The Terrible Twos: Surviving the Toddler Years

Podcast Transcript

Dr. Richard So:

Welcome to Little Health, a Cleveland Clinic Children's podcast that helps navigate the complexities of child health one chapter at a time. In each session, we'll explore a specific area of pediatric care and feature a new host with specialized expertise. We'll address parental concerns, answer questions, and offer guidance on raising healthy, happy children. Now, let's talk little health.

Welcome back to Little Health. I'm your host, Dr. Richard So, a pediatrician at Cleveland Clinic Children's. Today, as we continue our season on primary care, we're delving into the mysterious and often terrifying world of kids and the terrible twos. We'll be talking about epic tantrums and the sudden obsession with the word no. Our guest today is Dr. Carrie Cuffman, a developmental and behavioral pediatrician at Cleveland Clinic Children's, and a mom of two young boys. Welcome back to Little Health, Dr. Cuffman.

Dr. Carrie Cuffman:

Thanks for having me.

Dr. Richard So:

Let's get right into it. Terrible twos, what are they? You know, and why do they occur?

Dr. Carrie Cuffman:

Right. That's a, that's a great question. So, you know, the, um, terrible twos come out because kids at the age of two are really starting to develop the ability and capability to, um, you know, have their own opinions, have their own, um, thoughts on how things go. So, you know, in the way cognitive development happens in kids, that's why the terrible twos happen, because the goal of a two-year-old is to become more independent. Right? So, so that's what we're seeing when we see the kids say no or have tantrums, is them kind of ex-exerting their own independence, um, on their parents. Right?

Dr. Richard So:

Yeah. Let's talk about that word no a little bit. Because what I know about no is that that's a learned trait from parents.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

I think terrible twos, I think you can prevent them earlier-

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

... maybe 15 to 18 months.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

You know, because twos, they don't, they're still learning the words and they don't even know the meaning of the word-

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

No.

Dr. Carrie Cuffman:

Right.

Dr. Richard So:

You know? So around 15 months in my practice, what I usually do is I think little kids, they're, they're like dogs.

Dr. Carrie Cuffman:

(laughs) Yep.

Dr. Richard So:

All right. They can't speak to you.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

Right? But I think they understand what you're saying.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

And I always preach that they don't respond to what you're saying, but it, like a dog, it's more the tone of your voice and your facial expression.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

It's actually a fun part of being a, a parent-

Dr. Carrie Cuffman:

Yeah, absolutely.

Dr. Richard So:

... you know, is that 15 to 18 months before you get to knowing no, no, no. And I tell parents, "Don't use that word."

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

Because number one, when you use it, I tell them, "You want to save it for when it's emergency." But I always tell 'em, say, "Ah, ah, ah, stop, freeze."

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

You know, excuse me. Uh, but at other times, you know, it's like when they're touching it, you really have to have that poker face.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

Because I love that age, because it's the fun part where you actually get to learn to be a parent-

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

... of learning how to reprimand. But that poker face is so important, where the grandparents, they're smiling and they send that mixed message, no, no, no. And the kid does it right back to you.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

But eventually they learn that tone and that voice. So, talk to me about no again.

Dr. Carrie Cuffman:

Yeah. Completely agree with what you said. You know, with my own kids, my, my two boys who are both still pretty young, you know, we really tried to, um, do a lot of redirection, right, rather than saying no. So tell the kid what you want them to do instead. Don't just say no and, or don't say it at all, like you said. You know, so you're really teaching the kids at a very early age, you know, how you want them to behave without using the word no.

So, yeah, I completely agree with that. And, and I think that you can ca- teach kids, oh, you know, mom is telling me not to do this, but, um, you know, she's giving me an alternative approach to what I wanna do. Right? And that can really help in that two-year-old age.

Dr. Richard So:

Yeah, I agree a hundred percent on that part where saying no, it, it, the kids, they don't under, they don't understand how to express their feelings yet.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

You know, I think that's around between two and three years old when we watch those movies where you teach them fear, anger, disgust-

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

... uh, joy.

Dr. Carrie Cuffman:

Right.

