Maggie McKay (Host): Welcome to the Parent-ish Podcast, where experts at Children's Mercy, Kansas City talk about the little everyday things parents experience with their babies, teens, and in-betweens. Today we'll find out more about tantrums, how to recognize them. Why they can be normal and when they aren't and much more with Lindsay Groh, Psychology Resident.

I'm your host, Maggie McKay. Welcome Lindsay.

Lindsay Groh, M.S.: Thank you. Thanks for having me.

Host: Absolutely. So tantrums are just a part of life when you're a parent. That's just the way it goes. So, the more we know about them, probably the better for our patience level. What are the common triggers for tantrums in children and why do they happen?

Lindsay Groh, M.S.: Yeah, I'd like to think about tantrums as behaviors, right? We know that there are a lot of things that make up a tantrum. It might be screaming or kicking or hitting, throwing our bodies on the ground. But really, tantrums are behaviors and behaviors occur for about four reasons, we know in psychology. One, escape from a task.

So you might notice children are more likely to tantrum when you give them a command or a chore. When they're asked to do something they don't want to do, or they have to leave something they really like doing. The other function is access to tangibles, which means they really, really want something and they're not getting it.

The classic example is a kid in the store who wants a candy bar and their mom tells them no. Other times might be just not getting their way. The third function is attention, and whether we mean it to be good attention or bad attention as adults, all attention is good to kids and it's a big reward and motivator for them.

And then the last one, we consider automatic. So sometimes kids get dysregulated for sensory reasons, and we consider those behaviors that they then display to be automatically feeling good to them or automatically regulating. So those are kind of our four main triggers.

Host: And how do tantrums fit into a child's developmental stages? Are they a normal part of growing up?

Lindsay Groh, M.S.: Yeah, I think that a lot of times it depends really on your child's age. So we know what's typical is for children from as little as one to as old as five, to experience tantrums. And we know actually from studies done that about 83% of preschool aged children have a tantrum at least once a month, and there are nine things that kind of make up a normal tantrum.

You know, one is the usual fallout, meltdown, stamping your feet, holding your breath. Others are that tantrums usually happen with a parent at least half the time. And then they usually happen when kids are frustrated or angry or upset. They happen more when kids are tired, hungry or sick. When kids get something, or don't get something that they want.

And during daily routines like bedtime, mealtime, getting dressed, when they become frustrated easily, and usually tantrums can involve yelling angrily at someone. All those things are really normal, but we know that there's some things that aren't typical. So as kids get older and develop more, we expect tantrums to happen less. So only about 8% of kids three to five have a tantrum every day. So things to look for would be really deliberate or intentional aggression during a tantrum. Tantrums with adults that aren't their parents, staying angry for a long time after a tantrum, or having a tantrum out of the blue or for no reason. Continuing to tantrum to the point of exhaustion or deliberately breaking or destroying things during a tantrum, and then tantrums that last longer than five minutes. All those things we would consider atypical.

Host: So what are some effective strategies for parents so they can manage and respond to tantrums?

Lindsay Groh, M.S.: I like to think about what's happening right before the tantrum and what's happening right after. A lot of times parents feel overwhelmed and say there's just no pattern, but really we know that there are a lot of factors that could contribute. You might notice that your child's always having a tantrum when you start their bedtime routine, or they always seem to have a tantrum when they haven't taken their nap that day.

There are a lot of factors that might play in that we consider the antecedent, the A, then we have the tantrum, which is the B and the C is the consequence. What are we doing right after? I think if a tantrum is occurring and it's not in response to a command or a task, what we really want to be able to do is catch it early.

Tantrums usually have about four stages, so we know that in the first stage there's an early warning kind of period. Usually there's something that tells us our kids are amping up. They're starting to look like they might get over the edge, whether it's they're grumbly, they're ouchie, they're grouchy, they're sulking.

That's going to be a really important time to intervene. The next stage is the actual tantrum or the outburst where they might be restless, moody, they might explode per se, or resist anything you say. The third stage is the leave me alone stage. So maybe they just, they might feel sad. They might feel guilty about the tantrum.

They might not want to interact at all. They might feel upset that they have a tantrum. And then the last is as if nothing ever happened. The last stage is usually when they regulated back to their mood. So the best thing that we can do is catch that early warning stage. And during that time, we want to be able to model calm regulation ourselves as adults, which is usually the hardest part to approach it calmly without a lot of attention or panic. Try to help your child express what they're feeling in words by noticing, oh, it looks like you're feeling frustrated. Oh, it seems like you're feeling upset you couldn't have that candy bar. And then we also want to praise any effort that they have for controlling their emotion or taking a deep breath or pausing even if they haven't fully successfully calmed down from the tantrum.

I want to catch those small moments where we can help redirect them with positive attention. If this tantrum is occurring and it's in response to a command or a task you've given a child, then we really want to make sure that we are having a predictable consistent consequence every time.

So if your kid becomes dysregulated when you say, put your shoes on, wait five to 10 seconds to allow them to process that command. If they completed it, great. If they don't, repeat the command with a predictable consequence. So if you don't put your shoes on, then you have to sit in the timeout chair.

Or if you don't put your shoes on, then we lose five minutes of screen time, whatever yours is for your family. And if they complete it after five to 10 more seconds, great. Give them praise for listening. But if they don't, then follow through with that consequence. I think the most important thing about managing tantrums is that you're consistent in your response.

