About to Have a Parent Tantrum? Polyvagal-informed practices to help.

Another scenario common to all parents is the feeling of an impending or the presence of an actual parent tantrum.

We have all been there. We become so frustrated, so aggravated with whatever the current situation may be that we become angry, we may raise our voice, we may say or think things we would otherwise never contemplate. In essence, this is the parent equivalent of the classic toddler temper tantrum. How do we manage such a situation?

First, it is important to always remember that we are all human. Our physiology all works the same way. No matter how good our intentions, or how much we practice skills and strategies to manage our physiology, we are still human. As humans, we will not always get things right, we will not always show up or respond the way we would like and we may have reactions, even tantrums, that do not reflect our true nature or desires. This recognition is a component of the non-judgmental acknowledgement of our physiological state.

The first step in managing a parent tantrum, like with all situations, is the acknowledgement of the current physiological state without judgment or criticism. It is important to recall that our response to internal and external cues occurs, via neuroception, beneath conscious awareness and is not deliberately decided. As such, we did not choose to react to a given internal or external cue in a fashion that led to the tantrum. This does not reflect our intentions, values, or how we would like to respond to the stimulus. This is an unconscious reaction mediated by our nervous system.

While the manner in which we neurocept a given stimulus is not under our control, what happens next can be better controlled. If we are able, through training our nervous system, to rapidly identify the shift in our physiology, we are then able to implement the appropriate skills to shift our physiology towards the desired state. Using this concept, we can illustrate the process for the parent tantrum. In response to a particular internal or external stimulus, we have neurocepted a cue of uncertainly, risk, or threat. The resulting physiological response is a shift towards a sympathetic state. The nature and characteristics of a tantrum correspond very closely to this physiological state.

Following identification of the present sympathetic state, we can then implement our skills and strategies to shift our state towards a ventral vagal state through breathing, thinking, relaxing muscle tone, opening posture, and use of our voice. It is important to note that developing a wide array of skills and strategies is ideal as the preferred skill or strategy may vary at different times or under changing circumstances.

In order to provide the greatest opportunity for success in managing our physiology, it is therefore preferable to have many different tools in our proverbial toolbox. As with the case of shifting away from a dorsal vagal state, each successive instance in which we are able to modify our physiology in response to stimuli strengthens our ability to not only do so in the future but also to tolerate increased levels of stress without associated unwanted shifts in our physiology.

As can be appreciated from the above description, there is substantial empowerment available through embodiment of the skills and strategies based upon Polyvagal Theory.

By understanding our physiology and training the ability to manage our physiological state, we are better positioned to be at our best for ourselves and those around us. This approach respects and works with our physiology and does not attempt to overcome or override it. In so doing, we are best able to express our fullest potential in alignment with what we find most important and value most.

REFERENCES

Dana, D. Polyvagal Exercises for Safety and Connection: 50 Client-centered Practices. New York: W.W. Norton & Company; 2020.

Dana, D. Anchored: How to Befriend Your Nervous System Using Polyvagal Theory. Boulder, Colorado: Sounds True, 2021.

Delahooke, M. Brain-Body Parenting: How to Stop Managing Behavior and Start Raising Joyful, Resilient Kids. New York: HarperCollins, 2022.

Porges, SW. Polyvagal Safety: Attachment, Communication, Self-Regulation. New York: W.W. Norton & Company; 2021.

Porges, SW. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-Regulation. New York: W.W. Norton & Company; 2011.

Porges, SW. Presidential Address, 1994. Orienting in a Defensive World: Mammalian Modifications of our Evolutionary Heritage. A Polyvagal Thoery. Psychophysiol 1995; 32: 301-318.

A special thank you to Dr. Darin Davidson MD for his collaborative interview on Polyvagal Informed Practices.

Introduction into Polyvagal Theory

Have you ever been stuck in traffic? Has your child ever had a tantrum in public?

We have all been in these situations many times. When these circumstances occur, are there days when you respond in a calm and constructive fashion while at other times become frustrated, aggravated, or felt like giving up? Of course, we have all experienced these feelings and reactions to these situations at one time or another.

Why does this occur?

The situations are the same, or at least very similar, so why might we have such a different responses? The answer to this important question lies in the function of our nervous system. Specifically, the explanation relates to how our nervous system is continuously scanning our internal & external environment for cues of safety and cues or risk or uncertainty. While this may seem complex, an understanding of Polyvagal Theory makes this more accessible than it may appear at first.

