Dealing with Challenging Behaviour
Tantrums
What are tantrums?
Tantrums tend to start between two and three years old, although they can start earlier. During a tantrum, a child will often shout, scream and cry. They may also kick, hit or bite. Tantrums are very common and almost all young children have them - some more than others.
Why do they happen?
Tantrums occur because young children are not able to express themselves easily. Toddlers can also want independence and become frustrated when this can't or doesn't happen. Tantrums tend to decrease and/or stop after four years of age as children are better able to understand the world around them and communicate their needs and wants.
What can I do when my child is having a tantrum?
when you child is having a tantrum:
- Try to be calm and consistent - speak slowly and quietly, don't worry about what other people may think if you are in public and don't give in to the tantrum as your child may then see this as a way of getting what they want.
- Ignore the tantrum - ensure that your child is safe and explain that you will be there for them when they have calmed down, then carry on with what you were doing.
- Reassure - after the tantrum, reassure your child, talk to them about their emotions and if they are old enough, talk about how they might deal with those emotions differently ("use your words if you are angry").
- Positive reinforcement - try to make a point of noticing and commenting on good behaviours (such as "you are playing very nicely with your brother") so that your child gets attention for acting in the way you would like them to.
How can I prevent a tantrum?
Not all tantrums are preventable since this is a normal phase that toddlers go through. However, it is useful to have a predictable routine for sleeping and eating in order to prevent your child becoming overly tired or hungry. Ensuring that your child spends time outdoors being physically active can also help. Talking with your child about what you will be doing that day can prepare them for what is going to happen. Let your child make small choices about their day when this is possible. Distraction may also help if you sense that your child may be about to have a tantrum - keep a small toy nearby (in your bag) or point out something particularly interesting to your child.
What can I do if I need more help?
If you are struggling to cope with your child's behaviour, talk to your health visitor or GP.
Further information:
Separation Anxiety
What is it?
Separation anxiety in children is common and very normal. It tends to occur between the ages of six months and three years although it can crop up at other times in response to stress and change. Your child may not like being held by other people or may get upset when you leave the room. They may also cry and protest when you go to new places or leave them with other people, for example, at nursery.
Why does it happen?
Separation anxiety begins when a child starts to understand that they are dependent on their caregiver but this person/people are separate to them and can leave. This can make the child feel worried and insecure.
What can I do to help?
It is important to understand that this is a normal phase for your child. Although some children struggle with this phase more than others, it will almost certainly get better in time. Here are a few things you can try:
- Practice separation - try leaving your child for short periods of time, let them know what is happening and when you will be back.
- Say goodbye and go - have a short and predictable goodbye routine, make sure you leave after you have said goodbye.
- Use a comforter - some children like to have a familiar item (cuddly toy or blanket) when they are apart from their main caregiver.
What if I need more help?
If your child is extremely distressed and this does not improve over time, contact your health visitor to discuss your concerns
For more information click here.
Sleeping
How much sleep should my child be getting?
For age specific information on sleep please click here.
below are approximate guidelines that are suitable for most children to feel rested:
Age & Sleep Requirement:
0-3 months - 14-17 hours
4-11 months - 12-15 hours
1-2 years - 11-14 hours
3-5 years - 10-13 hours
6-13 years - 9-11 hours
14-17 years - 8-10 hours
18-25 years - 7-9 hours
Why is my child not sleeping?
There are many reasons why young children may have difficulty sleeping including:
- Sleep association (something or someone your child needs to fall asleep e.g. needing to be fed to sleep or held/rocked)
- Separation anxiety
- Being overtired
- Bedtime fears (being scared of the dark)
- Nightmares
- Night terrors
For older children, bad sleep habits, too much caffeine, too much screen time, worries, stress and mental health problems can all contribute towards poor sleep.
What can I do to help?
- Try to understand and address the underlying problem.
- Having a bedtime routine - a warm bath, dim lights and a story can all be relaxing and help to signal sleeping times.
- Have a consistent bedtime and wake time, adapting this to your child's sleep needs as they get older.
- A comforter may help a young child settle at bedtime and if they wake during the night.
- Avoid screen time in the hour before bed.
- Make sure your child has a cool, quiet, dark and comfortable place to sleep.
