The #1 thing that prevents me from having a really successful treatment session is when my patient cries. The crying isn’t the actual problem, it’s usually my patient’s parent coming into the session and consoling/interrupting the session to help their child stop crying. In fact, the crying actually doesn’t bother me at all, it’s usually the fine line I have to walk between pushing my patient to help them reach their PT goals and maintaining a good rapport with their parents who hopefully don’t hate me for making their child cry 🙂
The #1 thing I get asked by parents whose child cries with me and that child also receives therapy from multiple disciplines,
“How come my child only cries during your sessions, but doesn’t cry during occupational therapy or speech therapy or with the child development specialist?” and my answer usually is, “Physical therapy usually works on progressing your child’s mobility and involves making them maintain positions that are more challenging than just sitting and focusing on activities with the other therapists. Any adult would be uncomfortable when practicing different positions that they’re not used to, such as maintaining a squatting position against a wall.”
I usually have parents become upset with me if they see their child crying or “crying,” which is making a crying face without tears and the crying stops the second I let them do what they want to do :). And sometimes I lose patients because parents think I’m too “aggressive.” And I can’t blame them, because that means I obviously didn’t do a good enough job explaining my role in their child’s therapy and how the sessions would probably go.
So with that, when do I think it’s ok to let my patients cry?
Under 6 months
- I don’t push my little ones if they’re crying during this stage, since they probably haven’t fully learned how to cry to get out of therapy just yet! 🙂 So I let their parents do the consoling 🙂
- This is my gray area. The patients I see during this time are usually learning to crawl and walk, which means I am making them really use their hip, leg, and bottom muscles to help progress to crawling and walking. As a result, all these patients learn that learning to crawl and walk is hard work and they don’t like it :).
- At this stage, I begin to push my patients even when they cry, but I also let their parents console them too, since they aren’t at the age yet where they are throwing a tantrum to assert themselves. I push them a little because they are mostly crying to get out of an activity that they don’t want to do, and by this point they have learned that crying will help them out of most situations. I continue to encourage parents to push their kiddos and to not give in right away because it’ll become a behavior that will be VERRYYY difficult to deal with after they’re 18 months! And picking up their child every time they’re upset will also delay reaching certain milestones. (discussed in this post)
18 months to 5 years-
- Now! This is where the fun stuff happens in physical therapy in terms of crying :). 18 months is usually when temper tantrums start, and I am always fascinated by temper tantrums, and have to remember to keep working even though sometimes, I am impressed by my patients’ dedication to prove their point :).
- If I have a patient that has been allowed to cry to get out of doing anything they didn’t want to do since they were 6-8 months old, by the time I see them around 12-15 months, I am facing an uphill battle in physical therapy. Not only am I working with a kiddo who knows how to work his/her parents and thinks that crying will save them in physical therapy, I am also dealing with parents who frankly cannot handle seeing their child cry and want to swoop in a save them during the sessions.
- This is when I play 2 roles in physical therapy. 1- I have to teach my patient how to participate in therapy without falling apart. 2- I have to teach the parents that it is ok for their child to cry or throw a tantrum when they are asked to do something they don’t want to do.
When researching this post, I tried to search for relevant articles that weren’t too farfetched. I found a good one on parenting.com that I believe provides relevant info for parents and therapists. I’ll sum up the main points here:
- Let’s take a quick tour of the human brain, stopping at a little blob of gray matter behind the eyebrows called the prefrontal cortex (PFC). This is the part of the brain that regulates emotion and controls social behavior. It’s also the last area of the brain to develop; it has only just begun to mature at age 4. The authors posit that the underdeveloped PFC is what allows young children to master a new language much more easily than adults. Simply put, our kids’ more disagreeable behavior may be an evolutionary trade-off for the sake of human communication.
- “Kids this age think magically, not logically,” explains Gina Mireault, Ph.D., a professor of psychology at Johnson State College, in Vermont. “Events that are ordinary to us are confusing and scary to them.
- This feeling of heightened arousal causes our bodies to release cortisol, known as the “fight or flight” hormone. Maybe it should be called “tantrum juice:” Cortisol increases blood pressure, speeds up breathing rates, and may lead to confused or unclear thinking (sound like anyone you know?).