Dr. Richard So:

Right. Everybody knows who, what that movie is, but at, at this age, two years old, I think they're little echoes and they copy what you do.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

And I, I see the grandparent always smiling saying, "No, no, no." And they're waving their finger, and then all of a sudden the kid does it back. You know, and then it doesn't mean no anymore.

Dr. Carrie Cuffman:

Right.

Dr. Richard So:

It means I-

Dr. Carrie Cuffman:

It's just a, a joke.

Dr. Richard So:

It means, it means I love that song.

Dr. Carrie Cuffman:

Yeah, right.

Dr. Richard So:

Alright. And then that creates confusion.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

But I believe that when the kids have that, part of the terrible tantrums is that they're frustrated.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

And they don't know how to express it. And it could be a tantrum, it could be hitting, it could be biting.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

Right? You know, and we'll get into whining later, but with that tantrums, for example, you have a two-year-old-

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

... boy, and what do you do when you're at the store?

Dr. Carrie Cuffman:

(laughs) Right.

Dr. Richard So:

Okay.

Dr. Carrie Cuffman:

Right.

Dr. Richard So:

And he wants, you know, that Paw Patrol toy.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

You know, and you say you can't have it, and then you get complete meltdown.

Dr. Carrie Cuffman:

Right. Well, you know, the first thing is that you don't give in to a tantrum. Right? Because then you're just asking for more tantrums. Um, it's also helpful, I find, to, you know, label the feeling. You know, I see you're mad. I see you're angry. So you're giving them the words, just like you mentioned there. They can be little echoes. And so teaching them the feeling words is really important. So they eventually develop the ability to say, "I'm mad," rather than screaming.

Um, and then, you know, you can still console the child without giving them what they want. You know, saying, "I'm sorry you're mad. We're not gonna get the Paw Patrol toy." And then kind of moving on and redirecting the kid as best you can. There have been times where I've definitely had to take my kid outta the store. Right? (laughs) That has happened. That happens to everybody. So no parent should feel embarrassed when that happens. Right? Everybody in the, every parent in the store knows what they're going through. But, you know, it is much better to say, you know, "We're not gonna do that. I'm sorry you're mad." And then if you need to leave, you do. Right? And that's, you know, been my approach. So-

Dr. Richard So:

Yeah. I've seen one parent in the store where the kid couldn't get the sweet flavored yogurt and actually had a complete meltdown, shaking, trembling in the store right on the ground, you know? And the mom just stood there and she was watching him. I walked by and she goes, "Oh, he's just having his daily seizure." And I, and I walked by.

Dr. Richard So:

I, I didn't tell her I was a pediatrician, but I just go, "You're doing the right thing."

Dr. Carrie Cuffman:

Uh-huh.

Dr. Richard So:

But I, what I respected her for is that she didn't walk out of the store.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

All right. And she didn't give in.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

What is the balance between, you know, ignoring the tantrum, you know, with tough love versus coddling your child?

Dr. Carrie Cuffman:

Right. As a developmental pediatrician, I talk a lot about behaviors with, um, parents. And so, you know, every behavior has a reason. Right? So, um, when you're thinking about what the reason is behind the behavior, that helps you learn how to react to it, right?

Dr. Richard So:

Mm-hmm.

Dr. Carrie Cuffman:

So if a kid is having a temper tantrum to get your attention, the thing you do not want to do is give them your attention. Right? So, so in that case, you don't want to be, you know what, you might say, "Oh, I'm sorry you're mad." We're gonna move on to something else and then ignore the rest of the tantrum. There's a difference between a tantrum 'cause I want something versus a tantrum for attention. And so you need, really need to think about why the kid is having the tantrum.

And maybe if they want something, it's more appropriate to kind of stay by their side and remind them, you know, briefly, that you're there and you're waiting for them to calm down and, and being calm and, you know, gentle about it, versus a kid who's having a temper tantrum just to get your attention. And you really wanna do your best to ignore that more completely.

Dr. Richard So:

Yeah. What we learned about tantrums is that there's different phases, like a, like a trapezoid level.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

You got the rumbling phase.