What if I need more help?
If you need further help and support, speak with your health visitor and/or GP.
For more information:
Fussy Eating
What is fussy eating?
Many pre-school aged children can be fussy about what or how they eat. It is not uncommon for children to refuse to eat certain foods, eat a very limited range of food or refuse to eat at all.
What can I do to help?
The following things may help:
- Try not to worry or focus too much on food - if there are no problems with your child's growth and development it's best to wait for your child to outgrow this phase.
- Eat together as a family and eat the same meal, ensuring that your child has an appropriately sized portion and that their food does not have any added salt.
- Keep trying with new foods and offer them in different ways (e.g. offering carrot cooked, uncooked, grated, mixed in a sauce etc.).
- Get your child involved in preparing and cooking meals.
- Praise your child when they try something new.
- Aim for no more than two snacks a day.
- Don't cook to order, if food is uneaten at the end of the meal, just take it away without comment.
What if I need more help?
If you need further help and support, speak your health visitor and/or GP.
Further information:
Bedwetting
Up to the age of 5 years, wetting the bed is normal. It usually stops happening as your child gets older without the need for any treatment:
- up to 1 in 5 5-year-olds wet the bed
- 1 in 20 10-year-olds wet the bed
- about 1 in 50 teenagers wet the bed
- about 1 in 100 teenagers continue to wet the bed into adulthood
Bedwetting happens when your child makes more pee at night than their bladder can hold; unfortunately, young children often don't wake to the feeling of a full bladder, which means that they wet their bed whilst they are sleeping. It can run in families, and boys are more likely to wet the bed than girls.
The good news is you don't need to wait until children grow out of bedwetting - treatment is now available and recommended from the age of 5 years.
What should you do?
If your child is under 5, you don't need to see your GP about their bedwetting unless:
- it happens a lot and is upsetting them
- they're constipated despite you changing their diet
- they have also started wetting themselves during the day, but had been dry most days for a while
- they go to the toilet a lot during the day (for example, every hour), they can't hold on for even a few seconds or minutes, peeing is painful, or they're peeing less than 4 times a day
Other practical tips include giving them their last drink of the day no later than 90 minutes before they go to sleep and encouraging them encourage them to pee as the last thing they do before they go to sleep. Ask you health visitor or school nurse for advice if you are worried.
For commonly asked questions and excellent practical information about the treatment of bedwetting, click here.
For what is being done in Hampshire and Isle of Wight, click here.
Toileting
Strategies for toileting
Children all develop toileting skills at varied times and communication skills are vital to this process. Many children will follow simple instructions best when supported with a visual cue. This could be an object of reference e.g. “toilet time” and then show your child an object which would represent this. This approach can be used with a photograph, sign, or visual card too. Visual toileting strips in the bathroom area can help a child to remember what are the next steps, this can be at the side of the toilet area.
Social story or story books
Social stories can help increase understanding of the toileting process and help to build upon understanding of what will happen next. There are many social stories which can be purchased and individualised to the child and also many character story books are available in many book shops.
Toileting
Children with bladder and/or bowel problems cannot always rely on a good signal telling them they need to go to the toilet. In order to get the wee and poo in the toilet they need a regular toileting routine. Children tend to not spend enough time on the toilet and can hop on and off without concentrating on what they should be doing. It is important that your child feels comfortable and relaxed when using the toilet. Use a foot rest that is high enough that your child’s knees are slightly above the hips. Correct positioning helps to relax the muscles that support comfortably and easy passage of stools.
Toileting Top Tips
- You can use a sand timer to encourage children to sit for longer periods of time. This can be gradually increased, start with 2 minutes and gradually increase to longer intervals.
- Make sure the bathroom is warm and inviting! Close the windows and maybe put up some posters for your child to look at.
- Take advantage of the body’s natural ‘gastrocolic reflex’. Encourage them to try on waking and about 20-30 minutes after main meals and before bed.
- Try to keep to a routine, using the toilet around the same times every day and also when your child says they feel the need to go – always respond to the body’s urge to poo!
- Stay with your child. Do not leave the child sitting on the toilet by themselves for long periods of time.
