Children receiving cancer treatment and siblings can be quickly overwhelmed by their experiences.
When stressed children do not always have outlets for their emotions, strong feelings can manifest as challenging outbursts.
You can help your children by recognizing these tantrums are a result of inner turmoil, and identify ways to diffuse their stress before it bubbles over.
Tantrums Are Normal
Tantrums are simply how young children express strong emotions before they have learned to recognise and communicate their feelings, and they have not yet developed socially acceptable ways to diffuse them. These fits of stomping, screaming, verbally abusive rage or thrashing about in tears on the floor, and refusal/inability to co-operate are part of normal child development.
Usually starting around 1 year old, tantrums continue through the toddler years. They begin to fade away as the child’s communication skills develop and they become more able to define their feelings, wants and needs.
Expect Tantrums
Tantrums may happen when the young child is under intense stress. Older children who have grown past tantrums may also regress to tantrums. Regression is a natural coping response for overwhelmed children when they encounter unfamiliar, intense emotions or situations, lack the vocabulary or confidence to express their feelings, and have fewer healthy coping skills to navigate their experience.
While this behaviour is understandable, your child needs loving support to understand, express, and diffuse their emotions safely. With compassion and patience, help your child identify problems and develop ways of coping with their stress before it boils over.
Identify Your Child’s Triggers
Tantrums occur because the child feels overwhelmed by a situation and/or their emotions. The outburst is more extreme, and happens more easily and more often when the child is also physically uncomfortable – for example, they feel hungry, hot/cold, tired, or unwell. You can predict potential flash points by being aware of your children’s major stressors, and keeping a note of what triggers their tantrums. For example, having an IV inserted or being left with neighbours. Here are some common triggers for children affected by cancer:
- A specific medical procedure / anticipation of a procedure.
- Not understanding what they need to do, or what will happen.
- A change in familiar routines without clear explanation.
- Not wanting to be touched / wanting to be left alone.
- Not wanting to be left alone / separation from a parent.
- A transition: e.g. between home and hospital; day care and home.
- Having something or someone taken away from them.
- Picking up stress in the people around them.
- Sleep deprivation: reduced or broken night-time sleep, and/or loss of a usual daytime nap – such as with a hospital admission, or altered routine for siblings staying with friends/relatives.
- Delayed mealtimes (such as on EUA days), or altered diet – especially involving increased processed foods.
Diffuse Stress to Prevent and Minimize Tantrums
By recognising the potential triggers, you can take steps to prevent or diffuse your child’s stress and reduce the risk of a tantrum occurring. If stress does bubble over, your child will likely have much less angst, and calm down sooner. Some suggestions include:
Maintain Routines
Wherever possible, keep to familiar routines such as mealtimes, daily naps, and bedtime. Avoid long outings and social engagements that will unnecessarily tire your child, or delay their regular mealtime and sleeping routine. However, be careful not to eliminate the parts of daily life that bring them fun and joy while protecting vital routines, as these also help to reduce stress.
Prepare Your Child
Prepare your child for the procedure and give appropriate choices. Choices might be which arm for the IV, which comfort position or which distraction method.
For siblings who react to going to a neighbour, you can diffuse stress by taking time with them in advance to pack a special overnight bag, and telling them you miss them when you are apart. If possible, let them choose which friend or relative to stay with. Slip a special treat in the bag and tell them that when they find it, they will be reminded that you are thinking of them.
Provide Comfort Tools
If your children have a favourite comfort toy, blanket or pacifier, let them have this during potentially stressful events. Parents often withhold these comforts, feeling they are inappropriate for the child’s age. However, regression to previously outgrown behaviour is a common and natural coping mechanism in stressed children. Denying the needed comfort item will only intensify the child’s distress.
These interventions will only be helpful when you take time to prepare with your child in advance. They will be ineffective as last minute actions when your child’s stress has already bubbled over into a tantrum.
Create and Clarify Rules and Boundaries
With your children, define the rules and the consequences of breaking them, and stick to them. A key rule to reinforce around tantrums will be “Do not harm yourself or anyone else, or damage anything around you”.
Be reasonable about the standards you expect from each child. Remember that their emotional competence is still evolving; while you have a lifetime of experience to draw on, their ability to understand and express what they feel is being repeatedly overwhelmed. While bad behaviour must be addressed, most children need patient understanding and support more than discipline at this time.
Teach Emotional Literacy
Young children become overwhelmed by big emotions in the natural process of their development. When they face a major stressor like cancer, giving them loving support, tools and skills to learn about and work through their confusing feelings is critical.
From our blog, October 2021, Child life specialist Rebekah Reimer provides some practical guidance to help your child work through big emotions.
Support Your Child Through a Tantrum
When a tantrum has already begun, you can help your child find their way back to calm faster with the following:
- Stay calm with deep breaths; you will be more able to respond, rather than react to their angst.
- Remove sharp objects and trip hazards from your child and their immediate environment to prevent injury.
- Do not hit, shout at, or otherwise punish your child.
- Do not end the tantrum by bribing your child, or giving in to their demands. This teaches them to manipulate other people with inappropriate behaviour.
- Kneel or crouch down to your child’s eye level; this will help them feel more secure than if you address them from a stooped or standing position.
- Validate your child’s feelings by acknowledging that they are hurting – “I’m so sorry you are so mad right now”.
- Assess if your child may be too hot or cold and, if possible, take steps as needed to improve their comfort.
- If your child is hungry or tired, and it is practical to do so, offer food or sleep before engaging them in conversation.
- Help your child identify and name the emotion they are experiencing – “Can you tell me what you are feeling? It looks like you are pretty angry”; “It can be really scary not knowing what will happen next. Is that what you are feeling?”
- Reinforce the boundaries while validating your child’s feelings again: “I can see you are scared/angry about this situation, but you cannot hit your brother.
Remind your child that cancer is not their fault. Magical thinking is common in young children, and they will need regular reassurance. Loving conversation after tantrums are a key time to repeat the message.
Seek Help
Most children gradually adjust to life with retinoblastoma, and the experience of treatment. But for some, the impacts can be very tough. If your child’s emotions cause destructive behaviour that you cannot manage alone, ask for help.
A child life specialist, psychologist, social worker, nurse specialist, and the wider medical team can work with your children and entire family to address specific issues. If you are unsure of the most appropriate professional to approach for help, ask your oncology nurse for guidance and a referral.
