068 - When To Worry About Toddler Aggression with Drs. Janys Lim and Jack Herrin

Do your toddler’s kicks or hits have you questioning if it’s more than just the "terrible two's"? One of the most common questions is “When should I worry about my toddler's aggressive behavior?” And if that's your question, we've got you covered today because I've invited two trusted developmental and behavioral pediatricians to join us.

BY THE TIME YOU FINISH LISTENING, YOU’LL WALK AWAY WITH: 
•The single most common reason behind a lot of what we call "toddler aggression" (and it has nothing to do with your toddler wanting to hurt others!)
•One vital thing parents can do to prevent and manage "aggressive behavior"
•If you've been told, "You need to spank your child!" by someone who's seen your child hit or kick - you'll know why this backfires

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The Discerning Parenting Podcast is a free informational resource for parents. As a valued listener, you acknowledge that any information you get from this podcast is for your general guidance only, and ​​must never be considered a substitute for the advice provided by a doctor, therapist, or other qualified medical professionals who know your child specifically. Read our full disclaimer policy here.

Transcript

 One of the most common questions that I'm asked is, my toddler hit or kicks?  And it gets labeled as toddler aggression. And then the parents usually ask, When should I worry about my toddler being aggressive?  And if that's your question, we've got you covered today because I've invited two trusted developmental and behavioral pediatricians to join us.

So stay on. 

 Welcome to Discerning Parenting, the podcast for parents of kids aged 12 and under who have learned the hard way that a one-size-fits-all all approach to parenting won't shift the needle for you, your child, or your family. Together, We'll explore intentional strategies that see both you and your kids thrive. 

Parenting strategies based on well-conducted research in the areas of child development, brain science, and neurodiversity need practical for you.  What if you let go of perfect and embrace discerning parenting in your family instead?  If you feel like you've been stumbling your way through. And you're ready to leave behind fight or flight mode parenting.

Then this is the podcast for you.  I'm Dr. Victoria Angolasco, developmental and behavioral pediatrician and positive parenting coach, on a mission to help you release your parenting guilt,  so you can become laser-focused on what will truly work for you.  

We are in for a special treat today because we have two trusted developmental and behavioral pediatricians, Dr. Jack Herrin. who is practicing in Manila, Philippines, and Dr. Janice Lim, who is practicing in Ontario, Canada. And not only are they developmental and behavioral pediatricians, who have helped so many families who are in that same situation, who have been asking questions like, my toddler has aggressive behavior, should I worry about this?

Or why is my toddler having aggressive behavior? Not only that, but both of them are also parents.  So today, we're going to talk about the topic, Toddler Aggression, When to Worry. So  Jack, Janice, maybe you'd just like to share a little bit about yourselves. Anything that you'd like to share? Hi, it's Jack here.  

 I'm a developmental and behavioral pediatrician practicing in Manila. I'm a dad. I've got two daughters and they're both in high school.  And it's nice to be here today. Hi, I'm Janice.  I'm one of the developmental pediatricians whose practice centers on kids who have behavioral issues.  So I deal with a lot of autism or ADHD and just big feelings in general.

I also wanted to come on and thank you for the invitation, but I wanted to come on also to share maybe some of the Parenting techniques that I've also tried on my own kids because obviously, it's always a trial and error just because you do it for a living doesn't mean it's always effective at home.

So maybe I can share about that. And I also want to get some ideas of maybe how to deal with kids. I do have kids who go in elementary school.  So definitely not past the tantrum stage for some of them.  Yeah, so thank you so much for inviting me to this podcast. And thank you for being here, and I know that our listeners are all excited to  hear what you have to share with them.

So, this is one of the biggest questions. A  toddler is being aggressive or is labeled as being aggressive.  When should I worry? That's one of the most question common questions that, that I get. But before we answer that question, let's take a look at the term toddler aggression first.  Is it really toddler aggression?

 When is it, when is it toddler aggression? When is it not? Like, for example   Usually when they say that a toddler is shouting, or is kicking, or is hitting, or is biting, or is throwing things, sometimes it gets labeled as aggressive behavior. So what is aggression really? And are these things really labeled as ag as, you know, is it really accurate to label them as aggression or as aggressive behavior when a toddler does these things? 

Well, I think that before you label anything as aggression, you do have to go to the source of everything. What is making the child act in a particular way? Now, since we are dealing with toddlers, it does go back to how does you, how does your child communicate with you? How do you communicate with your child?

