Maggie McKay (Host): Welcome to Conversations Like No Other presented by Valley Health System in Paramus, New Jersey. Our podcast goes beyond broad everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. Thanks for listening. Today, Amanda Shaw, Licensed Clinical Social Worker with Valley Pediatric Subspecialties, joins us to discuss pediatric behavioral issues. Thank you so much for being here today.

Amanda Shaw, MSW: Thank you for having me.

Host: Let's just dive right in. What are the first questions you ask to assess a child when meeting parents for the first time?

Amanda Shaw, MSW: Parents reach out for all different reasons. Some examples that I hear often are, my daughter won't listen to me. She's throwing temper tantrums. I don't know what to do, or, my son won't take a bath when I ask. He refuses to get in. I can't do this every night. These are just some of the situations that many parents face on a daily basis.

You are not alone. Parenting is hard. So parents are normally reaching out to me when they feel stuck. They feel like they've lost control, like nothing they're doing seems to be working. So when I'm first assessing a family and a child, and parents, I ask a few questions. I want to know how their behavior's impacting their daily life.

What is the behavior that they're displaying in school? What is the behavior they're displaying at home? Do those match up or are they different? How's your child's health? Are they meeting their milestones on time? All of these types of questions really give me a better picture of the daily struggles that the parent and children are facing.

Host: And what's one thing parents are getting totally wrong about their child's quote unquote, bad behavior.

Amanda Shaw, MSW: Yeah, so a lot of parents are seeing bad behavior and they immediately respond with discipline. My son gets mad when I ask him to clean up the playroom. He refuses to do it. He cries, he screams. He even throws toys. I end up taking his toys away and putting him in timeout. So what you're kind of missing there is you're missing a moment of teaching. If you're jumping right into discipline, when a child's emotions are heightened, they're not really thinking clearly and they really need help, kind of problem solving difficult situations. So we want to ask ourselves, what is this behavior trying to tell us? That's oftentimes how toddlers and young children communicate is through actions, through their behavior.

So we want to look at like, are they tired? Are they hungry? Do they not feel well? Is the ask that we are asking too big for them? Is the demand too hard? So all of these things are things that we would miss if we just jump right into disciplining. And, we have to really look at what is the behavior trying to tell us so we can really help them try to problem solve.

Host: Amanda, what's the biggest red flag you hear from parents?

Amanda Shaw, MSW: When a parent calls and they say, my daughter's an angel in school, I never get a bad report, but when she comes home, she loses it. That's kind of a red flag that behavior management techniques may be needed in the home. However, on the other end, if we hear you know, my son's running out of the classroom, he's hitting other kids. He comes home, he can't sit still. He won't even focus on a movie. These are red flags for something a little deeper. We want to really make sure that we're addressing any medical professional needs that may be there. So maybe, you know, meeting with a pediatrician or a developmental pediatrician, a nurse practitioner, a neurologist.

We want to kind of look at the medical piece if we're seeing the behaviors across multiple settings.

Host: Do you think behavior issues always mean the child needs discipline?

Amanda Shaw, MSW: It is actually not always helpful to immediately discipline if a child is having bad behavior. We really want to look at co-regulation and holding boundaries. Those are often more successful than discipline. Something I hear often is, mealtime's a struggle. Every night, I'm trying to get him to eat his food. He barely eats what's on his plate, and then he wants dessert. So in that situation, you don't want to like go put them in timeout right away. However you can hold the boundary of, you don't get dessert if you don't eat your food. So maybe, we also want to look at instead of discipline of how can we engage this child differently, maybe something novel or something silly.

Let's make silly noises after each bite you have of the chicken nugget. So if we go to discipline, we're ultimately not helping them figure out how to problem solve the behaviors that they're having. So it's important to kind of remember tantrums are part of child development. Their brain is still developing.

So instead of trying to prevent tantrums by using discipline, we want to focus on tolerating the tantrum, staying emotionally constant, and then holding those boundaries for those kiddos.

Host: And what's the best way to help a young child control their emotions?

Amanda Shaw, MSW: Co-regulation is key. This is really hard because when our kids are dysregulated, when they're screaming, when they're yelling, when they're throwing things, as parents, it's difficult to stay calm. But that's ultimately what they need. So they're kind of looking at us to calm them down because they don't feel calm.

