← The Pediatrician Next Door - Simple Advice on Parenting and Family Health
The Pediatrician Next Door - Simple Advice on Parenting and Family Health
Ep. 123: Why Kids “Act Out”: What Their Behavior Is Telling You
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Dr. Wendy Hunter
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I know it might seem like it, but your kids aren't being bad, they just don't have any other way sometimes to express themselves to get their needs met. So we have to help them. And I'll tell you the simple solution to kids behavior problems and is that you as a parent, you need to try to be curious and calm and compassionate at the same time. But I know that's easier said than done when it comes to dealing with your kids really challenging behaviors, especially when they happen at a time when emotions are supercharged for you and for your kid. You know, when I went to medical school I thought that I was going to spend most of my time diagnosing disease by ordering lab tests and prescribing medication. But honestly that's like 10% of what I do. It is true that that's mostly what I did when I worked in the emergency department, but now that I'm in primary care, I'd say the majority of the conditions that parents bring their kids to me for are behavioral problems. And these behavior issues are like 100% related to a kid's health. Honestly, that's why I care. It's things like kids not sleeping. I mean we know everybody needs to sleep to be healthy and parents want to talk to me about tantrums and things like that. Today I've got some real life stories that have recently been asked of me in clinic or through a medical portal message. You know, like epic. The questions have in common that the parents in each scenario are like absolutely desperate for help, and they don't really know where else to turn. So they asked me, their pediatrician, and I'm flattered that parents think of me and of pediatricians when they want trusted advice. So that's what's next. Real questions from frustrated parents and the advice that I gave to each family. My hope is that if you're living through something like this right now, or if you've experienced something similar to it in the past, you. You're gonna feel less alone. And you might even leave this episode with a few new ideas to try. Or maybe one of your friends will talk to you about one of these problems and you'll know exactly what to say. I'm Dr. Wendy Hunter and I'm the pediatrician next door. I'm that doctor friend you call for practical advice about your kid's health. I mix the science of medicine with the reality of parenting. Sleep is issues have to be the most common thing that makes parents lose their mind. If you've been a parent, I know you can relate. Do you want to guess the second most common issue that makes parents nuts? It's poop. I'm going to share that in another episode. Not going to do it now. But no poop stories today, I promise. In terms of sleep problems, though, maybe your baby never sleeps longer than a few hours and wakes up screaming. Or maybe your 6 year old turns into a gymnast and refuses to stay in their bed. Either way, I promise there's help. The first question I got came from a mom whose 11 month old baby had never slept more than three hours in a row. Never. The mom messaged me through our portal. She said they had hired not one, but two sleep consultants. They followed strict sleep protocols for months at a time. Still, their daughter woke up screaming three or four times a night. And she screamed so intensely that she often would make herself vomit. One of the biggest pitfalls that I see in this type of scenario is that the parents often will feed their child every time the kid wakes up. And so the child becomes trained to eat in order to fall back asleep. We call kids like this trained night feeders. And after about, say, six months of age, you have to consider whether your baby really does still need to eat in the middle of the night. They probably don't anymore. But you know what they do need? They need to learn how to put themselves back to sleep. You see, every one of us wakes up in the middle of the night. Think about it, you know, you do. And we fall back asleep because we know how to. And our kids need to learn how to do that too. So these parents, they actually were not feeding her at night. They knew she wasn't hungry, but they thought something was clearly wrong. The mom felt like there had to be an allergy or some kind of food intolerance, something deeper, something treatable. And I want to start by saying this, mom is right to trust her gut. This wasn't just a case of crying it out gone wrong. This was a family in crisis. And it deserves a medical, not just a behavioral approach. So here's what I recommended. First I said we need to dig into the medical causes. I always think first about neurologic issues like certain types of epilepsy or sensory processing disorders. Those can lead to fragmented sleep or intense nighttime wake ups. In cases like this, I might refer them to a pediatric neurologist or a children's sleep specialist. That might be worth pursuing. Sometimes kids even