Behaviour

QUESTION:

Dear Dr Dunlop,

I’m wondering if I can ask you a question about my toddler.. she turned 2 in September. We’ve been having trouble with some behaviours and I’m unsure if it’s normal toddler behaviour or something that we should maybe see someone about.

She’s been going to daycare since the beginning of the year. She took a while to settle in but then had a good couple of months in the middle of the year. For the last 8 weeks or so she’s been becoming extremely upset when we drop her off. The educators tell us that she refuses to sleep there, barely eats, cries when they bring the food out at meal times and if they try to give her food she throws it on the floor and runs away.. she’s always been a bit funny with meal times there and would refuse the meals and only eat sandwiches however she did settle down a bit in the middle of the year and get a bit better.

At home her eating is fine apart from being a bit fussy. She also still has a day nap at home. The other behaviour I’m unsure about is that she immediately gets very upset, whenever anyone is talking around her but not to her, for example if my mum comes to visit and we are chatting, she will scream. She does it when my husband and I talk, and she also does it when she’s with her grandparents so it’s not just me that she’s doing it with. Recently we were at a birthday party and the moment I spoke to anyone, she would come running across the yard and would be screaming. She gets so worked up that she starts to gag and cough..

She’s never been a super easygoing kid, but this is getting too much. How do I know if this is something that’s just a phase and she will grow out of, or something that I need to look at behaviourally?

Thanks in advance, O

ANSWER:         

Dear O,

Thanks for your question and for visiting Kids Consult.

A few potentials spring to mind...

  1. Straight behavioural issue

  2. Behavioural issue with anxiety component

  3. A developmental disorder such as Autism

I suspect she lies somewhere in option 2 - typical developmental stage of self-centred, challenging boundaries behaviours, but with a degree of rigidity and need for control, which often has a basis in anxiety.

I'm always on the lookout for early autism signs, especially if there are sudden changes, and obviously that depends on all the other developmental milestones she may or may not be meeting. I don't raise it to alarm you, but just to throw it into the mix, albeit some way down the list.

She definitely needs to be reviewed. That could be with a Paediatrician first, or you could seek behavioural advice from a good Child Psychologist.

If you do go down a psychologist route for behavioural intervention, that should be through you as parents and advice to carers at daycare. They should only need to see you for 1-2 sessions max. If they have any concerns from their initial meeting with you, they may want to met your daughter once, but beyond that should have no ongoing need to see her.

I see lots of families who get bogged down seeing allied health people ad nauseam, and end up wasting a lot of time and money on "therapies" that have no evidence base to them whatsoever.

Regards,

Dr Scott Dunlop
Consultant Paediatrician