The concepts of Polyvagal Theory are becoming more commonly discussed and encountered within all areas of life. While the more frequent discussion of this theory may be relatively recent, it was first described by Stephen Porges, PhD in the mid 1990’s. This theory is evidence-driven and describes how our nervous system, specifically the autonomic component, functions in response to the cues and stimuli we continuously encounter in our internal and external environments. The theory further explains how our nervous system uses this information to direct responses across our entire body, including our thoughts, muscle tension, posture, hearing, voice, breathing, and digestive functioning.

The basis for these widespread effects is our vagus nerve and its connections to many aspects of our physiology. The true power of this theory lies not only in its explanation of how we experience the events in our life, but through the provision of skills and strategies that we can implement to direct our physiology in ways that are most supportive of what we are trying to accomplish in a particular situation.

Polyvagal Theory is based on details of our neurophysiology which are common to all social mammals.

There are specific core principles which are important to understand in order to apply the details of the theory in our lives. These include the physiological states determined by our nervous system, the process of neuroception, the social engagement system, and the concept of our physiological state as an intervening variable. With an understanding of these concepts, it is possible to embody the principles of the theory and improve our lives as well as the lives of those around us.

The physiological states determined through Polyvagal Theory are ventral vagal, sympathetic, and dorsal vagal.

These states are evolutionarily determined with the ventral vagal state being most recent. It is important to understand the characteristics of each state in order to be able to identify our state at any given time and learn to shift our state towards that which we choose.

The ventral vagal state is one in which we are grounded and connected to ourselves and others. Our thinking tends to be more oriented towards curiosity, being open to possibilities, and optimistic. Our muscle tone is relaxed, our jaw and facial features are softened, there is range & prosody in our voice, and our posture is open. Our breathing is deeper and slower, typically in conjunction with a diaphragmatic pattern. There is increased variability in the time between our heartbeats, referred to as heart rate variability. Our heart rate is increased during inhalation and decreases during exhalation, referred to as respiratory sinus arrhythmia. This state is considered as a state of safety and connection, both to ourselves and others. It is within this state that our body is in homeostasis and is able to recover and restore itself.

The sympathetic state is the widely known as the fight or flight response. This occurs in response to a perceived risk or threat. This state is characterized by anxious, angry, or aggressive thoughts. Our muscle tension and jaw tighten. The prosody and pitch of our voice loses its fluctuation. Our posture becomes more closed. Our breathing pattern typically becomes faster, more shallow, and centered in the chest. Heart rate variability is decreased.

The dorsal vagal shutdown state is best described by the response of the body to an overwhelming threat in which we try to conserve as much resource as possible by hiding and, at the extreme, feigning death. Our muscle tone is decreased. Our facial features become flat. Our breathing slows and becomes shallow. Our thoughts are consistent with giving up and hiding.

While each of these physiological states are appropriate and adaptive in certain circumstances, we are best able to express our truest and fullest potential as well as problem solve and perform to our highest capacity in either a ventral vagal state or a blended ventral vagal-sympathetic state. Due to this, the states can be organized in a hierarchy with the ventral vagal state at the top, followed by the sympathetic state, and the dorsal vagal state. It is important to note that we both descend and ascend this hierarchy through each state. In practice, this means that in order to ascend from a dorsal vagal state, we must first reach a sympathetic state, if even only briefly, before reaching a ventral vagal state.

The next foundational principle of Polyvagal Theory is neuroception.

This is the process by which are nervous system essentially scans our internal and external environments to detect cues of either safety and connection or cues of uncertainty, risk, and threat. This process occurs continuously and beneath conscious awareness. On the basis of whether there is a preponderance of cues of safety and connection or uncertainty, risk, and threat our physiology will shift on the hierarchy. If the balance of cues is in favor of safety and connection our body moves towards a ventral vagal state. On the other hand, if the balance is towards uncertainty, risk or threat our physiology moves first towards a sympathetic state and, if there are further cues of risk and threat or the initial threat is not resolved, then into a dorsal vagal state. It is important to emphasize that neuroception occurs whether or not we choose to acknowledge the process and develop skills to shift our states towards our chosen physiology. This process occurs beneath conscious awareness and, as such, it is not our choice to shift towards sympathetic and/or dorsal vagal states and to take on the characteristics of those

states.

The next foundational principle of the theory which will be discussed is the social engagement system.