Is your child capable of Speaking in one to two-word sentences, do they, are they more fluent than that, or are they having trouble communicating in general? Children who tend to communicate using shorter sentences may be prone to using actions. And, you know, how they, this is how they express their frustration.

They could probably hit or push.  They don't mean to be aggressive, but they're trying to call your attention, whether it's aggression towards a parent. Or to another child, that's their way of saying this is mine, or don't touch that, or I want some of this.  Yeah, that's true. So it can be related to their language skills  if they don't yet have the language skills to express their frustration, then actions like them, like these can be the only ways that they can express their frustration.

 Yeah. And we also have to think about  you know, what developmental stage we expect them to be in, right?  If we're thinking about the toddler, this is when your child is learning about limits and trying to push limits and learn their independence also. So some of that behavior is also because they want to test.

What are they, what do they have power over, right? And sometimes it's frustrating because the things that they have in their heads aren't what their bodies are capable of doing. And also definitely as parents, you have to set limits to what is safe and what is not. And so that can be very frustrating to a child.

And they're also realizing that now they can have bigger feelings that they can do something about, right? So a baby crying for four hours.  It's a baby crying for four hours, but a toddler who can now scream and push and run and kick at two years old is a whole different story.  So they might be expressing the same big feelings, but now they have more ways of expressing these big, big feelings.

So I think it's important to remember that it's not necessarily because they want to behave badly. Sometimes they are just behaving in a certain way, and it's really our conventions in society that have labeled that as good or bad, right? And so helping them learn the skills to identify like what are behaviors that are appropriate or not appropriate is also important.

And this is the stage where they kind of have to learn that and they have to do it by trial and error.  Yeah, that's so true.  Dr. Janice what you said about a baby crying versus a toddler acting in a way that we label as being aggressive And this is the importance of looking at the developmental stage of the child because that's something that sometimes a lot of parenting advice may not take into consideration. 

 Or even what Jack said when he said that we also take into account the language level.  Because I'm pretty sure we would deal with, let's say, hitting or kicking differently if it were, let's say, a one-year-old or a two-year-old versus a much older child. So, sometimes I see this in parenting groups or I see somebody ask a question like my child is kicking.

 What should I do? And then there's a lot of advice being given and Pupati even bothers to ask, okay, so how old is the child? Because the age of the child actually matters a lot.  I just wanted to add to what Jack had said. I completely agree that it's about language, right? And also about communication.

How effective is the child in being able to communicate? And how effective is a parent in being able to communicate to that child, to let the child know that they are able to respond to what the child is requesting? Right? Whether it's for attention, it's for time, it's for energy. If we're unable to communicate that we are about to give our attention or about to give our time or, you know, about to play with them, then the child doesn't know that, oh, you know, just a little bit more and mom or dad is going to be there for me.

 That's when some of the behaviors can come out. So I, I definitely think that the language is a piece, but I also think that as parents, we probably have to pay attention to how we communicate our intentions or our responses or our responsiveness to the child.  And to add to what Janice said earlier, it is about setting limits for your child.

What do I mean? So if they start crying, What is your response going to be to that? Is that something you're going to allow? Or is that something you, you know, if the child wants to grab a toy from his or her older brother, are you going to condone that? If you say that, okay, go ahead   give the toy to your little brother, then he or, then he'll know that, okay, I'm going to shout next time, or I'm going to hit his head  next time, because the toy's going to come to me after all.

But if you say. Maybe, okay, your brother's not done with it yet, and you can probably get it a little later, or if you choose to ignore the shouting or the hitting, the child will learn the limit that, you know, it's not really going to do any good, and they're probably not going to hit or shout or cry again the next time.

It really depends also, as a parent, on how do you respond to. Well  you know, the actions that you see coming from your child, whether it's appropriate or inappropriate, your response dictates their response.  Yeah, that's true. So earlier you mentioned that you were going to share some tips  that helped you.

 Oh, so  yeah, tips are a tricky one.  Yeah, because obviously we all like get really tired, right? Sometimes in our babies aren't necessarily on our schedule.  So maybe on that day they're not cooperative and they're not sensing that you've had a day yourself. I had a recent conversation with a friend once who's also dealing with her child with really big feelings.

And I was telling her, you know, one of the things that I realized is that I also have to be aware of my own feelings when my toddler or my child is acting up.  I remember that when my firstborn was maybe three or four  he refused to do some of the things that he needed to get done from a preschooler.

That being said, I mean, it's preschool, it shouldn't be a big deal, but as parents, you want your child to do really well, right? So you're trying to assist them in the things that they have to do.  And I remember we would get into like  fights, we would butt heads because I really wanted him to finish certain tasks and he wouldn't say yes, right?

