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.

Nervous System Regulation & Parent Health: Part 1 of 2

Developing the ability to regulate our nervous system is crucial to promote our health, wellbeing, and be at our best in any role in life, particularly parenting. 

Recovery and restoration are essential processes in the promotion of health and wellbeing.  Ventral vagal activation is necessary in order for this to occur.  In addition, a relative lack of ventral vagal tone and increased and chronic sympathetic and dorsal vagal activation have been associated with several physical and mental health conditions, including cardiovascular ailments, impaired immune function, chronic inflammation, anxiety, and depression.

In order to best maintain and enhance our health, an intentional recovery routine is important. 

This includes mindset training, sufficient quantity and duration of sleep, adequate nutrition and hydration, and physical activity.  While it can be challenging, if not impossible, to fully prioritize each of these elements, particularly with young children, it is important to optimize each to the extent possible.  These elements each function to promote ventral vagal activation leading, at least in part, to recovery and restoration.  When multiple of these factors can be combined, the effect is greater than the sum of its parts.  Another important consideration is specific training of mind-based and body-based skills to promote vagal efficiency, thereby further improving ventral vagal activation.

This process is proactive in nature and is at its greatest positive impact when integrated within a daily routine. 

In doing so we not only benefit from the regular effects of ventral vagal activation but also increase our ability to access these strategies and their effects when most in need, specifically during high stakes situations.  In order to best be able to be of service to others, our own health and wellbeing must be optimized.  This is a necessary factor in being the best version of ourselves in any, and all, situations.

Follow this blog for Part 2 on Nervous System Regulation & Parent Health! Visit @parentsuitcase on Instagram and Pinterest! Thank you to our collaborator, Dr. Darin Davidson MD MD, MHSC, FRCSC on this topic. Dr Davidson is a Polyvagal-Informed Coach and Concierge Care Physician who works with professionals both virtually and in-person.

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.

Parenting & Childhood Illness Prevention

I read an article this morning from WSJ about the the current viral surge that has parents, providers, children, and schools scrambling for solutions. What are some of the various concerns that parents are reporting:

• Lack of paid time off / flexibility to take off for family illness; roughly 104,000 Americans missed work due to child care issues in October, the highest number on record by the Bureau of Labor Statistics since 1994.*

• Lack of backup care

• Concerns about COVID-19

• Missing out on in-person school instruction

Parents have experienced their ample share of challenges and work cancellations over the past 2-3 years as a result of the pandemic. Not only are parents navigating school safety concerns, they are also doing their best to optimize family wellbeing by adopting preventive health measures to ensure that all family members are as healthy as possible. As parents who are already dealing with significant family / work / household stressors, what precautions can we take to help mitigate & prevent the spread of illnesses?

Practicing hand hygiene skills with frequent handwashing at home: 

According to CDC, keeping hands clean with handwashing can help to prevent 1 in 3 diarrheal illnesses and 1 in 5 respiratory illnesses.**

Here are some key opportunities to wash hands**: 

1. Before & after food preparation and eating

2. Washing before & after caring for a friend / loved one that is ill

3. Before & after wound care- cuts, scrapes, or other more involved wound care.

4. After using the restroom and / or changing a soiled diaper

5. After blowing your nose, coughing, or sneezing- this is a great habit to cultivate at home in order to strengthen that practice at school.

6. After touching animals, handling pet food, or animal excrement

7. After handling garbage and waste materials

I have been reading a lot of articles and social media posts on respiratory illnesses lately, in particular respiratory syncytial virus (RSV). RSV typically circulates during colder months and into early spring. Here in the U.S., roughly 58,000-80,000 kiddos <5yr old are hospitalized to due RSV.*** In infants & young kiddos, the following categories are considered higher risk for severe illness from RSV:***

-Infants, especially those <6 months of age, kiddos born prematurely.
-Children <2 years old with chronic lung disease (like asthma), congenital heart conditions
-Children with weakened immune systems
-Children with neuromuscular conditions: the weakened respiratory muscles can make it difficult to clear mucus

Similar to the prevention tips above, practicing optimal hand hygiene plays a big role in mitigating the spread along with staying home when feeling sick, covering coughs / sneezes (along with subsequent handwashing), abstaining from smoking around children, avoiding utensil & cup sharing, etc. RSV can live on outside of the body for several hours, therefore keeping high-contact surfaces clean (i.e. doorknobs, toys, countertops, appliance handles, etc.) can help to decrease viral contamination.

What else contributes to overall optimal health? SLEEP!

Optimizing our sleep hygiene- sleep is a crucial part of our own wellbeing and overall function. Children and adolescents who lack enough sleep are at higher risk for obesity, type 2 diabetes, poor mental health and attention/ behavioral issues.** It can also impact their academic performance due to lack of attention. ‍

The American Academy of Sleep Medicine recommends the following: 

Children ages 6–12 years: 9 - 12 hours per 24 hours

For 13–18 years of age: 8 - 10 hours per 24 hours

What else can we do to optimize our sleep health? Avoiding blue light exposure before bed- everyone has different opinions on the specific amount of time before bed (I personally try to avoid it at least 1 hour before bedtime). Keep you room cool, dark, and quiet like a cave- this is something I learned from Dr. Shelby Harris on Instagram. Some other things we can do before bedtime: read a paperback book, avoid alcohol at least 4 hours before bed, and avoid caffeine roughly 6 hours before bedtime.