This describes the connection from our brainstem to the muscles and organs in our face and chest through various cranial nerves. Many of the characteristics of the physiological states described above specifically reference the head and neck region. The resulting changes in facial features, voice, muscle tone, posture, and breathing not only reflect and impact our own physiological state, but also provide cues to those individuals around us. Through the process of neuroception, those individuals will then determine whether or not we are providing cues of safety and connection or cues of uncertainty, risk, and threat. It is through this social engagement system that we are able to influence the physiological state of ourselves and those around us. If we truly feel safe and connected in our body, we are able to project these cues externally through the social engagement system and this will allow those around us to shift their physiology towards a ventral vagal state. This process is termed co-regulation. The ability to shift our own physiology towards a ventral vagal state is termed self-regulation. Typically, it is not possible initially for younger children to self-regulate. Rather their future ability to self-regulate is dependent upon co-regulation from their caregivers when they are young.

The final foundational aspect for consideration is the principle of physiological state as an intervening variable.

Functionally, this corresponds to the understanding that our current physiological state will influence the process of neuroception such that a particular cue may be neurocepted as a cue of safety and connection if we are in a ventral vagal state but may be neurocepted as a cue of uncertainty, risk, or even threat if we are in a sympathetic or dorsal vagal state. This principles informs our everyday experience of noticing different reactions to very similar events, such as the traffic and public tantrum examples, described above.

In response to cues of uncertainty, risk, and threat both internally and externally, we have seen how our physiology can shift towards sympathetic and dorsal vagal states. This process is not in and of itself maladaptive. Rather it is the normal, predictable, and expected response of our nervous system in response to these cues. By extension, the hallmark of a healthy, resilient, and adaptive nervous system is not the lack of dysregulation towards these states. Rather, the defining feature of resilience within our nervous system is our ability to restore stability following periods of dysregulation. In particular, it is our capacity to efficiently and effectively self-regulate.

Follow along to read more about Polyvagal Theory and Parenting in this next blog!

Blog contribution from Darin Davidson MD, MHSC, FRCSC Polyvagal Informed Coaching & Concierge Care

Follow on social media: @ParentSuitcase on Instagram and Pinterest

REFERENCES:

Dana, D. Polyvagal Exercises for Safety and Connection: 50 Client-centered Practices. New York: W.W. Norton & Company; 2020.

Dana, D. Anchored: How to Befriend Your Nervous System Using Polyvagal Theory. Boulder, Colorado: Sounds True, 2021.

Delahooke, M. Brain-Body Parenting: How to Stop Managing Behavior and Start Raising Joyful, Resilient Kids. New York: HarperCollins, 2022.

Porges, SW. Polyvagal Safety: Attachment, Communication, Self-Regulation. New York: W.W. Norton & Company; 2021.

Porges, SW. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-Regulation. New York: W.W. Norton & Company; 2011.

Porges, SW. Presidential Address, 1994. Orienting in a Defensive World: Mammalian Modifications of our Evolutionary Heritage. A Polyvagal Thoery. Psychophysiol 1995; 32: 301-318.

Single & Solo Parent Support: A collaboration with Dr. Monica Krishnan, PharmD

Are you a single / solo parent that is in need of support?

In 2021, there were approximately 15.6 million children living with a single mother in the United States, and about 3.6 million children living with a single father.* It’s clear that single & solo parent households are becoming more prevalent in this country—- why are we not adapting socially to meet the needs of these seismic household shifts?

Today I am collaborating with Dr. Monica Krishnan, PharmD who is one of my favorite collaborators from Instagram. I’ve collaborated with Dr. Monica in the past on “the invisible workload performed by pharmacy staff” which emphasizes the often unseen labor pharmacy staff perform on a routine basis. As I’ve mentioned in previous posts and blogs, burnout is a hot topic but it’s not a trend. In order to attack it from multiple angles, we (the burnout specialists) have to highlight & define the “invisible” workload and gaps in resources / support to make any sort of enduring, substantial changes.

Dr. Monica, a solo parent, had some thoughts on her own experience that she wanted to share with Parent Suitcase.

“Solo parenting is not easy as it comes with many challenges. It also comes with a beautiful opportunity to grow as a person, and over time I have learned that I am the perfect parent for my two beautiful daughters. Remind yourself by looking in the mirror and say out loud you are a rockstar and you are doing the best you can! Remember you are doing twice the work so pat yourself on the back daily!”- Dr. Monica

The United States has the world’s highest rate of single parent households and they are less likely to live with extended family**. How can we as a community maximize the resources that single & solo parents have while also advocating for additional resources to be readily available in both work & home atmospheres? Here are our Top 8 tools & tips following by some valuable links to other single & solo parent resources….