And then I realized, okay, I'm about to scream at my child, right? I'm about to raise my voice. And of course, I'm not perfect. I'm not gonna say I've never done it. I've done it lots of times, right?  But I realized one day. Okay, you know what? I'm just going to label how I'm feeling right now.    And I'm going to help him realize that I have big feelings too.

So I actually told my child, look, I'm going to step away, right?  And I'm going to take deep breaths because I need some quiet time for myself.  And I am going to come back when I am more calm.  And so I took some deep breaths in front of him and before I left, I said, Okay, I, I want you to understand this isn't a punishment for you and I love you just the same, but I need quiet time, and I left.

Obviously it wasn't that long winded when I was explaining it to him because he was three, but basically that's the concept that I had tried to explain to him in less words.  And after like a few minutes.  He actually came to look for me and said, like, you know, I'm ready to do my work now. And I said, Oh, great.

Like, but can you hold on? Maybe give me 30 more seconds to calm down before I go and help you out. So I think what that's also taught me is that as parents, we also have to be aware of how we're reacting to our children.  when our children are dysregulated or having particularly difficult behaviors. 

Because it's really important for us to be able to show them.  some of the skills that will help them control and maybe manage their own big feelings.  And so I think modeling that behavior is also going to be helpful because then they understand that it's not because they're little, it's not because they're out of control, but they understand that everybody has to deal with these feelings and there is a way to do it. 

in a safe way. I think, yeah. So  that's it for me. I apologize for using some terms that probably are not.  We're minors.  Janice for sharing that.  What a wonderful story. So  it shows that first, definitely we're not perfect as parents. Nobody is a perfect parent and we shouldn't expect that from ourselves.

And also. It's okay to show our kids that we are upset or that we are frustrated and then to model to them how, how we handle it, to model how we regulate our own emotions.  So to answer the question   when should we worry about a toddler's aggressive behavior? So  I guess this is something like  sometimes when a toddler gets aggressive, a parent can hear a lot of different advice.

So they can hear something like, no, that's okay. That's because it's the terrible tools. You don't need to go do anything. They will grow out of it. And sometimes they hear the opposite. They're going to say that. Oh no  people are going to alarm them. Oh no, if you don't do something right now, your toddler is going to be a teenager and then he's going to still be kicking and hitting and biting everybody.

So, sometimes they would even get, receive advice like, you know, you need to spank him now. You need to show him who's boss. You need to stop the power struggle right now. Otherwise, he's going to grow up and he's never going to listen to you. So, the parent gets confused. So, is this something that is part of the terrible twos?

Is this part of being a toddler, regulating their emotions, or is there something more? So that's one of the biggest questions that we get in our clinic. We get patients who are referred to us for  what are labeled as aggression  issues. So how do we help the parent to know? when this is something that they need to  seek a consult on.

Now, while in answering this question, I just want to remind everybody that everything that we say in this podcast is for general information only, so it's not to replace a diagnosis or a consultation with your pediatrician, or it's not to replace any intervention. If somebody has recommended it, so don't ever use anything that you hear in this podcast as a reason for not getting  consult or intervention or services.

Anytime you're worried about your child's development or behavior, go and speak with  your pediatrician or with a licensed professional that you trust about it.  So I'm actually going to say something that's kind of similar, right? So I agree it's not medical advice necessarily that we are able to share.

through this medium. But one of the things that you mentioned kind of reminded me of some of the families I see in clinic. I feel that a lot of parents have very good intuition when it comes to their kids kind of needing something. They're not quite sure what the diagnosis might be. You know   they might pick the wrong diagnosis that they , read off of the internet, but they have that.

 feeling that something's not quite right and I always encourage parents to talk about that and to bring it up with their doctors because most of the time when they're seeing and observing their child at home they're seeing something and they're sensing something that maybe they don't have a medical term for but a doctor can help kind of figure out whether or not that is a problem that they have to continue monitoring or maybe they need a referral for.

I think it's really important because  Yeah, parents know their children. So when something's a little bit off, never feel ashamed, maybe, or embarrassed to bring it up with the doctor.  It might be nothing. That's what we all hope. It might be nothing, but it could be something. At  the same time, I'd like to add to that  in order to better know your child, I do believe you still should have, you still have to talk to other people about it.

Meaning, talk to your spouse, talk to your, maybe the grandparents, do they live with you? Do you  get the opinion of an older brother or an older sister? I mean, your elder sibling, your child's elder sibling. You know, you might not be home all the time, but at the very least, try and see if everybody's view of Your son or daughter's aggressive behavior is congruent with everybody else's.

