The Checkup: Managing the Storm of a Toddler’s Tantrum
http://ift.tt/2hmQg2d So what should parents do, faced with a tantrum? “I don’t think any child having a tantrum can respond to what I hear all the time: ‘Use your words,’” Dr. Egger said. Instead, the parent should try to be a “container,” she said, to keep the child safe, and then talk about it afterward. “You have to see it like a storm,” she said. “Manage the storm, then find out what was happening beforehand.” “Things are unglued,” Dr. Egger said. “What do children need to become reglued? They need that feeling that there’s a competent grown-up who is there to contain them.” The last thing you want, she said, is for a child to have the feeling of pushing against a wall, only to see that wall fall down. Dr. Potegal suggested that parents think about what function a tantrum is serving for a child: Is it attention getting, with negative attention better than no attention? Is there something tangible at stake, like food or a toy? Or is there something the child wants to escape doing? Tantrums typically happen when children are hungry or tired or when there has been some significant change in their routine, Dr. Egger said. The children with more problematic tantrums, she said, are the ones who are triggered by anger and frustration, or by transitions — they aren’t particularly tired, they’re just furious that it’s bedtime or bath time. And sometimes there’s no clear trigger, which can be a sign that all is not well. “Parents describe the tantrums just coming out of the blue,” Dr. Egger said, “‘Do you want to wear your blue shoes or your red shoes?’ and you’re done.” It’s less common and more concerning for children to have tantrums regularly with babysitters or teachers, and in fact, Dr. Egger said, “kids who have tantrums outside of the home at school and day care, at church, outside, that’s another flag.” Children with increased frequency of tantrums — almost every day, or even more often — and who bite, kick, hit or break things during the tantrums are the children to worry about, Dr. Egger said. Such children are eight times more likely to meet criteria for “impairing mental health disorders,” such as anxiety disorders, attention deficit hyperactivity disorder and depression, and also more likely to develop problems later on. “And when we follow these children into early and middle childhood, these aggressive early childhood tantrums may be associated with emotional disorders like anxiety and depression,” she said. “Most children who have tantrums that are really severe in duration and intensity aren’t just normally angry, they have something else wrong with them,” said Dr. Gabrielle Carlson, professor of psychiatry and pediatrics at Stony Brook University School of Medicine. “They may have A.D.H.D. or depression or another psychiatric disorder.” For a long time, she said, tantrums were understood as aggression, but more recently, psychiatrists have begun to think of these children with “a very short fuse and a very large explosion” as being highly irritable, rather than aggressive. A child’s irritability may be a clue to some medical problem causing pain or distress; it’s a rare explanation for tantrums, but there are certainly children whose tantrums decrease or stop when they get treated for reflux, or some other cause of underlying discomfort, or for something that is impairing their ability to communicate and leaving them frustrated. And children with developmental disabilities and autism also often have tantrums, so it’s important to assess the child’s general development. “My son, who has grown up to be quite a nice lad, used to have really, really bad temper tantrums,” Dr. Carlson said. “He would scream and yell and throw his shoes. It would last about 45 minutes.” She would put him in his room, “and then he would come out, he would tell me he was mad and sad.” She worried about it, she said, and she thought it was abnormal. “He turned out to have A.D.H.D., it wasn’t just a normal kid being a little bit delayed outgrowing the terrible 2s,” she said. “He had a developmental condition, and the oppositionality and poor anger management were among the signs.” So if tantrums are frequent or aggressive (hitting, kicking, biting, breaking things), parents should by all means get help, rather than blaming themselves. If you find yourself changing family routines or avoiding triggers out of terror that you’ll provoke a tantrum, that’s another sign that you should seek help. And finally, if an experienced day care provider or preschool teacher says these tantrums are something out of the ordinary, take that seriously, though a healthy typical child can certainly have an occasional nuclear meltdown, and many of us have terrible memories of one public agony or another. But if it’s happening regularly, talk to your pediatrician, think about possible medical problems, and get a referral to someone experienced in early childhood who can evaluate the child for mental health issues — a child psychiatrist or psychologist or developmental specialist. To say that extreme tantrums may be a sign of something else is only to say that that child — and those parents — may need some extra help, and the sooner the better. Continue reading the main storyHealth via NYT > Health http://ift.tt/2koaaw3 October 30, 2017 at 05:36AM
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