need a sleep study that's called a polysomnogram. And that can help doctors uncover what's happening when the child is waking and crying. So. So I put this on the possible list of next steps if we didn't figure out something else that could be causing this sleep problem. So next I thought I should pay attention to the mom's gut instinct and we should look at the baby's gut. Babies with cow's milk protein allergy, they don't always have blood in the stool, so this is still a possibility. And some kids have silent reflux that can peak at night. Silent reflux means that the child is having reflux of acid from their stomach to their esophagus, but they don't actually spit up, so you don't see it. And that's why we call it silent. All right, what about constipation? That's a possibility that can sometimes disrupt sleep without being so obvious. So I suggested trying two to three weeks off of dairy. And the parents were going to need to switch either to a pre digested formula like Nutramigen or Alimentum. But this mom was still breastfeeding, so she herself had to go dairy free. I figured if there's no improvement, the next step might be testing for actual food allergies or referring her to a gastroenterologist. Although I have to say, it's really pretty uncommon to have a food allergy or a GI disease at this age. So again, I put that at the bottom of my list of plans, but I kept it in mind. If none of that explains what's going on, I might need to go further. It's possible that the baby has some kind of rare genetic or metabolic disease that can cause chronic discomfort or like bad sleep. But again, this is pretty unlikely because all babies have a newborn screen. And so we catch most metabolic disorders really early in life. Plus, this baby was totally normal. Otherwise she looked normal and she was developing really normally. So I sent these ideas and recommendations to the mother again through the portal, and I saw her in Clinic about 10 days later for the baby's well visit. And guess what? About three days after mom stopped eating dairy, the baby slept through the night. She has had pretty much great nights ever since then. It's kind of crazy. The baby is pretty old to have a milk protein intolerance, but that is what we're suspecting now. Here's what I really want to say to families like this. This is not your fault. You're not overreacting. This can be well beyond normal sleep troubles. And the emotional toll on the whole family is very real. If you're burned out, you're depleted, or even if you're struggling in your relationship with your partner, you're not weak, you're human and you deserve support. I love that these parents hired a sleep consultant. You know, I love them. Sleep coaches are almost always able to be extremely helpful in getting your child to sleep well with their support in a very short time. I cannot say enough about how great sleep consultants are. They're easy to find and I've done a few episodes with them. If your baby is not sleeping, nobody is sleeping and you don't have to do this alone. So talk to your pediatrician or start sleep training. And if you need advice, check out my episode 27 or 103 for my discussions and tips from a few different sleep coaches. They'll also tell you how to find one. The second message I received was from a mom of a six year old who seemed fine during the bedtime routine until the very end. Every night, just after mom finished reading a book, the kid would start bouncing on the bed, doing cartwheels, and basically parkouring around the room. Then she would start screaming and punching. And that chaos could last like 45 minutes. So understandably, this mom was feeling really, really overwhelmed. She said she tried to stay calm, but that nothing she had tried worked. So what's going on here? Again, this may sound like bad behavior to you, but to me, I would call this something more like emotional dysregulation. You gotta think the way the child is thinking. Emotional dysregulation sounds better, but also it gives this child a reason she's not just being bad. She doesn't know what she's doing or why, and she doesn't know how to regulate how she's feeling. At age 6, kids are still learning how to handle their really big feelings and bedtime. Especially the moment after the story ends and your connection to your parent is about to end. That can feel huge. And in a lot of kids, it can trigger a sense of loss. They don't realize it. It can be associated with separation anxiety or even pressure on the child to be able to fall asleep, you know, the right way. Here's what I suggested. You have to put your child's shoes on, right? You got to put yourself in her perspective, you know. First, I said, you gotta rework your routine. Instead of ending with the book, which obviously feels like a drop off into alone time to this child, I told the mom she needs to add sort of a cool down phase after reading. Think of it like the final stretch after a workout. This mom could do things like a short breathing game or a body scan. I love that one. Or even just a lullaby. Those are things that can help bridge the gap between the time of connection when you're