- Ensure the toilet is comfortable to sit on. Some children fear they will fall into the toilet, so it is important to get an add-on seat for smaller children.
- A footstool is very important to ensure your child has good support for their feet.
- Put some toilet paper into the bowl first so that there is no splashback when a poo is passed. Some children get a fright if there is a splash!
- When sitting on the toilet your child should be able to lean forward and rest their elbows on their knees higher than their hips.
- Your child should be relaxed when sitting on the toilet and not straining.
- Talk to your child when following these steps so that they know what you are trying to achieve.
- Motivate sitting by having a ‘Toilet Tub’ - this could contain a special toy, book or chosen fidget toy to only play when they are sitting. It really helps if you can make it fun.
- Making your child laugh, blowing bubbles or a balloon can help contract their tummy muscles.
- Massage tummy in a clockwise direction.
- Many children find sitting on the toilet challenging. Trying a First and Then approach may help with resistant behaviours e.g “First Toilet, Then Dinosaurs”.
- Add a character of interest on the walls of the bathroom.
Toileting Chart
Positive Feedback
We all need to be motivated to make behaviour changes so our children will need the same. You can see in your child’s face, their smile and their eyes that children respond to praise. Giving your child positive feedback is a key part to help your child manage constipation. Download the chart here.
A sticker chart is an easy way to reward your child’s positive behaviours. The idea is that there are specific toileting goals represented by different animals on the Potty Chart. Once they have reached the animal they put a stick on the woodland toilet trail. Every time they reach an animal on the Potty Chart they get a small reward such as:
- Special stickers
- Fun stationary – pencils, rubbers, colouring pencils
- Craft activity
- One-on-one activity with parent – special story, trip to the park, board game
Tips
- Be consistent – always give stickers and verbal praise promptly
- Focus on the positives, give stickers for positive behaviours
- Give verbal praise with each sticker
- Don’t take stickers away once the child has earned that sticker
What if my child doesn’t respond to toileting charts?
Not all children will respond to toileting charts and rewards, if that is the case for your child we have a variety of resources we can share. Visual social stories can often be helpful and you can try tailored rewards for children with additional needs.
Toilet Training
When to start?
Most children are ready to start potty training between 18 months and 3 years of age. However, all children are different and it is important to wait until your child is ready. You might feel your child is ready to start potty training when you notice the following:
- Your child can get on and off of the potty
- Your child can pull their clothes and underwear down
- Your child can follow instructions
- Your child knows when they have a wet or dirty nappy and they tell you this
- Your child can stay dry for an hour or two
- Your child knows when they are doing a wee and they tell you this
- Your child knows when they need to do a wee or a poo and they may tell you this in advance
How to start?
- Choose a time when there are a few other big changes such as house moving or a new sibling arriving
- Keep a potty in the bathroom (and one downstairs if the bathroom is upstairs)
- Once you have chosen a time to start, swap nappies or pull-ups for pants
- Encourage your child to sit on the potty regularly, particularly after meals and at any time you know your child normally does a poo
- Encourage boys to sit down to wee - this helps them to empty their bladder properly and makes sure they can poo as well if they need to
- Don't make a fuss if they have an accident but do praise them when they succeed
Night-time potty training
Night-time potty training might take longer than daytime potty training. If your child's nappy is dry or very nearly dry in the morning, they may be ready for night-time potty training. Make sure that your child uses the potty just before bed and then make sure it is nearby in case they need to use it overnight. Use a waterproof sheet and have clean bedding and pyjamas to hand. If things aren't going well, stick with nappies for a little longer and try again later.
What to do when there are problems?
If after you start potty training, it appears that your child was not quite ready, go back to nappies/pull-ups and try again in a few weeks. If you have any other concerns about potty training, talk to your health visitor and/or GP.
For what is being done in Hampshire and Isle of Wight, click here.
Further information:
When should you worry?