Dr. Richard So:

You got the peak seizure, which is flat on top.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

And then you have the resolution phase.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

So when we prevent tantrums or you make any type of intervention, you can't really do it when th- there's the peak screaming and crying, but you either gotta do it on the way up or on the way down.

Dr. Carrie Cuffman:

Right. Exactly. Yeah.

Dr. Richard So:

To me, toddler stands for, it's my little mnemonic, uh, timeouts for aggression, divert, distract, and if you can't divert, distract, you, let 'em rest.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

So talk to me about like, rumbling and prevention of tantrums.

Dr. Carrie Cuffman:

Right, yeah. So the, when they're kind of on the escalation phase there, the rumbling, that's your time when you're... can try the redirection, try labeling the feeling, um, that sort of strategy. If they're really going at their peak, then probably ignoring is best in that situation. Right? 'Cause they are, you know, kind of in a fight-or-flight mode. They're not thinking rationally, if toddlers do much rational thinking, right? (laughs)

Dr. Richard So:

Yeah.

Dr. Carrie Cuffman:

They're not super rational yet, but even less rational at that point in time. And so nothing you say or really do at that peak moment in time is probably gonna make a difference. So ignoring is probably the best strategy if they're really kind of peaking. And then as they come back down, once again, you can try those other strategies of kinda redirecting, moving them along to go to the next thing, whatever it might be.

Dr. Richard So:

You're a parent, and I'm a parent, and everybody's raised a little bit differently.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

So when there's the tantrums, you know, I really like your empathy of acknowledging their feeling.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

And I think, more importantly, is the parent has to be intact with their own feelings.

Dr. Carrie Cuffman:

Yeah.

Dr. Richard So:

Because when the kids rise up in tension, you feel it. And how we were raised often dictates what our response is.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

So if the kid goes up in rage, there's parents, it's like they try an alpha dog and go up on top of them.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

And try and talk about don't do this, don't do this, don't do that.

Dr. Carrie Cuffman:

Yeah.

Dr. Richard So:

You know? And what I think is, is that you have to stay calm.

Dr. Carrie Cuffman:

Yes. Absolutely. Yeah. You know, if you think about, um, when, if you're, if there are two adults who are getting angry at each other, uh, both people getting angry does not help them calm down. Right? And so about, when you think about a kid who has even, you know, fewer emotional regulation skills as an adult has, uh, the parent must stay calm to help the kids stay calm. That's exactly right.

Dr. Richard So:

Yeah. I, I think it's the hardest part is staying calm and realizing that if your kid is crying, it's gonna stop.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

It's gonna stop.

Dr. Carrie Cuffman:

Yes.

Dr. Richard So:

And then if you don't get them on the way down, it's gonna peak right back up.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

At, at what point do you think where there's a difference when there's a problem between having tough love and your kids having tantrums? When would you, when would they call me or would they call you as a developmental and behavior pediatrician?

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

When is that time?

Dr. Carrie Cuffman:

Like when they're having like, too significant of tantrum. So the answer to this question depends on the kid's age. Right? Because we expect toddlers to have tantrums. We expect three-year-olds to have tantrums, four-year-olds, even five-year-olds to have tantrums. And so if your kid is having such significant tantrums that they're hurting themselves, hurting other people significantly, you know, a little bit of aggression in the preschool age range is actually really normal. So I'm not worried about a little swat here and there, but like, consistently having really significant aggression is a good time to go and talk to your pediatrician.

Or if your kid is having hours-long tantrums that you can't bring them down from, um, every day or multiple days a week, that's another good reason to just talk to your pediatrician or, um, a developmental pediatrician to just see if there's something else that may be going on, um, in your kid, um, that needs, you know, further addressing by professionals. Right?

Dr. Richard So:

Yeah. That's great advice. Part of tantrums, you know, what we get at is, you know, there's hitting, there's biting. We know that a lot of that is because they have poor communication skills. They haven't learned to express their feelings or express their frustrations. And it leads to biting-

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

... or hitting. You know, what are some good books that you think that are good out there for kids?

Dr. Carrie Cuffman:

Ooh.

Dr. Richard So:

'Cause I learned that becoming a, a complete pediatrician, you have to master development and behavior.