Try and see, okay, what did you see? How long was it?  What made it happen? And try to put the pieces together. Don't base it on one episode or two episodes, but try and see how does this  behavior affect everybody? How long has it been going on? Is there another side to it?  I think these are the things that You have to, these are the data that you have to gather before you go to your doctor.

 So I guess  we can look out for certain warning signs or certain  what we call red flag signs. Like for example  if there are signs of  language delay that could be  triggering that aggression. And  you listen to our other episodes. Also, we have episodes about language. When do we expect babies to say their first words?

And also about  what to do if you're two year old is babbling, but not yet talking. So we do have episodes about language development. You listen to our other episodes  that too. Or if you notice certain signs, like for example  Your toddler, toddlers, we're expected  we expect toddlers to be able to point to objects, we expect them to be able to look at where we point, we expect us, we expect them to be able to have  by the time  they're about to turn three, at the latest, they're supposed to be able to have interactive conversations with us.

So if you see that they're not doing these things and couple that with the signs that they're behaving aggressively, then that's one of the red flag signs that we may need  to seek out professional help for that. I also think that we have to think about the consistency of  or the frequency  that we see the behaviors because  Sometimes  say your child is crying and kicking, right?

And inconsolable.  You have to figure out, okay  is this because of a medical problem? Is it because of pain? Is it because of an emotion that they're feeling? And sometimes maybe you can find the cause of it and figure out a solution for that. But if, say, your kid is always having certain behaviors that you're not quite sure why it consistently happens, like the  mouthing, but mouthing to the point not only when they're hungry or they're seeking to soothe themselves, but maybe mouthing and eating non food items, which can be because of a medical condition and nutritional deficiency, but also could be a sensory behavior where they need it.

The other things that I would think about is, say, the mouthing. Is it just sucking on something? Is it sucking on their fingers, right? Which we see in a lot of the kids, which might be developmentally appropriate. But is the mouthing like, I need to bite on something? And does it, does it have to be someone, right?

Like, so if you're thinking about the behaviors  and thinking about maybe how aggressive it is, one of the things that I always try to observe is, is it self injurious and is it seeking to maybe injure another?  Whether it's intentionally trying to harm another person or not, I think in the toddler stage, I would  feel it's very unusual to find that the child is wanting to hurt somebody intentionally.

I think it's always because they're seeking for a response.  for a need that other people are unable to understand. But I think if it's like a self injurious behavior, definitely it's something that you need to check out, bring to your tedious attention, because even if it's like based on pain that you're feeling in their bodies, one of the things that we notice is say dental cavities,  right?

It's not obvious. It's not a wound that we see necessarily. But if they're feeling that pain and they need to bite on something and they need to bang on their heads or the sides of their cheeks  this is something that you need to pay attention to because you could address it as a medical problem, but it could also be a behavioral problem that signals, say, a neurodevelopmental disorder.

So things like that you have to think about  and feel free to bring up with your  medical provider. Because I think it's important for them to investigate.  Thanks so much for sharing.  Any last  thoughts or tips or anything about the topic?  Well, going back to our topic of having an aggressive toddler comes back to getting the, you know, the complete picture.

Great. Try to get as much information as you can, do your own observation at home or at school,  and, and, and try to figure out what's going on.  Remember that at that age, he or she may not be the best person well, he or she may not have the ability to properly say or convey what he or she is thinking or feeling.

And there's a lot of guesswork there. And, you know, being a parent is a lot of guesswork too. So it's really about trying to make the best decision for your child using all the information that you have at hand.  Yes, that's true. And also it's very important when we're dealing with behaviors like these, we don't just look at the behavior in isolation.

And sometimes that's a problem with  when we get  sometimes pieces of advice, like it's very, it's very often on the internet, you see posts like Okay, one magic phrase you can use to end hitting once and for all. So, well, I don't know if you'd agree, but I don't think there's a magic, you know, some magic thing that we can do, but it has to do with understanding the child as a whole.

It also has to do with what we do the rest of the time when our toddlers are not being aggressive, how we connect with them  how we communicate with them. And I know that sometimes parents can get a lot of advice, like  for example, a child hits, so they say, you know, you need to hit your child so that your toddler will know that  it's painful when he gets hit, he's going to know not to hit. 