12-18 months
12-18 MONTHS
Contact your health visitor or GP if your baby is 12-18 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag their leg or foot when crawling or walking
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink
- Finds it hard to stand or walk, for example:
- Can’t pull to stand
- Fall over a lot when standing still
- Doesn’t cruise (walk while holding on to furniture)
- Walk on their tiptoes a lot
18-24 months
18-24 MONTHS
Contact your health visitor or GP if your baby is 18-24 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag their leg or foot when crawling or walking
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink
- Find it hard to balance when standing still, or fall over a lot
- Can’t walk by themselves
- Walk on their tiptoes a lot
- Are suddenly unsteady when walking
2 years
2 YEARS
Contact your health visitor or GP if your baby is 2 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your child’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when crawling or walking
- Rarely use one of their arms to play, eat and drink
- Find it hard to balance when standing still or fall over a lot
- Can’t walk by themselves
- Mostly walk on their tiptoes
- Are suddenly unsteady when walking
- Haven’t started to run
- Move from laying down or sitting to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing
3 years
3 YEARS
Contact your health visitor or GP if your baby is 3 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your child’s arms or legs, making it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely uses one of their arms to play, eat and drink
- Find it hard to balance when standing still or fall over a lot
- Can’t walk by themselves
- Mostly walk on their tiptoes
- Are suddenly unsteady when walking
- Have not started to jump or run
- Move from laying down or sitting to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing
4 years
4 YEARS
Contact your health visitor or GP if your baby is 4 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- Find it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely use one of their arms to play, eat and drink
- Find it hard to balance when standing still
- Suddenly become unsteady when walking
- Find it hard going upstairs or uphill
- Trip or fall a lot
- Walk on tiptoes most of the time
- Feel pain in their arms or legs
- Move from laying down or sitting on the floor to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing.
5 years
5 YEARS
Contact your health visitor or GP if your baby is 5 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- Find it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely uses one of their arms to play, eat and drink
- Find it hard to balance, or trip or fall a lot
- Persistently walk on tiptoes
- Suddenly become unsteady when walking
- Feel pain in their arms or legs
- Move from laying or sitting on the floor to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing.
15 months
Your Child By Fifteen Months
Social/Emotional Milestones
- Copies other children while playing, like taking toys out of a container when another child does
- Shows you an object she likes
- Claps when excited
- Hugs stuffed doll or other toy
- Shows you affection (hugs, cuddles, or kisses you)
Language/Communication Milestones
- Tries to say one or two words besides “mama” or “dada,” like “ba” for ball or “da” for dog
- Looks at a familiar object when you name it
- Follows directions given with both a gesture and words. For example, he gives you a toy when you hold out your hand and say, “Give me the toy.”
- Points to ask for something or to get help
Cognitive Milestones (learning, thinking, problem-solving)
- Tries to use things the right way, like a phone, cup, or book
- Stacks at least two small objects, like blocks
Movement/Physical Development Milestones
- Takes a few steps on his own
- Uses fingers to feed herself some food
18 months
Your Child By Eighteen Months
Social/Emotional Milestones
- Moves away from you, but looks to make sure you are close by
- Points to show you something interesting
- Puts hands out for you to wash them
- Looks at a few pages in a book with you
- Helps you dress him by pushing arm through sleeve or lifting up foot
Language/Communication Milestones
- Tries to say three or more words besides “mama” or “dada”
- Follows one-step directions without any gestures, like giving you the toy when you say, “Give it to me.”
Cognitive Milestones (learning, thinking, problem-solving)
- Copies you doing chores, like sweeping with a broom
- Plays with toys in a simple way, like pushing a toy car
Movement/Physical Development Milestones
- Walks without holding on to anyone or anything
- Scribbles
- Drinks from a cup without a lid and may spill sometimes
- Feeds himself with his fingers
- Tries to use a spoon
- Climbs on and off a couch or chair without help
2 years
Your Child By Two Years
Social/Emotional Milestones
- Notices when others are hurt or upset, like pausing or looking sad when someone is crying
- Looks at your face to see how to react in a new situation
Language/Communication Milestones
- Points to things in a book when you ask, like “Where is the bear?”
- Says at least two words together, like “More milk.”
- Points to at least two body parts when you ask him to show you
- Uses more gestures than just waving and pointing, like blowing a kiss or nodding yes
Cognitive Milestones (learning, thinking, problem-solving)
- Holds something in one hand while using the other hand; for example, holding a container and taking the lid off
- Tries to use switches, knobs, or buttons on a toy
- Plays with more than one toy at the same time, like putting toy food on a toy plate
Movement/Physical Development Milestones
- Kicks a ball
- Runs
- Walks (not climbs) up a few stairs with or without help
- Eats with a spoon
2.5 years
Your Child By Thirty Months
Social/Emotional Milestones
- Plays next to other children and sometimes plays with them
- Shows you what she can do by saying, “Look at me!”
