Nolan Alexander (Host): Welcome to the Live Greater podcast series: Information for a Healthier You from the University of Maryland Medical System. This is an episode in a series of podcasts answering frequently asked questions about what's normal in childhood development and when parents may need to seek a specialist. I am Nolan Alexander, and with me today is Dr.

Debbie Badawi from the University of Maryland Medical System. We're discussing a parent's guide to what is normal, emotions and big reactions. Dr. Badawi thank you so much for joining us today and talking more about emotions and something that I see in my toddler—big reactions.

Deborah G. Badawi, MD: Thank you for having this is a very important topic and something that, we see often.

Host: I can't wait to dive into it. I feel like I deal with this every single morning at home, so hopefully I can walk away as a better father here. and a lot of kids, they have big feelings, they have big reactions to things, and I never know when it's going to surface. So what tends to be normal and what tends to stand out?

Deborah G. Badawi, MD: children in their toddler years often start to have tantrums, that are big reactions. And that's a normal developmental progression where children are starting to understand that they have some autonomy in their lives they're letting you know what they want and what they don't want, and they're kind of testing those limits.

So having some tantrums and some big reactions is typical. we become concerned if that lasts much beyond toddler and preschool years, and also depending on how much it's impacting their daily life and the daily life of your families.

Host: What would be something that you would say is kind of the barometer there of impacts the true daily life, not just something that's, a learning process for parents and for toddlers too, but it's truly like impactful to our day to day.

Deborah G. Badawi, MD: that's a very good question. So it's really the frequency and the intensity of those tantrums. So again, we expect tantrums to, subside over time. But, you know, a young toddler in their 2s or so can have two or three tantrums a day, and that would be very typical. we also look at the intensity.

Are they crying, stomping their feet, maybe falling down? We sometimes see that. or are they, having more extreme reactions, hurting themselves, hitting other people, breaking things? Those would be considered more intensive tantrums and things that we might have to intervene for.

Host: So what else goes into telling the difference between a typical tantrum, against a child who at the time is maybe emotionally overwhelmed?

Deborah G. Badawi, MD: So that's also a very good question and a challenging one to answer sometimes. one of the biggest indicators is how a child does between those tantrums. a typical child development would result in a child having tantrums, resolving that tantrum fairly quickly, you know, under five or 10 minutes, and then being able to move on.

We're more concerned about a child being emotionally overwhelmed if they're having longer tantrums, longer than 10 or 15 minutes, and again, if they're very, very intense that, you know, are including injury to themselves or someone else destroying things.

Host: Have you seen an impact on child's emotions from poor sleep, being sick, or maybe just a change in routine?

Deborah G. Badawi, MD: Yes, absolutely. So again, just like adults, when children aren't feeling well, they have fewer, resources to put towards managing their emotions, right? So when we're feeling stressed or upset, it takes a lot of, cognitive and emotional energy to manage how we respond to that. So if children aren't getting enough sleep, if they're, stressed by, some kind of changes at home or a change in their routine, that may come out in more frequent, and more intense tantrums.

Host: I'm curious, what does brain development have to do with a child's ability to calm down or try to regulate their feelings?

Deborah G. Badawi, MD: So brain development has a lot to do with emotional regulation. one aspect is being able to communicate feelings, right? So as children get older, one of the reasons their tantrums become fewer and, intense is because they can communicate their feelings more accurately. so language development and cognitive development has a lot to do with it.

The other piece that has to do with it is how stressful a child's life is in general, and there's Some really good science in the last decade showing that children who experience, what we call toxic stress or significant day-to-day stress tend to have, lower threshold for getting very upset. So there's a lot that brain development has to do with how we manage our emotions.

Host: What's an example of that stress as far as day-to-day stress day-to-day stress might be things like, housing insecurity, food insecurity, maybe living with a parent or a caregiver who's undergoing a lot of stress themselves, having a lot of either physical or mental health challenges, because that can also lead to a lot of changes in a child's routine.

Deborah G. Badawi, MD: So those kinds of daily stressors, can impact a child's ability to regulate their emotions.

Host: you brought up a couple of good barometers here about tantrums and the frequency in just, you know, five to 10 minutes and then recovering. And then as children start to develop an age, you talked about brain development less frequent as far as the tantrums. But when do emotional reactions start to seem less like a, phase of development in life and more like something worth checking out?

And when should parents talk to a pediatrician, therapist, or potentially a school counselor?

