By: Nerissa Bauer, MD, MPH, FAAP
As a behavioral pediatrician, I have seen and heard it all. Children who have tantrums to end all tantrums in the middle of a store. Children who refuse to eat or won't sit still at a restaurant―which quickly escalates to screaming and throwing food. Children who unbuckle themselves from car seats or kick other children at school for no apparent reason.
It can be scary, overwhelming, and challenging to confess these situations out loud. Not simply because these behaviors are happening, but because parents often feel confused, hurt, bewildered and embarrassed when they do.
Why won't my child listen to me? What did I do wrong? Is there something wrong with my child?
Let's face it, children don't come with instructions. And life is beautiful and messy, complicated, and hard. And there is no such thing as a "perfect" parent. Sometimes, a child's behavior happens not because of
family genes or anything a parent did or did not do―but because of something that has been happening or has happened to the child or to someone in the family.
For children who have tantrums, it can be because they don't yet have the words to tell you what is bothering them. Or maybe they can't make sense of what is happening around them and the strong feelings inside are hard to control.
Beyond Adverse Childhood Events (ACEs)
For many families, events happen that are unpredictable; these events can be traumatic and affect how a child feels and behaves. For example, when parents make the hard decision to
separate or divorce, it can be very confusing for young children. They may act out, cry or feel sad, lose developmental skills, or
have trouble sleeping. Some have problems concentrating and have a hard time at school.
Potentially traumatic events like these are referred to as ACEs―Adverse Childhood Experiences―and they are more common than you may think.
Experiences of social inequities also can be traumatic and trigger toxic stress responses. Examples include living in poverty, family separation, being the target of racism, or rejection because of sexual orientation or gender identity. And, certainly, the COVID-19 pandemic has caused children many troubling losses.
How adversity can cause "toxic stress"―and how to help prevent it
Our body has
stress systems to protect us so that when faced with a scary situation, we are ready to run and hide. This "fight or flight" response can be triggered whenever a child is scared of any number of things such as dogs, the dark, or spiders. This same system can also be turned on when a child experiences any adverse experience.
However, ACEs are likely to last longer than a single moment, which causes children's stress systems to be turned on for a long time. When this happens, the stress becomes "toxic" to their overall health. The more ACEs children face, the more harm they can have over time. Likewise, chronic ongoing adversity can have an equally negative effect. In fact, adults who've experienced one or more ACEs as a child or are exposed to ongoing chronic social inequities over time are at higher risk of depression, cancer, heart disease, diabetes and other health conditions during their lifetime.
Positive childhood experiences: collaboration, connection, and communication
The good news is that parents can help buffer children from this stress before it becomes toxic. Providing safe, secure, and nurturing relationships (sometimes called "relational health") helps reset the body's stress system. In addition, research suggests positive childhood experiences (see "More information," below) are just as important.
One of the most important is to spark moments of connection. This may be through shared book reading, for example, or participating in family routines and community traditions. You can also model how to accept all emotions. Relational health is key to combating adversity, and promoting skills like collaboration, connection and communication that are essential to help children develop resilience and thrive.
Your pediatrician can help
When parenthood gets challenging, talking with your child's pediatrician is a great first step. Pediatricians are trained to not only monitor your child's physical growth, but also their social-emotional health. They can help you build your "team" and support system―whether your child is relatively healthy, has ongoing developmental or behavioral concerns, or your family is going through hard times.
Pediatricians also want to know how you are doing, how your family is doing, and if you feel supported and able to navigate those messier moments of parenting. Expect to be invited to share stories about your family life and the daily stresses and struggles of parenting. They will also ask about your own childhood experiences and current living circumstances. So, bring your questions and concerns.
Remember, no question or concern is silly, minor, stupid or unimportant. When parents share what is happening within the family and their community, it helps pediatricians understand why a child may be acting out or having problems at home and school. It can also help them understand how to better support your family.
We want to ensure all children, and their families, have the resources and skills needed to thrive. To that, we will always be ready to listen, without judgment and with compassion.
About Dr. Bauer
Nerissa S. Bauer, MD, MPH, FAAP, serves as the Chair of the Technical Assistance Project Advisory Committee of the AAP Screening and Technical Assistance and Resource Center (STAR) Center and host of the Pediatric CARE podcast. She is a past executive committee member of the AAP Section of Developmental and Behavioral Pediatrics and the Council of Early Childhood. She is a behavioral pediatrician and sees patients in Indianapolis, Indiana in a private practice. She also served on the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) steering group. Follow her on Twitter
@nerissabauer and on her blog,
Let's Talk Kids' Health.