reading a book and that alone time of sleep. A more gradual transition could possibly help this girl. So after the book, I said, don't just leave. Have your daughter lay down, have her close her eyes and you can put your hand on her and talk through, say, a breathing exercise. A good one we like for kids is let's smell the flower and blow out the candle. It works for adults too. So you gotta tell the kid to breathe in and imagine smelling a flower and then picture a candle and blow it out. Another thing you could do is a gradual body relaxation. So you could say, let's lie here and see if your toes feel sleepy yet. And then you work your way up the body. These kinds of transitions help soothe a child's nervous system and your own. And they give kids a sense of predictability, especially if you do the same thing every night. Kids love that. You can tell your child you want to find the one that she likes, and then you'll do the same one every night. And until then, you can try a few different things. Second, I told the parent to try naming her child's behavior and without shame. So I said, try something like say to her, wow, it looks like your body is having a hard time slowing down. Let's help it calm down together. So this approach can be more effective than saying, why are you acting like this? Because it shifts the tone from Confrontation to collaboration. Another thing this mom could try is using a transition object. So so some kids do better when they have a physical cue that it's time to go to sleep. So you could try something like getting a new lavender scented pillow or a stuffed animal that only comes out at bedtime. A lot of people already have this or even a little sleep stone that they keep under their pillow and can rub. It gives them something consistent to focus on during a moment that can feel quite uncertain to a child. Some kids also like to have one of their parents T shirts put on a pillow and they can snuggle with that, especially if it smells like the parent. And last I said the mom needs to look for any hidden stresses she might not know about something going on. Has something changed at school or at home? Is her daughter processing something really big? I mean, I'm sure you've noticed that at bedtime when all the day's sort of emotional baggage kind of spills out and when a kid can't say what they feel, it might be that their body says it for them. So I saw this mom the following week for the girl's younger brother's appointment and the mom said that this plan actually worked. Bedtime changed completely once she added just a simple transition activity with the lights off right after finishing her book. She didn't have any particular stresses she could identify, but it was the end of her kindergarten year and there were a lot of events at school, so she thought maybe that was the stress trigger. But then I saw the mom another week after that and they had had a very rough night the night before. They had stayed out late at a Memorial Day party actually, and it had thrown off their routine. So the mom did say she felt very confident that she could get right back on track. We all get a do over when we need it, both as kids and as par Foreign through Play Starts with Lego Duplo With Lego Duplo, toddlers can develop real life skills while having fun with colorful bricks made just for them. Large, easy to grip and safe to explore. 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Okay, give it a try. @mintmobile.com Switch upfront payment of $45 per 3 month plan $15 per month equivalent required New customer offer first 3 months only, then full price plan options available, taxes and fees extra. See mintmobile.com in the first half of the episode, we talked about sleep, those long, exhausting nights when nothing seems to work and your child's behavior leaves you confused, frustrated and exhausted? But what about the daytime struggles, the battles over chores and fairness and emotional outbursts that leave you wondering, is this possibly normal? It can't be. Or you wonder, like, what am I missing? So now I've got two more stories to share with you. This is from two very different kids, both of whom are pushing back hard on their parents in ways that are painful and confusing and often feel deeply personal for their parents. The first issue is a message I got from a mother whose 14 year old son had become increasingly aggressive, defiant and demanding. I had actually just seen the parents and this boy for a visit about his school performance and we had spent more than an hour together and we had made a plan for the future. It's actually a very complicated situation, so I won't go into it. But the parents are divorced and they are definitely not on the same page and they're actually not even in the same country, like figuratively about rules or consequences. So the mom described that her son lashes out at his sister, he refuses to help around the house, and he even threatens to report his mother to the police if she doesn't meet his demands. The father, on the other hand, says he has none of these issues at his house. So this mom feels like she is out of options. She does not have