- The next time your child has an episode, Potegal recommends asking yourself “What function does this inappropriate behavior serve?” If your tyke is looking for attention or a “tangible” (toy, food, or other treat), the best response is to ignore the behavior and maintain your own emotional composure.
- Potegal calls this the Anger Trap. “If you get just as mad and irrational as your child, it’s like throwing gas on a fire,” he says.
- But he warns of another trap, too: the Sadness Trap. “When you comfort a child in the middle of a tantrum, you reinforce the behavior. Instead, say ‘I’m sorry you’re upset. When you calm down, I’ll give you a hug and we can talk about what happened.’” This way, you offer support and sympathy while still showing your tot how to regulate his emotions.
- But the above strategy doesn’t apply to an “escape” tantrum: a child going bonkers because he doesn’t want to do whatever it is you want him to (clean up, sit at the table, etc.). In this case, ignoring him gives him what he wants: You’re no longer demanding that he wear his coat, or whatever it is that needs to be done. Putting him in a time-out chair doesn’t work, either, since that’s time he’s not putting on his jacket. If your tiny rebel makes no move after the five seconds are up, which he won’t at first, take his hands in yours and gently force the coat on.
- Toddlers are a literal force of nature who confound even the most calm and prepared. But there’s a silver lining to these flop-and-flail-filled years: Just as kids can quickly slip into anger and sadness, so can they slip out of them. The average tantrum lasts about three minutes, according to Potegal’s research. That’s why, shortly after a tantrum, your kid is back to playing as if nothing happened, while you’re still quaking from the event a half hour later.His immature PFC (that mushy part responsible for social cues) allows him to move on without dwelling on past hurts.
How to prevent tantrums? – this is from another useful article on parenting.com
- Avoid the triggers. Try to figure out what sets your child off. Does he lose it when he’s hungry or tired? When he’s in the car seat for longer than 20 minutes? Plan ahead to stave off tantrums: Carry a snack, make sure he’s rested, or stop for a break between errands.
- Offer options. When toddlers feel overwhelmed, they need your help, but they still want to have a say in things. That’s why offering two options (more is just confusing) can prevent a meltdown. Try saying, “Would you like to see the polar bears or the monkeys?” instead of “Which animal do you want to see first at the zoo?”
- Give fair warning. If you have to tear your child away from something fun or drag him somewhere he’ll hate, preparation can nip frustration in the bud. Say, “We’re going to go home after one more trip down the slide.” Little kids are more likely to behave if they know ahead of time what they can and can’t do.
- Show your child how you want him to act. Since one reason kids scream is that they don’t know what else to do, teach your child to use words to express himself. Good ones to start with: “Can you help me?” and “Excuse me.” The more specific you can be with your own requests, the better. Telling your child you want him to “be good” isn’t really informative. Instead, tell him you want him to ask for things in a quiet voice.
We see all types of temper tantrums during therapy sessions, we also see all types of parents too! This means I see parents who handle tantrums well and parents who are ready to crack under the pressure of temper tantrums and parents who do not know how to handle their child’s behavior.
- So if you’re one of those parents that is doing well handling tantrums, congrats and keep up the good work!
- If you’re having trouble, make sure you seek help! You may be doing more harm than good even if you think you are doing your best if you feel very very stressed/distraught over dealing with tantrums.
- Here’s a helpful link for parents who are looking for help.
- Also, if you think you’re child’s tantrums are very different from other children their age, try not to ignore it under the assumption that, “every child is different, and my child just has more anxiety than other kids.”
- Here is some advice from another article if you’re concerned about your child’s tantrums:
- You should consult your doctor if:
- You have questions about what you’re doing or what your child is doing.
- You’re uncomfortable with your responses or you feel out of control.
- You keep giving in.
- The tantrums arouse a lot of bad feelings.
- The tantrums increase in frequency, intensity, or duration.
- Your child frequently hurts himself or herself or others.
- Your child is destructive.
- Your child displays mood disorders such as negativity, low self-esteem, or extreme dependence.
Categories: Child Development