Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And today, we are delving into the world of temper tantrums. And if you're a parent, you know that this is a difficult situation, whether you are in the home or out of your home, it's scary, it is traumatic for both the child and the parent. So, we're going to talk about that today.

And joining me is Dr. Lauren Webb. She's a clinical psychologist at New York Presbyterian Hospital, Weill Cornell Medical Center, and she's also an instructor of Psychology and Psychiatry at Weill Cornell Medical College - Cornell University. Dr. Webb, it's a pleasure to have you join us today. So,

Melanie Cole, MS: what

Melanie Cole, MS (Host): really are tantrums? Do we know what they are?

Lauren Webb, PhD: Temper tantrums are emotional outbursts that often young children have. And I like to think they're kind of when kids experience really big feelings that they just don't quite have the skills yet to know how to handle or cope with.

Melanie Cole, MS: That's so true. That's what I was told and I told you off the air that my daughter was a tantrum thrower, and it was very difficult. And I know that it was, some of it was because she couldn't express her frustrations. So when you say that, do we know what causes them? Is it sometimes lack of language skills, frustration, or is there something else physiologically or psychologically going on that we don't know about?

Lauren Webb, PhD: There's of course always unanswered questions a little bit, but what we do know is that when I reference those big feelings, I think as you said, we typically think of the emotions of frustration or anger. For example, if a toddler or a preschooler is told no or told that they have to transition and stop playing. But these tantrums can also happen in the context of other big feelings such as anxiety. So, for example, if you think about a little one who has a lot of separation anxiety, we often might see them tantrum when they have to separate. It can really be a wide variety of emotions that might pull on these tantrums.

Melanie Cole, MS: Is there an age parents can look forward to when these things typically subside?

Lauren Webb, PhD: Yeah. We typically say around in that preschool age range. And I always like to mention much with other developmental milestones, we have a range, but it can be a little earlier, it can be a little later. Some kids are also what we call supersenser, and they just feel emotions so intensely. So, it can be a little bit different for every child, but around that preschool age is when you'll hopefully start to see the tides turn.

Melanie Cole, MS: Parents, you do have something to look forward to, and difficult as it is. They happen at home, they happen out. And we're going to talk about the differences between those and what we do as parents. So, let's start with at home. Now, I know, Dr. Webb, my doctor said, "Hug her." And I was like, "Are you kidding? I don't want to hug her." And I know that is the right thing when they're really doing it. But as parents, my gosh, we are just filled up with our own emotion and frustration and inability to know what to do to stop this zero to a hundred that our kids can go through sometimes. So, give us some advice about when they happen at home. When we start to see it, and we usually can tell just a little bit in advance, we start to see it happening, what do we do?

Lauren Webb, PhD: There's actually a lot of different methods you can use and they all go together, but there's a lot of different things you can do to help your kids get through a tantrum. There are some things on the front end you can do to try to avoid the tantrum. But let's say you're in it, the tantrum is happening, the first thing I always mention is that actually most behaviors that happen during a tantrum are often attention-seeking. And those more "minor" attention-seeking behaviors you can actively ignore. So, that would be things like whining, crying, screaming, tugging on you a little bit. All of that, you can use that skill of active ignoring, and I can explain what that is a little bit.

But then, for the other behaviors that we see, anything destructive, more physical, aggressive, that's when we use timeouts. But going back to active ignoring, really what the gist of that is, is that most-- well, all kids and even all adults-- we all want attention. And it actually doesn't really matter if it's positive or negative. Of course, we all much prefer positive attention. But kids are willing to take negative attention too, if that's kind of the best that they can get in that moment.

So, we know that really to actually extinguish a behavior that we don't want to see more of, we want to ignore it and give kids no attention at all. So, that might look like having a really neutral face, not responding to them, turning your body. You can even take a break yourself if you need to. But then, jumping on when kids are engaging in any positive behaviors. So, praising them. Let's say, they're whining, but using gentle hands. You can praise them for using their gentle hands and say, "Thank you so much for using your gentle hands." Let's say they're whining a little bit, but then they stop or they're crying and screaming, and then they stop, you can immediately jump on that and say, "Good job using an indoor voice," or, "I really love when you use an indoor voice."

Melanie Cole, MS: Yeah, those are great suggestions and sometimes I wish I could go back and change some of the ways, because it is really difficult on parents. And before we get to what we do outside, since we're in our own homes, what do we do to keep our own anger in check, Dr. Webb? Because I think that's where the disconnect happens. The child is seeking attention or they're frustrated, any of the reasons you've given us and we're trying these things, time out, we're trying the ignoring, we're doing all these things. Maybe it's working, maybe it's not, but we're still filling up with our own emotions, what do you want us to do when we start to feel our own anger rising, but we don't want to lash out, we don't want to show that to our child? What do we do then?