Host: Let's talk about prevention, Lindsay, preventing tantrums before they start. What proactive steps can parents take in that department?

Lindsay Groh, M.S.: So I mentioned a little bit before that trying to intervene when kids start to have those distress signals as early as possible, is great. But other times when they're already calm, can be really good opportunities to teach emotion regulation skills. So whether that's, teaching them how to take deep breaths or to count to five before they move their body or tensing their muscles on purpose and then loosening them.

Those are all great skills, but we'd want to teach them when they're already calm. Something that they have to kind of practice, like muscle memory. That way they have more skills in that first stage. Other things can be just modeling it as a parent. Model losing a game on purpose and regulating yourself.

Additionally, I think you can choose your battles. If you know that your kiddo is going to tantrum anytime you give a command; let's give choices, set expectations beforehand, catch them being good, and use a reward chart. We just want to make sure that there are enough opportunities for good behaviors to be displayed and that we're setting them up for success.

Host: How do frequent tantrums affect family dynamics? What can parents do to maintain a positive environment? Because it really can affect the whole family.

Lindsay Groh, M.S.: It definitely can. We know that tantrums, especially when they're occurring every day or more, are big increases in parental stress and when we have more stress as parents, we're less able to respond in a calm and consistent way. So it kind of ends up in a negative cycle. Additionally tantrums happening this often can model negative behaviors for other kids in the home.

And I think as far as what parents can do to maintain a positive environment, I always try to encourage parents to give opportunities to catch them being good. So, spending five minutes, one-on-one with your child each day where you're following their lead and engaging in a play activity they like, can build up a ton of good, positive attention.

It's a great time for you to notice that they're sharing with you or using gentle hands or using an inside voice. It's just a great way to set them up for success and give them a heavy dose of positive attention so they're less likely to seek it out in negative ways other times.

Host: That's a great idea. When my son was in first grade, they had a teacher and she had this whole thing about caught being good and she had a chart on the table and she would call it out when a student was good, which I thought was great.

Lindsay Groh, M.S.: We know that kids are more likely to work for reward, when they know exactly what they're supposed to do rather than things that they're trying to not do. So reward charts work great because they know, oh man, if I do these things, I'm going to earn these stars rather than if I just don't have a tantrum today, then I earn a star.

Host: When should parents consider seeking professional help for their children's tantrums? What signs indicate that tantrums might be part of a larger issue?

Lindsay Groh, M.S.: Yeah, I like to tell parents that there's no perfect number, right? It could be that you're having a tantrum every day with your 2-year-old, but it's really manageable. It's lasting very short periods. Or it could be you're having a tantrum with your five-year-old, but it's really explosive every time, or destructive or dangerous.

So I think what matters is impairment. How much is it getting in the way of your child's ability to get what they need to get done, to have good relationships with their family, to have good social relationships in school, or to even participate in school? Because a lot of times when tantrums become impairing, we're getting calls home from teachers or being sent home. So I think one of those things to look for is impairment. Other things that sometimes come up are your child's development, and whether they're reaching their milestones, right? So a lot of times we know that kids are more likely to have tantrums if they're behind in their language because they just can't express their needs to you.

So I would say watch those language milestones and talk to your pediatrician. Other things that sometimes happen are tantrums in response to sensory sensitivities, and that can be a marker for some other neurodevelopmental things happening. So I would say no perfect number. Think about how much it's getting in the way for your family and talk to your pediatrician.

Host: And what are some common myths and misconceptions about tantrums that parents should be aware of?

Lindsay Groh, M.S.: One of my main interventions for parents is if a tantrum has components that are ignorable, then we're going to remove attention from them. And I know that's kind of a controversial thing to say these days because I know there's a big theory out there that if we ignore our children, we're letting them get away with it.

Or if we ignore our children, it could cause trauma in our relationship. We actually know that when we use our attention to catch kids being good and remove it for things we don't want to see, like whining, crying, yelling; we are actually more likely to boost the warmth in our relationship and promote those positive behaviors.

So the first myth I like to tackle with parents is that ignoring is this bad, scary thing. Really, it's reusing your attention as the tool. Another thing that I think comes up a lot with families that I work with is the idea that, you know, I have tried ignoring before or I've tried time out before and it just doesn't work.

Tried everything. And there is nothing to manage my kids' tantrums, which I hear you. They can be very overwhelming. I think in those cases, a lot of times maybe it's that we need an expert to weigh in and we need an additional support to help us structure our day different or come up with a better strategy.

I really, think there's usually someone who might have to come in and look at it from an outsider's view. Right. And the last one that I encounter a lot is, that one-on-one talk therapy or play therapy, treats tantrums. I think emotion regulation skills are great to have. But a lot of times kids at this developmental stage are too young to be able to have meaningful effects from something like talk therapy and really, the best gold standard evidence-based treatment for tantrums is parent management training, which is setting up the environment with parents to be the most successful for the kids rather than talk therapy.

Host: Well, Lindsay, thank you so much for sharing your expertise. This has been so eye-opening and very helpful, especially to parents. I'm sure.

Lindsay Groh, M.S.: Thank you.

Host: Again. That's Lindsay Groh. That concludes this episode of the Parent-ish Podcast. For more parenting tips and tricks, visit us@parentish.org where we help you celebrate the craziness and challenges of parenthood.