‍Staying up-to-date with preventive health measures as advised by your healthcare team. If you have any specific questions on vaccines, please connect with your healthcare team to discuss. If you want more information on immunization schedules per CDC, check out: https://www.cdc.gov/vaccines/schedules/

Eating nutrient-dense foods and healthy options as much as possible. During high holiday season, a lot of our celebrations & gatherings include meal preparation, leftovers, and (most likely) LOTS of sweet treats and desserts. I am not a nutritionist, but I do know that balance is key! Here are some ways to eat healthy while also on a budget: 

Batch you meals and plan your recipes based on seasonal ingredients, budget, and availability. What can you buy that is local, easy to store, and cost-effective? Be creative when making your own recipes and keep it simple. One of my favorite places to search for recipes is Epicurious.

Look at labels: do you notice any words or preservatives that you are unfamiliar with? You can do some investigating and look them up online by searching for reputable sources. You'd be surprised at how many prepared foods & condiments have unfamiliar preservatives, gums, and additives.

Limit added sugars when possible- what other options can you add for sweetness? Berries and other fruits are great alternatives.

Think about fiber intake! Fiber is so important for digestive / bowel health. What can you integrate into family meals? Consider beans, grains (like bulgur, barley, and oat bran), broccoli, carrots, green peas, apples, etc. There are lots of healthy options!

Maintaining some sort of physical activity on a routine basis: (before doing any exercises, please consult your healthcare team to determine what is safe, effective, and advised for you!)

Personally, I prefer to diversify my physical activity in order to keep it fun and the variety allows me to target different muscles groups. Here are some of my favorite exercise activities along with a brief summary of what they entail: 

HIIT workouts: this exercise is a form of interval training which involves quick bursts of high-intensity exercise with intermittent intervals of rest / lower intensity exercise. I tend to integrate at least 5-15 minutes of HIIT exercise into my cardio routines.

Kettlebell workouts: this piece of equipment looks like a bell and varies in heaviness. Integrating kettlebell exercises into your workouts can help to strengthen your core, increase overall strength, and increase power endurance.

Barre workouts: a great way to improve posture and alignment, lean & tone muscles, and to improve balance. This is one of my absolute favorites and it's an exercise routine that I find truly humbling! Barre classes are generally lower dumbbell weights and higher repetitions.

Treadmill: a great one for cardiac health and pretty self-explanatory. You can walk, increase the incline to boost your heart rate, or can vary the speed and intensity as you prefer. I’ve seen a lot of social media posts on the “12-3-30” Walking Treadmill Routine which is described as an effective way to strengthen muscles as well as providing cardiovascular health benefits. As a reminder: before starting any workout, it is important to consult your healthcare provider to see what routines are best suited for you.

Rowing machine: total body workout that also allows you some time to practice meditation as it is (or can be) a repetitive motion activity. If you are looking to obtain a full body workout, it's a nice alternative to using a treadmill or an elliptical and it's great for all fitness levels.

Limiting snack sharing / sharing of drinks if and when possible. 

This can be a tricky one for kids! In order to reduce the spread of illnesses, try to be mindful of snack sharing and discuss the rationale for doing so at home. As mentioned above, continuing to practice regular hand hygiene also helps to mitigate the spread of illnesses.

Staying home when we are sick

This is a BIG one. I know that it can be difficult to miss a work day if either you or your child(ren) is sick. In order to prevent illnesses from spreading, it's important to maintain good hand hygiene and to stay home when you are not feeling well. Check with your employer about their sick leave policies and flexible work options in the event of personal / family illness. CDC has some great resources on how to handle Influenza as an Employee

We can also practice some stress reduction measures in order to keep our stress levels low (which can also benefit our immune systems). This practice looks different for everyone!  

What other ways can you think of to prevent the spread of illnesses?

Follow Parent Suitcase: Your resource hub for parental wellbeing, parent advocacy, and resources for parents & families. You can find more resources at Parentsuitcase.com and also on @parentsuitcase on IG and Pinterest

All sources are linked & referenced above in order:

https://www.wsj.com/articles/how-sick-is-too-sick-for-school-rsv-flu-and-colds-strain-parents-and-school-nurses-11668999005

https://www.cdc.gov/handwashing/

https://www.cdc.gov/rsv/references.html#factsheet

https://www.cdc.gov/rsv/downloads/RSV-in-Infants-and-Young-Children.pdf

https://www.cdc.gov/flu/prevent/vaccinations.htm

https://www.cdc.gov/diabetes/healthy-eating-budget.html

https://www.prevention.com/fitness/workouts/a39584587/12-3-30-workout/?utm_source=google&utm_medium=cpc&utm_campaign=arb_ga_pre_md_pmx_us_urlx&gclid=CjwKCAiAmuKbBhA2EiwAxQnt70mNPFAKgPJzzD5WRDCBgCcCUl9pSCiZJa-ALu74upSA7c8UoeNf-RoCl3gQAvD_BwE

https://www.cdc.gov/flu/business/stay-home-when-sick.htm

#childhoodillness #familyhealth #familywellness #healthykid #healthyparents #healthykidscommunity #healthyparenting #parentalburnout #childillness #parenthealth #burnout 

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.