© 2012 Roy Benaroch, MD

Christy posted: “My seven year old son has been having trouble managing his anger. He is typically a very laid back child with a great temperament. However, when something does upset him he will usually lash out — hit, kick walls, slam doors, throws items, yells and screams, and will take it out on everyone and everything around him. It is a tornado effect. When this happens, we calmly and firmly tell him to stop the negative behavior and we then send him to his room to let him calm down. Unfortunately, things usually get worse when we talk with him. After a series of fits, tears, etc., he will come back to apologize but won’t let us discuss things. He will just say ‘Can we please forget it?’ or ‘Can we not talk about it?’ I feel that we need to discuss things with him so he understands his behavior and so it doesn’t happen again. However, he always wants to sweep everything under the rug. I would love any advice you have that could help calm him down before he gets to that ‘anger’ point. Any advice?”

Anger and frustration are emotions we all have sometimes, and they’re feelings that many of us could do a better job managing. They’re especially difficult for children to handle, because they haven’t yet developed mature communication skills and the ability of modulate emotions—when they’re mad, they’re MAD with a capital ‘M’! Many adults, unfortunately, haven’t really learned to manage anger very well, either. So I’m glad you’re trying to help your son learn to cope with this better. Lessons learned well now will help him for the rest of his life.

First, keep in mind that the goal isn’t to tell him not to get angry, or make anger itself something “bad” or something that needs to be punished. Getting angry, that’s OK. What you’re trying to do is teach him how to get angry in a good way.

You’ll want to make sure that the adults in your son’s life are managing their own anger well. Adults serve as models, and if you or Dad are yelling and screaming, that’s what your children are going to learn. Children will learn far more from what you do than from what you say.

Talking about anger management is important—but many parents do it at the wrong time. Once your child has “lost it”, you’re not going to be able to have a meaningful or useful discussion. Send him off to his room to cool, and don’t follow him, and don’t raise your voice. At the height of a tantrum, you’re not going to teach anyone anything. Right afterwards is still not a good time for a big discussion. He’ll still be overwrought, and embarrassed, and he’s going to feel picked on if you start up the lecture as soon as he’s calmed down. Instead, you should wait until a few hours later, or even the next day, to bring up the explosion. “Wow,” you might say. “You were really upset. Maybe there was a better way you could have handled that, do you think? Rather than screaming and throwing that toy, what would have been a better way?” Try to get the right answers out of your child, without saying them yourself. Make sure he hears positive reinforcement, too:

Child: “I shouldn’t have hit my sister.”

Wrong response from parent: “Yeah! But you still always do it! What’s wrong with you?”

Better response: “That’s right, I knew that deep down you knew that already. What would be a better thing to do next time?”

Child: “I should have just taken some deep breaths, or just walked away.”

Wrong response from parent: “Why don’t you ever do that? You always make it a fight!”

Better response: “That’s exactly right. I know it’s hard to remember to do the right thing when you’re mad. I’m proud that we could talk about this now, and I know you’re going to try to do better next time.”

Sometimes, indirect teaching works best. Children can find “the big talk” kind of scary and intimidating—that’s when you sit ‘em down, and tell ‘em what’s expected of them. Instead (or in addition), try some indirect teaching by putting on a puppet show, where the characters get angry at each other, and handle it well (or maybe one character can be “the good guy” who teachers another character how to not freak out.) You could get your own child to be the voice of a puppet himself. Indirect teaching can also occur by discussing people you see together, or making up stories together, or painting a scene. The idea is that by talking about how other people feel and how other people learn, your child can learn himself—but without the direct baggage of thinking about himself as the person who is the disappointment.

Make sure that you’re teaching your child what he ought to do, not just what he shouldn’t do. You shouldn’t just say “Don’t hit, don’t scream, don’t yell, don’t throw …” without giving him some ideas about what he can do when he gets angry. Some good ideas:

• Take deep breaths (sometimes a very-specific number helps, like “14.” There’s a magic in counting.)
• Go to your room and scream into your pillow.
• Flip your mattress over (this is surprisingly difficult for a child to do, and—bonus!—you’ll get your mattresses rotated!)
• Punch a (safe) punching bag.

Most importantly, recognize that a child’s own temperament isn’t something that can easily change. Learning to handle anger in a mature way isn’t a weekend project. For many people, it takes years to learn this skill. There will be good days and bad days, and some setbacks too. Remember to continue to model how you want your children to act, and provide plenty of specific positive reinforcement when your child makes even a few baby steps in the right direction. If you’re feeling discouraged, or you don’t feel that you and your child are making headway, ask your pediatrician for a referral to a family therapist or another counselor with experience in anger management in children.

© 2012 Roy Benaroch, MD

“I can just tell he has an ear infection! Can’t you just call in an antibiotic?”

I don’t want kids to suffer, and I don’t want kids having to go to an ER or busy after-hours place on the weekend. (In Atlanta, parents have a great after-hours alternative—kids can see a real pediatrician after hours!) Why not just call in weekend antibiotics without seeing the child? If a parent thinks their toddler has an ear infection, how likely is it that they’re right?

Researchers in Finland tried to find out. In a 2010 study, they reported their findings based on 469 children over a 2 year period who were brought to a clinic because of parental concerns of a possible ear infection. The children were all aged 6 – 35 months. Prior to their exams, parents recorded the degree of ear pain, irritability, crying, restless sleep, fevers, and many other symptoms. Examinations were performed with state-of-the-art equipment, and videos of the ear exams were reviewed by an ENT specialist to confirm the diagnoses.

It turned out that none of the symptoms could reliably differentiate children with ear infections from children whose ears were normal. Not pain, not height of fever, not how the children were acting. Parents who reported these symptoms were just as likely to have  a child with or without a real ear infection. Ear rubbing was actually more common in kids who did not have an ear infection.

The only reliable way to tell if a child has an ear infection is to look at the eardrum. Even then, it’s not always easy. Sometimes there’s wax, and sometimes, even for me, children squirm and yell. Unless you get a good exam, there is just no way to know. And it is important to know, before you start antibiotics– if you’re going to use antibiotics at all. Since many ear infections will improve without antibiotics, unless a child seems really miserable it’s often best to wait a few days, especially if it’s a weekend. An ear infection that got better on its own didn’t need to see the doctor, anyway!

So: if your child seems to have an ear infection on the weekend, do things to help him feel better. A gentle heating pad or a dose of ibuprofen or acetaminophen will provide quick relief. Emergency, weekend care is really only needed if your child remains miserable even after pain medication. Starting antibiotics without a sure diagnosis is like flipping a coin—you may be doing more harm than good.

© 2012 Roy Benaroch, MD

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