1) Build your support system/ community: Who provides you external support? You community may be comprised of local friends, family members, parent groups, mentors, etc. When you are cultivating your own social safety net, take into consideration level of trust, reliability, and parental competitiveness. The goal is to feel secure in your exchanges vs. competing for the “Best Parent Award”. I have shared some other in-depth information on how you can do this in previous posts on Parent Suitcase

2) Ask for help - don’t be afraid to ask for support, you deserve help: Support comes in many forms- mental health support, physical support, household task support, etc. Solo parents bear a massive responsibility to their families; for many single & solo parents, working part-time / full-time / double shifts to remain (or achieve) financial security is a reality. Address household tasks in an age-appropriate manner and create a flexible household action plan so that the lion’s share of the workload doesn’t fall onto one person’s shoulders. For mental health support, seek out health-related advice from your healthcare team if you are feeling like you need some additional professional guidance.

3) Developing a mindfulness practice: This one came highly recommended by Dr. Monica as a solo parent working frontline in the midst of a pändem1c. According to Jon Kabat-Zinn, the 7 Key Attitudes of Mindfulness are: not-judging, patience, holding a beginner’s mind / open & curious, trust, not striving / present moment focus, acceptance, and letting go.*** We both love Dr. Gandhi and her sessions on IGLive and IGTV: Ruminations on Gratitude

4) Self-care essentials: Dr. Monica’s Self Care Tool Box: exercise, therapy, meditation, nature walks, scheduling joy, listening to inspirational podcasts, maintaining a gratitude practice (Dr. Gandhi’s practice), finding your tribe of women, or trying a new hobby.

5) Build a network with other parents for additional support: setting up a reliable carpooling schedule / backup transportation, offering occasional backup sitter care, opportunities for social connection.

6) Schedule “me time“ daily: even if it’s 5-15 min/day! Self-investment is a key component in maintaining overall optimal health & wellbeing. Whether you decide that those 5-15 minutes are spent on nothingness or they are best spent painting, use that opportunity to give back to yourself. Before you became a parent, you had hobbies, interests, and needs that needed to be met. As a parent, the same applies, even if it takes some sifting through weighted layers of responsibilities and never-ending, scrolling daily task lists.

7) Feel all your emotions- some days are harder than others! That “not-judging” attitude that Kabat-Zinn mentioned…

8) Seek mental health supported if needed: I mention this EVERYWHERE and Dr. Monica stands firm on this, too. If you are feeling too overwhelmed or need some additional coping strategies to manage your daily life, there is no shame in seeking out additional mental health support. There are so many providers that are championing this now on social media- mental health is a component of our overall health and both are uniquely intertwined.

And now for some additional single & solo parent resources:

Single Parent Advocate: visit their website to see how single families can find healing and hope
The Single Parent Project: dedicated to providing financial relief and other resources
A Single Mother: Grants for Single Moms: a collection of all grants available to U.S. single moms and other resources
Single Mother Guide: a breakdown of grants and their amounts by state and living situation
Parents Without Partners: single parent support group for all single parents & their children

Without ample support systems in place, single & solo parenthood can feel overwhelming. “Special stress for single parents often arises from a critical economic situation, little social support and the increased demands arising from the child’s sole care and upbringing. Also, single parents more often fear that they have too little time for their children and their education.”****

Gather your practical resources here and share your own favorites below with us! We are so grateful that you are spending your valuable time reading this collaborative blog and can’t wait to hear from you.

Follow @parentsuitcase and @drmonicapharmd for more content that can help you live a more supported, resourced life. Join us on our platforms as we provide practical, real world resources and support for all families and stay tuned for more on this topic!

Request a “Parent Suitcase” topic by DM here!

Sources:

*https://www.statista.com/statistics/252847/number-of-children-living-with-a-single-mother-or-single-father/

**https://www.pewresearch.org/fact-tank/2019/12/12/u-s-children-more-likely-than-children-in-other-countries-to-live-with-just-one-parent/

***https://www.sc.edu/about/offices_and_divisions/housing/documents/resiliencyproject/7keyattitudesofmindfulness.pdf

****Sartor, T., Lange, S., & Tröster, H. (2022). Cumulative Stress of Single Mothers - An Exploration of Potential Risk Factors. *The Family Journal*, *0*(0).