Deborah G. Badawi, MD: There, are some good barometers, I would say, for when to start seeking help. And I think one of the, biggest measures would be how that child is doing in between the tantrums. So is this a child who has a tantrum at a time when you would expect? You know, like you're leaving a birthday party, or you said no to an ice cream cone, right?

is this a child who's having tantrums with any, mild frustration during the day, and are they able to recover? Do they have that tantrum, and then they go back to playing and, seeming like they're comfortable and happy? Or are they having tantrums and always seem to be simmering? Or, does the family or the, teacher always feel like they're walking on eggshells because the child may have a tantrum at any moment?

I

Host: How have you seen anxiety, sensory overload, or ADHD sometimes show up as big reactions?

Deborah G. Badawi, MD: for anxiety and sensory overload, those tend to lower a child's threshold for what they consider frustrating or intolerable, And again, those are children that typically will not come back to, their typical happy selves in between, right? They're children that are always going to be showing showing some signs of being upset or uncomfortable or just not happy.

Children with ADHD can have is, I think, best described as emotional impulsivity. So typically, they tend to have maybe quicker and more intense reactions to frustration. But then again, they usually come right back to baseline or back to their, typical selves in between those episodes.

Host: Dr. Debbie Badawi from the University of Maryland Medical System joining us today. Debbie, what have you seen as far as signs that parents can look out for that might suggest a child is struggling emotionally, even if sometimes it looks like it's just bad behavior?

Deborah G. Badawi, MD: I think there are a, couple of signs that children may have some challenges going on beyond typical emotional development. One is not a disorder at all actually, but children who have what has been termed a challenging temperament. So just children who tend to respond more intensely to emotions in general, children who have more of a need for, routines are a little bit more rigid.

So those children may not have a, disorder, but they may require some support in terms of learning how to manage those intense emotions and learning how to be more flexible when it comes to dealing with daily frustrations. I think the biggest indicator, that a child may need more support in general is again, what their mood is like typically.

are they able to go about their day? are they able to make friends? You know, that's a big challenge for children. Are they getting along with other children? Are they able to make progress in school, or are their emotions impacting all of those other areas of their life as well?

Host: How can we as a parent help in those situations to help our children regulate those emotions, manage them as you talked about, and also just help them communicate what emotions they're feeling? How can we as parents help in that manner?

Deborah G. Badawi, MD: Probably the best thing we can do, and the very hardest thing to do, is for us as parents to try and remain calm in that situation. oftentimes, as parents, we feel like we need to lecture our child or talk to them about why their behavior is inappropriate in that moment. And really the best thing we can do when they're upset is to try and remain calm, keep them safe if they're, hurting themselves or, keep other people safe, and just provide them a safe space to calm down and pull themselves together.

Modeling for them ways to label their emotions and ways to navigate problems is very helpful. So, again, maybe even talking to your child about how you really wished that you could go out with your friends tonight, but you can't because it's raining . You know, giving them an example of how you deal with disappointment in a positive way.

So I think being a good example, and giving them labels for their emotions are probably the best ways that we can help them learn to regulate their emotions.

Host: Debbie, I'm going to ask this question on behalf of myself. You know, if I find myself in a situation where I don't respond calmly in the moment, how can I try to get on the right path as a parent to remember what you said and even think about that in the next time?

Deborah G. Badawi, MD: Absolutely. And we are all human, so we are not going to be calm every time our child is having difficulties regulating their emotions. So I think going back after the fact and letting your child know that, Mommy or Daddy got really upset, and I wish I hadn't done that. but I was very frustrated, and I was tired, and I know you feel that way sometimes too."

So again, it's kind of modeling for a child what they can do and how they can think about those times when they're frustrated. a matter of never losing your cool, but trying, you know, always striving to stay calm more times than you don't, right?

Host: Well, I really do appreciate that, and I'll certainly keep that in mind as we wrap up here. Anything else that you think is important for our listeners to take away from today's episode?

Deborah G. Badawi, MD: So I think the biggest thing I would take away is that, as parents, we know our children best. So if you as a parent are concerned about your child, I recommend talking to your pediatrician or seeking out help from a therapist or a school counselor. your instincts are probably correct. And again, it doesn't hurt if, you know, you seek out help and you're told everything is fine.

at least you've put your mind at ease.

Host: Dr. Badawi thank you so much for joining us today and helping us out as parents.

Deborah G. Badawi, MD: Thank you very much. It's been a pleasure.

Host: Listen to more at umms.org/podcast YouTube, or your favorite podcast platform. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. And don't forget to check out the other topics on A Parent's Guide to What is Normal. We look forward to you joining us again, and please share this on your social media