Dr. Carrie Cuffman:

(laughs) Yes.

Dr. Richard So:

And what are the books that, that you-

Dr. Carrie Cuffman:

Yeah.

Dr. Richard So:

... would tell parents? 'Cause I think at that age, kids, they love to read. They're copycats and they want to say and do whatever they're reading in the books.

Dr. Carrie Cuffman:

For my two-year-old, I really like the Grumpy Monkey books. I don't know if you're familiar with those-

Dr. Richard So:

Uh-huh.

Dr. Carrie Cuffman:

... but they're really, really good. Talks about being grumpy and, um, you know, the, the monkey is grumpy and then kind of eventually gets over it and realizes he's, he's missed out on a lot of fun. Right? Um, so that's one of my favorite. I've had other, um, families really like the Spot Emotion books. It's a lo- much longer series, and it's sometimes actually used by schools. So that's another good set. But the Grumpy Monkeys are some of the favorites in, in our household.

Dr. Richard So:

Yeah. I've used Teeth Aren't for Biting.

Dr. Carrie Cuffman:

Yes.

Dr. Richard So:

Hands Aren't for Hitting.

Dr. Carrie Cuffman:

Uh-huh. Yeah.

Dr. Richard So:

Those are the basics, but I just want to get your professional opinion-

Dr. Carrie Cuffman:

Yep, yeah.

Dr. Richard So:

... on what the, some of the other ones.

Dr. Carrie Cuffman:

(laughs) Yep.

Dr. Richard So:

Um, w- how about, here's another one that, that really, really is tough for parents i- during the terrible twos is the whining child.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

You know, there's different cries out there, and there's the aha.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

And you know, there's that cry. What do you do when the kid's always whining with that, you know, you wanna give in.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

As a parent, we talk about emotional regulation, your kid, but emotional regulation for your kid where I just wanna pull my teeth out, my kid's whining.

Dr. Richard So:

He, she wa- It's winter outside and she wants to wear the sparkly shoes, and that's like-

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

... inappropriate.

Dr. Carrie Cuffman:

Right.

Dr. Richard So:

You know?

Dr. Carrie Cuffman:

Yeah. Yeah.

Dr. Richard So:

What do you do in those cases and wha- what advice do you have for parents?

Dr. Carrie Cuffman:

Right. So, you know, I think that, you know, whining is kind of, I think of as, it's a very annoying behavior, but it's kind of a lower level behavior compared to a tantrum. Right? So that is a perfect behavior to use your ignoring skills for, right? So if the kid is whining, so, you know, for example, they want something special to drink, you're not giving it to 'em. They're just whining, whining, whining about it. You know, you can say something like, "You know what, I, I understand you want that, but you know, we're gonna do this now. We'll talk again when, when you've moved on, or, you know, when you're ready to do our next activity."

And so you tell them you're gonna ignore them. You don't blatantly say, "I'm going to ignore you," but you warn them that, you know what, I'm gonna withdraw my attention from you until you are kind of over this and responding to me more appropriately. Right?

Dr. Richard So:

Yeah. It's really hard for a parent to learn about tough love.

Dr. Carrie Cuffman:

It's really hard.

Dr. Richard So:

When you say, "Ignore," that's really, really hard.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

And it's hard for parents, you know, their emotional response is, is a negative. It's like, "No, you can't do that, don't do this, don't do that."

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

But then, like me, when my wife gives me a list of five things to do, I can only do three.

Dr. Carrie Cuffman:

Uh-huh.

Dr. Richard So:

So they, they get confused and they don't know what to do. So I always give them additional options or different choices.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

You know?

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

But sometimes, what's the number one cause of their tantrums or their outbursts? They're sleepy.

Dr. Carrie Cuffman:

Yes (laughs).

Dr. Richard So:

That's the number one thing.

Dr. Carrie Cuffman:

Yep.

Dr. Richard So:

They're sleepy or they're hangry.

Dr. Carrie Cuffman:

Hungry. Yeah.