Disclaimer: The information on this platform is not intended or implied to be a substitute for personal professional medical advice, diagnosis, or treatment. All platform content including text, graphics, images, and information is for general information purposes only & does not replace clinical consultation with your own doctor/mental health professional.

When a child is diagnosed with cancer: Part II

Treating a child with cancer does not start and stop with the medical interventions.

There must also be careful consideration & management regarding the emotional and psychological health of the child, the parents, other siblings (if applicable), and the family in general. It is important to maintain as normal a routine as possible for the child, including schooling, time with friends, and enjoyment of other activities. While this may be disrupted if inpatient treatment is necessary & during recovery from treatment, the more the usual routine can be followed, the better for the overall health & wellbeing of the child and family. Of course, if modification is necessary for comfort, that is completely understandable. You have to do what works best for you and your family, and sometimes that means being flexible and adapting as needed.

What are some ways to create stability in routine?

1. Reading familiar books, maintaining a similar bedtime rouotine

2. Eating a family meal together

3. Doing something creative or something that brings you joy, particularly an activity that requires minimal effort

4. Prioritizing rest when needed

5. Working on school activities together (if applicable)

6. Finding ways to remain social, even if it can only be virtual (based on current needs & recommendations from healthcare team)

7. Scheduling virtual calls with school friends

Involvement of child life specialists can be very beneficial in this regard. This service is frequently available through pediatric specialty centers. Child life specialists work with children & families to help them cope with some of the stressors they may experience while being treated for cancer. They help families by providing different coping strategies while undergoing different medical procedures, preparing mentally for various tests / diagnostic procedures, providing parent education and ways to be supportive & educated on such procedures, developing coping tools for sibling support, etc.

There are many resources that can assist families, particularly during the treatment phase of childhood cancers. Connecting with other families with children with similar cancer types and treatments is critical to increase support for the family. Obtaining financial resources regarding travel and accommodations, if needed, is also available through many organizations and should be explored. It is also important to obtain reputable information from such sites as ‘cancer.net’, ‘cancercare.org’, ‘childrenscancer.org’, as well as sites dedicated to the specific type of cancer. If you follow me on Instagram, I recently covered this topic and offered some resources specifically for childhood cancer support here:

1. Comfort items for hospital stays

2. Parental Health & Childhood Cancer

3. “My child just received a cancer diagnosis, what is my first step?”

4. How to support a family whose child was diagnosed with cancer

5. National Childhood Cancer Awareness Month

In anticipation of upcoming appointments, it can be helpful for parents to put together a list of questions to ask the treating providers. These 6 questions can include (and are not limited to) the following:

1. Is the diagnosis correct and how do we know? This question is not intended to offend the treating provider- the intention is to provide more insight on clinical findings, diagnostic results, pathology findings, etc. The more informed we can be as parents, the more we can understand the details of the child’s care plan, collaborative next steps, and how to best navigate it.

2. Can we have a second opinion? Again- this question is not intended to offend the treating provider. Having a second opinion can also help the family to feel more confident and empowered in the care that they are receiving and to further confirm the stage of the disease & diagnosis. Also, some centers may offer more advanced treatment options.

3. What are the treatment options and the associated advantages & disadvantages? The discussion of quality of life is a major consideration here. Being informed on the possible advantages & disadvantages of certain treatments allows you to feel more empowered while making such personal family decisions. It is important to consider and discuss the goals of treatment, which includes not only treating the cancer itself but maintaining comfort, symptom control, and quality of life.

4. Is the treating provider a pediatric specialist or is a referral to a pediatric specialist necessary?

5. What resources and services are available to help with support for the family and finances? Here is a list of resources for additional financial support: financial assistance for teens & children

6. How do we maintain as normal a routine as possible during treatment?

By considering the factors discussed above, the unimaginable difficulty of treating childhood cancer can be made somewhat more manageable for the child and family. For more information on this topic, please visit @ParentSuitcase on Instagram.

#childhoodcancer #cancercaresupport #childhoodcancerawareness #parentsupport #parentingresources

Disclaimer: The information on this platform is not intended or implied to be a substitute for personal professional medical advice, diagnosis, or treatment. All platform content including text, graphics, images, and information is for general information purposes only & does not replace clinical consultation with your own doctor/mental health professional.