any idea how to fix his behavior problems. She has tried taking away his electronic devices, she's tried reasoning, she's tried giving him more structure and less structure, and she even made posters that she hung around the house that illustrated good behavior, but nothing has made a difference. This kid still yells at his mother. He calls her horrible names that I can't Repeat now. He even stole her credit cards and ordered takeout food and online games, like a lot of them. So here's how I think about a case like this. First, this is not just about his behavior. It's really about control. One clue is that he hasn't had any behavioral problems reported from school. So he is capable of self control and he's capable of being a decent human. When kids feel like their world is unpredictable or divided, like in a high conflict divorce or inconsistent co parenting, kids are going to dig in. They're going to resist authority, test boundaries and purposefully provoke conflict. Because ironically, that gives them a sense of power and control. It's called counterwill. A child's instinctive resistance to being controlled. It's not just defiance. This is how they survive and get along. This kid also just wants his mother's attention. And if he isn't getting it for positive behavior, he's going to be satisfied with negative attention. See, his mother, she works a lot, she doesn't have a lot of time for him, and she doesn't cook for him. In fact, I asked her what was the last fun thing that they did together and she couldn't think of one moment. So what can she do? I told her she needs to avoid power struggles with him. She can't just play into them or engage with them instead. Instead of arguing or over explaining, which is always the natural response, I told her to try being calm instead and give him a clear structure when he's being really difficult. I told her, just calmly tell him what you need him to do and then just leave it. Don't repeat yourself. No threats, no lectures, just stay quiet and let it be. I said, if he doesn't do what you have asked, I told her to try to use natural consequences. If he refuses to help with meals, then he gets to eat whatever's available. You're not punishing your child at this age. You're just stepping out of the tug of war. And if he's refusing to do chores or cook or help at all, that is not this parent's cue to start a fight. It's her cue to calmly hold her boundary. She can say, I cook to take care of you, but I'm not going to be ordered around. If you don't like what I make, you can cook for yourself. And then let it be. Let him try. The less emotional energy you give to this resistance, the sooner it loses its power. Now, when it comes to aggression towards his siblings, especially physical aggression, this mom has to have zero tolerance and she's going to have to intervene. That means separating them physically in the moment without engaging emotionally, and that can be really hard. So she needs to say to him, your behavior is not safe. I'm keeping everyone safe. That's it. No debate. And then later, when everything's calm, she does need to go back to him and help him reflect. She needs to set some quiet time aside, alone with him, and just quietly ask, what happened? What were you feeling? What do you think you could do next time and stay quiet. And yes, it might feel like she's talking to a brick wall at first, but she's modeling emotional reflection and that matters more than it seems. As for his hateful language towards her and another issue that I hadn't mentioned yet, he actually is intolerant to other ethnicities as well, despite the fact that he is mixed race. So this is a tough one to deal with. Preteens and teens often will repeat extreme views that they've heard just to get a reaction. But be aware, arguing with them is usually going to make it worse. So instead I told her, get curious. Ask him, well, what do you think makes someone cool? Or share books or shows that feature diverse characters but just don't say anything? And she needs to celebrate the moments of empathy that she does see, no matter how small they are. I told her, you need to always stay calm and let him know that threats and fighting will result in you getting outside help, like from a family therapist. And I do recommend that, because here's the bottom line, she cannot fix this alone. If you're co parenting with someone who doesn't enforce rules or boundaries, your influence is going to feel limited. But don't give up. Focus on keeping your own home consistent and safe and emotionally steady, because that does make a difference, even when it doesn't feel like it right away. Next, I got a message from a mom with a very different concern. Her 8 year old daughter is struggling at home. She's doing great at school, but at home, absolutely everything feels like a battle with her. The girl is always very serious. She doesn't take anything lightly. She takes things personally. She's constantly questioning fairness and she gets stuck in arguments with her parents and siblings all the time. The mom says she feels like she's walking on eggshells and that everything is just too hard for her