- Follows simple routines when told, like helping to pick up toys when you say, “It’s clean-up time.”
Language/Communication Milestones
- Says about 50 words
- Says two or more words together, with one action word, like “Doggie run”
- Names things in a book when you point and ask, “What is this?”
- Says words like “I,” “me,” or “we”
Cognitive Milestones (learning, thinking, problem-solving)
- Uses things to pretend, like feeding a block to a doll as if it were food
- Shows simple problem-solving skills, like standing on a small stool to reach something
- Follows two-step instructions like “Put the toy down and close the door.”
- Shows he knows at least one color, like pointing to a red crayon when you ask, “Which one is red?”
Movement/Physical Development Milestones
- Uses hands to twist things, like turning doorknobs or unscrewing lids
- Takes some clothes off by himself, like loose pants or an open jacket
- Jumps off the ground with both feet
- Turns book pages, one at a time, when you read to her
3 years
Your Child By Three Years
Social/Emotional Milestones
- Calms down within 10 minutes after you leave her, like at a childcare drop off
- Notices other children and joins them to play
Language/Communication Milestones
- Talks with you in conversation using at least two back-and-forth exchanges
- Asks “who,” “what,” “where,” or “why” questions, like “Where is mommy/daddy?”
- Says what action is happening in a picture or book when asked, like “running,” “eating,” or “playing”
- Says first name, when asked
- Talks well enough for others to understand, most of the time
Cognitive Milestones (learning, thinking, problem-solving)
- Draws a circle, when you show him how
- Avoids touching hot objects, like a stove, when you warn her
Movement/Physical Development Milestones
- Strings items together, like large beads or macaroni
- Puts on some clothes by himself, like loose pants or a jacket
- Uses a fork
4 years
Your Child By Four Years
Social/Emotional Milestones
- Pretends to be something else during play (teacher, superhero, dog)
- Asks to go play with children if none are around, like “Can I play with Alex?”
- Comforts others who are hurt or sad, like hugging a crying friend
- Avoids danger, like not jumping from tall heights at the playground
- Likes to be a “helper”
- Changes behavior based on where she is (place of worship, library, playground)
Language/Communication Milestones
- Says sentences with four or more words
- Says some words from a song, story, or nursery rhyme
- Talks about at least one thing that happened during her day, like “I played soccer.”
- Answers simple questions like “What is a coat for?” or “What is a crayon for?”
Cognitive Milestones (learning, thinking, problem-solving)
- Names a few colors of items
- Tells what comes next in a well-known story
- Draws a person with three or more body parts
Movement/Physical Development Milestones
- Catches a large ball most of the time
- Serves herself food or pours water, with adult supervision
- Unbuttons some buttons
- Holds crayon or pencil between fingers and thumb (not a fist)
5 years
Your Child By Five Years
Social/Emotional Milestones
- Follows rules or takes turns when playing games with other children
- Sings, dances, or acts for you
- Does simple chores at home, like matching socks or clearing the table after eating
Language/Communication Milestones
- Tells a story she heard or made up with at least two events. For example, a cat was stuck in a tree and a firefighter saved it
- Answers simple questions about a book or story after you read or tell it to him
- Keeps a conversation going with more than three back-and-forth exchanges
- Uses or recognizes simple rhymes (bat-cat, ball-tall)
Cognitive Milestones (learning, thinking, problem-solving)
- Counts to 10
- Names some numbers between 1 and 5 when you point to them
- Uses words about time, like “yesterday,” “tomorrow,” “morning,” or “night”
- Pays attention for 5 to 10 minutes during activities. For example, during story time or making arts and crafts (screen time does not count)
- Writes some letters in her name
- Names some letters when you point to them
Movement/Physical Development Milestones
- Buttons some buttons
- Hops on one foot
Advice and Guidance
Self care and Prevention
Video Showcase
Related Conditions
Further Information
