed them into bad behaviour and provide them with an opportunity to calm down.  I do this by not setting a specific time limit but telling the child to remain in the time-out area until they have calmed down. This places the control back in the child’s hands – they themselves can affect the outcome, by choosing their own actions (and regaining the control lost during their tantrum).

TIME IN

Sometimes when a child is really out of control, they need you to stay with them to help them deal with their feelings. I use this with my daughter when I know she is past the point of being able to calm herself down independently (thankfully she is now 5 and we don’t really get to this point anymore), but other children may need this method more often or even all the time initially. This process involves the parent staying calm and taking charge until the child has regained control. Sometimes it involves you holding them (and if they won’t let you do that, staying close) and using kind words to reassure them that the feeling will pass and that you understand how they feel.

TAKE CHARGE IF YOU NEED TO

If your child has a tantrum because they aren’t allowed something that they want – do not give in.  The perfect example of this is when my 2-year-old refuses to get out of the bath (ie pretty much every day).  Instead of pulling him kicking and screaming out of the water (usually resulting in a protest vomit, necessitating putting him BACK in the bath, which is exactly what he wants thus reinforces the bad behaviour), I pull the plug and let the water drain out.  Usually it isn’t long before the option of getting out is better than sitting in an empty bathtub getting cold.

REMOVE THEM TO A SAFE PLACE

If the child is in danger of hurting themselves or others, they should be removed to a quiet, safe place to settle down.

 

Some approaches are gentler, others a little more firm, but there a few common themes that run through all of these strategies:

  • Remain calm (I know this is easier said than done… sometimes you might need to remove yourself to a “parent time-out” until you are able to be calm)
  • Smacking doesn’t help
  • Be consistent (both yourself between events, as well as maintaining consistency between different parents caring for the same child)
  • Don’t give in. This will only show your child that the bigger and the longer they tantrum, the more likely it will be that they will get what they want (resulting in bigger, and longer tantrums)

Once the storm has passed…

  • Praise your child for calming down
  • Give them a hug and reassure them that you love them no matter what
  • Promptly redirect them to another activity

 

When should you seek the advice of your doctor or paediatrician:

If your child has tantrums

  • That persist past pre-school age
  • That more often last longer than 15-20 minutes in duration
  • That frequently results in injury to themselves or other people
  • Associated with a mood that is persistently low between tantrums (as opposed to returning to normal)
  • That seem to occur unprovoked

 

Tantrums are NOT fun.  They are really stressful, frustrating, exhausting, exasperating and at times, downright embarrassing for parents to deal with.  You are not alone.  I know this because of the number of parents who have messaged me, or asked me in clinic to “please blog about toddler tantrums.”

It does get better (well, at least it did with our daughter and I keep telling myself this lately), but in the meantime I hope this post has given you some strategies to try at home to TAME THOSE TANTRUMS!!

Until next time – stay sane!  (I will be trying to!)

 

xxDr Megs

For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/

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