daughter and she can't get anything right with her. So here's what I told her. First, this child sounds like she has a very sensitive temperament and probably always has. And she has a strong sense of Just so if we look at this a little bit differently, those aren't necessarily problems to fix. They could be considered strengths to understand and support. Although that can be challenging. Of course. When kids do well in school, but they fall apart at home, usually it's because they're holding it together all day at school. They mask their frustration, they meet expectations all day long. They have to manage their peer relationships. And then when they get home, they finally can exhale and they lose it, so to speak. And yes, that exhale can look like grumpiness or arguing or even just a plain old meltdown. And that's not because as a parent, you're doing something wrong. It's because you feel safe around your family. And this is where temperament comes into play. Some kids are naturally far more reactive. They feel emotions more deeply and they will push harder against boundaries that they find. And that can be a highly verbal or highly sensitive or very literal child. And when things feel unfair again, they dig in. So here's what I told this mother that I thought might help. I said, start by validating her feelings and then explain things later. Instead of saying to your child like that's not a big deal, instead say something like, I know that felt really unfair to you, huh? Because often kids will de escalate if they feel like you hear them. I also told this mom not to try to over negotiate. So sometimes you just need a lot more empathy. Rather than trying to convince her to comply with what you want her to do. The other thing she can do is say something like, I see you're someone who really cares a lot about fairness. Let's figure out how to handle this without getting stuck in the same loop. I also shared some great parent resources for this mom. I love the book the Explosive Child. It's by Ross Green. For some kids like this, it's a lifesaver for understanding kids who struggle with flexibility and are easily frustrated. I also like Raising your Spirited Child by Mary Sheedy Kinka. It's all about high energy, intense kids. I also like the Peaceful Parent Happy Kids book by Laura Markham. That one has a lot of practical and research based approaches to emotional coaching. That one's pretty good. And for quick tips and for handouts, I like the online resource the Child Mind Institute. And there's also a good one, Harvard's center on the Developing Child. Those are good websites. Those organizations have really good tools to build emotional regulation. And they even have visual aids like Emotion wheels and games like Name it to Tame It. Those can be really helpful for A child who has really big feelings. So I think this mom is probably going to need a lot more outside resources and support to help her child. You know, parenting isn't just about getting your kids to do what you want. It's about helping them become the people that they are meant to be. And sometimes that road really is very rocky. If your child's acting out or shutting down or is testing every limit, it doesn't mean you've failed. So if you're tired and overwhelmed or even questioning, if you're making a difference, hear this. You're doing a fine job. You're doing the hard, loving work that often goes unseen. And fortunately for us, oftentimes we do get to see it. When our kids get older and they literally tell us that we did a good job. I know it's easy to feel like you're doing something wrong sometimes, but difficult kid behaviors are signals. They are clues that something deeper is going on. It might be medical, it might be emotional. It could be both. Some kids do need more structure and some kids need more empathy. It's confusing because everyone has different needs and they sometimes have both needs at the same time. The answer isn't always going to be more discipline or sticking to a schedule. Sometimes it's more compassion and, like I said at the beginning, having curiosity. Sit down in a calm time and just ask your child what's going on. And you also need to have a willingness to ask for outside help. There are lots of good therapists out there that can help you or your child. So if tonight is another hard night, take a breath. You're not failing. You're parenting a human. And sometimes that human needs a little more support than we expected. Thanks for being here with me today. If this episode helped you, please share it with a friend. They may be in the trenches, too. And don't forget to follow or subscribe to the Pediatrician Next door so you never miss an episode. For more from the Pediatrician Next door, find me on the web@ pediatriciannextdoorpodcast.com if you've got a question about the weird things kids do, send an email to hellopediatriciannextdoorpodcast.com for a chance to hear your voice on the show. I'm Dr. Wendy Hunter and I'm the Pediatrician next door. This show is produced by Red Rock Music. Make sure to subscribe and leave a review wherever it is you're listening. I'll be back next time with more.