Lauren Webb, PhD: I always think of the emotion curve with tantrums. It's going up and then it's going to stay there for a few minutes and then it's going down. And as kids ride their emotion curve, parents are going to ride their own emotion curve. So as kids get more dysregulated, parents, siblings, whomever is around, will probably get dysregulated too. And to your point, it is really, really hard to try to manage a little one's emotions while also managing your own emotions.

And I think the biggest, most important thing is to try to validate yourself as a parent and remind yourself that this is normal, trying the best that you can. You're probably doing a lot better than you're even giving yourself credit for. First and foremost, just give yourself grace. When you're actually in it though, I always like to say Try to remain consistent and try to practice upfront so that when a tantrum is happening, you almost have this playbook that you're just reading from. You don't have to really think about it. You know exactly what line you're going to use.

So for example, if you're doing a timeout, you just have a go-to line: "Because you hit me, you're going to go to the timeout chair, the timeout space, whatever it is." And it doesn't have to include any more words. You've already explained to the child, what happens, why it happens. You just go through the motions, almost like a robot in a certain sense. When parents are really struggling with their emotions in the moment too, you can also try to use some distress tolerance skills. There are a lot of them. But different mindfulness practices. You can have certain skills to basically help your emotions kind of come down and keep in check. If you have a partner or someone around who can support you, you can even tap in and out a little bit if you're getting really overwhelmed. So, there are a lot of options, but it is important to make sure that ultimately you're giving yourself grace and know that you're doing the best you possibly can do in that moment.

Melanie Cole, MS: Tag teaming is essential. It definitely is. Now, what if they won't sit in the timeout chair? What do you do then?

Lauren Webb, PhD: Yes. And we have our runners. They'll maybe get to the chair and then run away too. So, we always say try to keep ringing them back and reset the clock essentially. So with timeout, we do always recommend that you explain to kids exactly what will happen. And that includes explaining, "Okay, when you sit in the timeout chair, you're starting the clock. If you get off the chair, you have to go back on and we're restarting the clock." Doing that is meant to hopefully help nip that behavior in the bud a little bit so that kids can see, "Okay, I really have to sit here for a minute, two minutes, whatever it is, and follow through on this."

But let's just say you have a child who is not sitting in a chair. There are a few different options, but one option I do bring up is some type of loss of privilege. So, that's something where you can basically, again, upfront know what's going to happen. You don't have to kind of pull it out of your back pocket in the moment. But maybe there's no more screen time for the rest of the day, or maybe there's some type of loss of a special toy. So, you can have that as your kind of backup for the runners.

Melanie Cole, MS: Yeah, you need backups. Sometimes you do have those runners. Now, what about when we're out? We often see kids in the grocery store or at the library or someplace and they're throwing a tantrum because they don't get what they want, or they want a particular candy or chips or something and the mother says no. What do we do then when our children are out and they're throwing a tantrum? I will tell listeners, I was lucky my kids didn't do it out, only in. So, it was kind of like they were almost too embarrassed. Are kids embarrassed when they throw tantrums outside the home?

Lauren Webb, PhD: They certainly can be and they also certainly cannot be. Tantrums happen, because kids aren't really sure what to do with the emotions in an appropriate way. But at the same time, it is developmentally appropriate for them to have tantrums. But when you're in public, in the most perfect world, if I was giving the most perfect scientific answer, I would say, well do exactly what you're doing at home. I know that that realistically is not always possible. Try to problem solve ahead of time. What can you do in public that you're also doing at home? Is it possible to ignore? Are there certain places where you're more comfortable ignoring? So for example, if you're at grandma and Grandpa's house, are you okay with ignoring some of those minor misbehaviors? Whereas maybe at a supermarket, you wouldn't be so okay with ignoring. But try to problem solve that ahead of time and match as much as what you're doing at home to what you're going to do in public.

That being said, it gets tough. There isn't a timeout chair sitting across the room. So, I will always mention to parents if, you know, it's getting to a point where you're going to give in, or let's say they want the lollipop, they're screaming, they're crying, and, you know, "I'm not going to be able to ride this out. I just don't have it in me today to deal with a temper tantrum," I will say, get the lollipop right away. You don't have to wait it out. You don't have to let the temper tantrum get to its full peak, because what we know is next time that happens, the temper tantrum is going to go to the full peak right away because essentially kids' brains are learning, "Oh, I just have to go immediately to 100 and I'll get what I'm asking for." So, kind of giving in a little sooner than later so that we don't let that happen again the next time.