Dr. Richard So:

Yeah. Those are the two things where actually where there's tantrums, I don't ignore them.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

It's tough on that one, but I, those are the two caveats in it. It's kind of like when Mrs. So is hangry, she gets whatever she wants, but-

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

... with my toddlers as well is that when they're sleepy or hangry, I tell parents not to ignore the tantrums.

Dr. Carrie Cuffman:

Right. Well, I think that, you know, kind of goes back to I was talking about like, why, why you're doing a behavior. Right? And in that, that, the kid might not know, they can't put into words, I'm hungry or I'm sleepy. But that's what they're asking you for, right? So you can help them out by saying, "Oh, it seems like you're starting to feel tired. Let's get you ready for bed." And, you know, move them through that so you're not ignoring that tantrum. I completely agree.

I don't... The same thing, you know, when my kids are sick. It, you can't, you know, I don't think any parent can ignore their sick child crying. Right? You know, that is, that's probably not appropriate. Right? Because we also wanna model and teach empathy. So, you know, I, I do think there are times when it's not appropriate to ignore or do that because you do need to, to model kindness and empathy for your kid.

Dr. Richard So:

Yes. Identifying that your kid is tired, you may see the eye rub, you may see the yawn.

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

You know, and a good thing to do is when you can't divert and distract that child, okay, that's a sleepy kid.

Dr. Carrie Cuffman:

Right, right (laughs). Yeah. Right.

Dr. Richard So:

So that's the kid I'm picking up, and you pick 'em up, you put over your shoulder and you say, "I know, I know. I, I know you're-

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

... you, you're upset."

Dr. Carrie Cuffman:

Mm-hmm.

Dr. Richard So:

And then all of sudden they fall asleep in two minutes and you're like, "Good dad, you made the right decision."

Dr. Carrie Cuffman:

(laughs) Right. Yeah, exactly. Exactly.

Dr. Richard So:

Um, when you get to two years old, they're becoming a little bit more independent and they're learning to fight for themselves. And one thing that is always hard for a parent is bedtime battles-

Dr. Carrie Cuffman:

Right.

Dr. Richard So:

... where, "I'm not sleepy." You know, and it's, it's not, they're not sleeping. And what do you do?

Dr. Carrie Cuffman:

Right. That's a great question. So, you know, I think the, the first kind of rule of bedtime, and I talk to my patients about this all the time, is you have to have a routine, right? Bedtime, wake up time should always be the same. And you should have a really, you know, set routine around bedtime that is calming. Right? And doesn't include screens.

So at my house, we do, um, bath and then we read books, and then we say our prayer, and then we get in bed. Right? And, and that is how it always is, right? But, you know, you can run into trouble as kids start getting older and they wanna get out of their beds or that sort of thing. So being really consistent about bringing kids back to bed and, um, setting kind of firm limits around bedtime is really, really helpful. You know, we've used some, there's a really nice strategy that I like called the Bedtime Pass.

Dr. Richard So:

Tell me more about that.

Dr. Carrie Cuffman:

So, um, this is for like, older kids. Probably not even quite two-year-olds yet, but three-year-olds or so can handle this. But you give them like, a physical pass that they can use like, once during the night to get out of bed, but if they don't use it, then they get like, a very small reward in the morning, a sticker on their chart or something like that. Right? It's helpful for kids because they have that like, physical reminder that, you know, if I keep this, I get something in the morning. Versus, you know, sometimes it's hard for kids to not have like, a physical or visual reminder of things. Right?

And so, um, so that can be really helpful and help parents set limits in a, a really more kind of effective way around getting out of bed overnight or getting up, you know, for the, kind of those curtain calls around bedtime.

Dr. Richard So:

Thanks a lot, Dr. Cuffman.

Dr. Carrie Cuffman:

You're welcome.

Dr. Richard So:

The terrible twos, they may be a wild ride, but it's also a crucial time for your child's development. Try and embrace the chaos. Celebrate your small victories as a parent. Breathe and cherish any precious moments. Thanks for listening to Little Health, and thank you, Dr. Carrie Cuffman.

Thanks for listening to Little Health. We hope you enjoyed this episode. To keep the Little Health tips coming, subscribe wherever you get your podcasts, or visit clevelandclinicchildrens.org/littlehealth.