But I wonder how is a toddler going to understand that because especially since toddlers learn by example. So if they hit and then we hit them back and then we're supposed to teach them that they're not supposed to hit. What do you think about that? How does that work?  Yeah, I'd like to just add that  categorically speaking, corporal punishment is not the way to go.

 It's not, it's proven to be not effective in terms of. Teaching skills, right? So when you're trying to teach a child to behave better, you want to give them adaptive skills. You want to give them good behavior that they can model. So it might be that the pain makes them stop doing something, but it doesn't help them understand why they shouldn't do it or why what they had done was not necessarily good or not a desired behavior.

Well, I think that corporal punishment is not the way to go.  Earlier we talked about Wait, before we go into that, can you back up first? And what do we mean when we say corporal punishment?  Oh, spanking. Spanking is a big issue. Jackie, wanna talk about this?  Yeah, so examples like, okay, the child hits. So I'm going to hit the child.

I'm going to spank the child. So he knows that hitting is wrong. Or sometimes maybe things like Okay  pinching the  ear or slapping the face, anything, anything that has to do with physically, physically touching the body in any way. So you could be shoving him, pushing him against, you know, even, even just, you know, giving him a hard shove.

Hey, I don't like what you're doing, something like that. And I think that that should still count as.  So something, so something like that. But  if, for example, a child is hitting a sibling and then you get between him and the sibling, so that's okay. In fact, that's a good thing to do. Or you carry the child away from the situation  that's okay.

But what we don't want is to use  use a touch or something like that. Score a, a punishment. Okay. I think it's important to distinguish that touch with force. Is what we would consider corporal punishment, right?  Because obviously there would be times when maybe your child is reaching out and trying to scratch somebody else.

Obviously, you have to touch the child and prevent that from happening. And what I usually tell parents to do is to try to have the child keep their hands to themselves. So have a consistent language that says, you know, hands to yourself or gentle hands, right?  Sometimes you can hear some people say quiet hands so that they know where to put their hands. 

 Or some parents will say hands off. I particularly don't feel that that's appropriate for some kids because hands off what, right?  So it's better to say like where to put their hands.   That being said, I think touch with force is problematic because it shows the child a behavior that they can repeat.

Right? If you're doing it to help them behave better, they will end up thinking that that is a good thing. And so that is a strategy or a technique that they might use on other kids or other adults. When they don't like something, they might end up hitting the other person and then they're labeled as rude or aggressive when that is not the intention of the child.

 So I think we have to be very careful when we use  spanking or even in the old times, I would think like belts, right?  Or even having them like any sort of physical contact that seeks to contain them with a lot of force is probably going to be ineffective because all they remember is to Maybe the pain, but they don't understand why in the first place  the behavior had to be corrected. 

Well, you know, to add to that, we talked about your child's ability to comprehend or to understand or to converse. And if you think about it, if your child does not really understand why he's being hit, then hitting him for any reason is not going to work at all.  And. If you say that, well, my child understands that he is not supposed to hit, then you might as well just talk to him and say, I didn't like your behavior.

What, what can we do? How can we talk to your friend and probably ask for the toy without hitting or grabbing? So by the time your child is old enough to understand, there's still no reason to hit at all. You just have to talk to him in a nice way and make him understand verbally what you want done.  And I think for the kids with cognitive difficulties, so the kids who have say lower level of intelligence where their understanding might not be so good, I think one of the dangers in model behavior that's not desired, like the behaviors that you don't want to happen, is that once they see it, it can become a habit, right?

And so it's really, really hard to try to correct that and extinguish it because their language might be limited  their understanding of consequences might be limited. And so once they see it, that's a very effective way of teaching something, right? And so it's harder to take it out and explain like, no, you're not supposed to do that.

Oops, that was a mistake, right? So I think it's very important to keep that in mind, that what they see is some of the first things that they will learn first. Because it's so easy to imitate.  And most kids will imitate rather than listen.  When they're much, much younger.  Yeah, that's true. Now, thank you so much for sharing with us  your expertise and then for sharing also your experiences and your stories.

And I know that today  our listeners  learned a lot from you. So  thank you.  Thanks for having us.  But if you'd like to know more, you'd check out our course. We have a course called Teaching Emotional Regulation, and Drs. Jack and Janice are also  two other doctors who are teaching this course with us.

And we've received wonderful feedback about this course and how it has helped parents teach emotional regulation to their toddlers. You check out  discerningparenting. com slash toddler. And you're going to see our resources for toddlers. Again, that's  discerningparenting. com slash toddler. And if you enjoyed our episode today, don't forget to follow our show and also to leave us a five star review so that we'll be able to reach and help more parents.