Melanie Cole, MS: This is really good advice for frustrated parents. What about after the tantrum, Dr. Webb? Do we pretend it didn't happen? Do we just forget about it and move on? Because sometimes there are so many of them, you don't remember each one. But holding a grudge as a parent against your child, it breaks my heart to think that I might have held a grudge sometimes, and I didn't mean to, but you know, those emotions are all around us. So, what do we do after the fact?

Lauren Webb, PhD: Yeah. It's really hard, because I have so many parents come to me and say, "Well, I want to make sure they know what they did is wrong. And how do they know if I don't communicate it and bring it up again and talk about it." And the fact of the matter is that your child is very smart and you've talked about it before and you've maybe put into action that active ignoring or a loss of a privilege or a timeout. So, they do know what they did was wrong, and they do know that there's a limit and there's a boundary there. So, you don't actually have to rehash it.

And in fact, when we do rehash or kind of do these callbacks to the tantrums, it can end up being pretty invalidating for kids and it really puts focus-- actually, what we're doing is giving more negative attention when in fact we could actually be using those moments to heap positive attention on these kids and praise them for all of the behaviors we love that they're doing so that their brains can learn, "Okay, wait a second. I'm getting all of this positive attention when I'm behaving using an indoor voice, gentle hands, whatever it is. But I don't get any attention at all when these other things are happening." So really, the best thing to do is try to use your own coping skills to cope with the very normal feelings that come up of "My child just had this horrible temper tantrum, how am I supposed to now just go back to playing?" So, kind of use your own coping skills there, but also use a lot of praising for your child for what they're doing really well in the moment after a temper tantrum.

Melanie Cole, MS: I can tell you that as a grandmother, I'm going to be- I'm not one yet-- but when I am, I'm going to be so much better at dealing with these tantrums.

Lauren Webb, PhD: Yeah, we get our do over.

Melanie Cole, MS: I get a do over and I'm going to be like, "Okay, give them to me. I got this."

Lauren Webb, PhD: Yeah. So chill. Yeah.

Melanie Cole, MS: "You guys go on out. I got this. I'll take care of it." So, when do we know, Dr. Webb, that it's really time to bring in our pediatrician to get some help outside of ourselves when it's really so bad that we don't know what else to do?

Lauren Webb, PhD: So, on one hand, I say my rule of thumb for temper tantrums, but really for any mental health problem that's coming up, my rule of thumb is when it starts to get in the way of your child's life or your family's life, that's kind of our general rule of thumb of when it's time to seek help. That being said, especially with temper tantrums or these early childhood problems that do come up for most children at some point, I also don't think it's a problem to ever seek more help if you are just struggling a little bit. There are a lot of books out there, a lot of resources, therapists, pediatricians, doctors who can help. And it can even be a session or two of meeting with someone to just really understand the skills, the basics of how to do time out and get a handle on that so that you can use the skills with your kids.

Melanie Cole, MS: This is such great advice. And let's finish off with one last piece of advice. How can we avoid them? Can we?

Lauren Webb, PhD: Well, yes and no. Some of them may be, some of them are inevitable. But there are some ways that you can try to avoid them. And again, I think of that emotion curve. We have the before stage, we have the before-before stage. So, the antecedents, the things that may be coming up before that we can look out for are: Does your child tend to have temper tantrums when they're really hungry, when they're really tired? We can try to control those a little bit. So, maybe we pack more snacks or maybe we even have to move dinner time up a little bit or do an after-dinner snack a little before bedtime to try to avoid the bedtime tantrum. So, we can adjust for those things to try to avoid some temper tantrums.

The other thing that we can look for are any warning signs that come up. So for example, some kids it's zero to 100, and it's really hard to pick up on warning signs. But other kids, you might see their little feet stomping, their little fist balling up, or them getting a little edgy in their tone of voice. That's when we know, okay, maybe we back off for a little bit. Let them cool off. We give them some praise for how they're handling their emotions well, and kind of try to let them cool off a little bit before it reaches the peak.

Melanie Cole, MS: You've given us a lot to think about, and thank you for offering your expertise for frustrated parents because it gets to a point where we don't know what to do. But parents, she's given us a lot of great information for something that all of us go through. I don't care how great your kid is, they're going to have tantrums at some point in their life. And Dr. Webb has given us great ways to deal with them. Thank you so much for joining us today.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointment at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcast, Spotify, iHeart, and Pandora. And for more health tips, go to weillcornell.org and search podcasts. And parents, don't forget to look at Back to Health. We have so many great podcasts there for those of us that are adults. Thanks so much for listening. I'm Melanie Cole.

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