And when kids are dysregulated, they're not logically thinking. So a parent might say, my daughter gets angry when her brother knocks down her tower. She screams and she even hits him. So, it's important to kind of help her do a few things here. You're going to want to help her name her feeling, regulate her body, and then problem solve.

So we can say something like, it looks like you're feeling angry that your brother knocked down your tower. Do you want to take a break on the couch with mommy or do you want to do some rainbow breaths? Once the child is calm, then you can kind of say to him, what can we do if our brother knocked down our tower?

The child may say, we can say, please don't do that. And then you're going to say, okay, great. Let's go try and tell him that. So our goal here is to help teach our child how to regulate her body and then how to problem solve a difficult situation. If you're just jumping into discipline for hitting her brother, you kind of miss that whole chance to teach her how to cope with difficult emotions.

Host: Let's say my child is hitting and fighting me. What's the first thing I should do?

Amanda Shaw, MSW: Okay, so ensure safety, right? So we want to gently block or move away from the hits. We want to make sure siblings or other people are not at risk. And then it kind of goes back to that co-regulation, staying calm. Ultimately, your kiddo is feeling super out of control, and if you meet them with yelling, it's only going to heighten their stress response.

So they're going to kind of take our lead when they see us calm, even when they're fighting and hitting, as long as they're being safe and in a safe space, being the calm to their chaos is really important and it's going to ultimately help them calm their bodies.

Host: What's your favorite tool to offer in deescalating a behavioral meltdown?

Amanda Shaw, MSW: When kids are escalated, it's important, like I said, that we stay calm. We want to make sure that we're still holding the boundaries, but step number one, is we have to deescalate them. So some things that I really like is deep pressure. Some hugs. Sometimes if a child's really having a hard time, a behavioral meltdown, you can say like, Hey buddy, it looks like you're having a hard time right now.

Do you want a hug instead of stop? We're not doing that right now. Because then they're stress response is just going to increase versus trying to kind of calm them down. Some other fun tools you can use are like pillow sandwiches or different grounding techniques. Let's label all the red things we see in the bedroom, or let's count to 10 or can you tell me how soft is your stuffy right now?

Can you show me where this stuffy's nose is? Distraction can also kind of deescalate a kiddo. So that's really important to really make sure that we are calm during this escalation process. And then just working on grounding our children.

Host: If you could offer one sentence for parents to repeat when their child's melting down, what would it be?

Amanda Shaw, MSW: I hear you. You're safe. I am calm. It's okay. One thing that I've noticed, if you say kind of like, I'm calm. They're almost looking at the parent to be like, oh, am I freaking you out right now? And then I'm going to also freak out now too. So if you kind of verbalize to them like, mommy's calm, daddy's calm, you're safe. It's okay. But a lot of what I tell parents is don't talk too much because when they're dysregulated, they are not logically thinking. So sometimes if we're talking too much or trying to even teach them a lesson during that time, they're not really hearing us. So even sitting quietly, and just being like, I know, I know, it's okay. Is really all that they need.

Host: Yeah, kind of like adults.

Amanda Shaw, MSW: Exactly.

Maggie McKay (Host): Sometimes. Um, in closing, is there anything else you'd like to share?

Amanda Shaw, MSW: I think just that like parenting is really hard and I think it absolutely takes a village. And, when our children have behaviors, it could feel really overwhelming. And there's people out there like, therapists who can help with different techniques, that you can use in your house to help manage these behaviors and help our children really thrive and learn how to problem solve in difficult situations and, really teach them how to calm their bodies and, ultimately leads to a happy and healthier household.

Host: Thank you so much for sharing your expertise. We really appreciate this information.

Amanda Shaw, MSW: Thanks for having me.

Host: Again, that's Amanda Shaw. For more information about Pediatric Subspecialties at Valley, please visit valleyhealth.com/pediatricspecialties. Thanks for listening to Conversations Like No Other presented by Valley Health System in Paramus, New Jersey. For more information on today's topic, or to be connected with today's guest, please call 201-251-3351 or Email Valleypodcast@valleyhealth.com.