OT Tips for De-Escalating a Child’s Melt-Down

Before we discuss ways to reduce a melt-down, let’s clearly define what exactly a melt-down is and what it looks like. Popular pediatric occupational therapy terminology includes specific words to describe the differences between a “temper tantrum” and a “melt-down”:

  • Any child can have a temper tantrum, which is a set of poor behaviors exhibited by a child who is trying to get what he or she wants (i.e. attention, food, candy, phone, movie, toys, etc.). A temper tantrum usually resolves once a child gets exactly what they are after or once they’ve given up, and that’s up to the parents on how to best approach that resolution. Temper tantrums include the typical signs like screaming, throwing stuff, hitting others, flailing on the floor, and incessant crying.
  • A melt-down is caused by factors that are much more difficult to see or to understand. Children exhibit temper-tantrum like behaviors, but for other reasons besides trying to get something from parents. The most difficult part of dealing with a melt-down is that it cannot be simply resolved by giving the child items that normally would make them happy. Symptoms are similar to a temper tantrum including screaming, throwing things, and so on. However, depending on the child, melt-downs can display even more confusing behavior such as self-injury or abnormally aggressive behavior (i.e. biting their wrists, head-banging, hair-pulling, biting or scratching others, etc.). There may be pupil enlargement as well as other vital or physiological changes (i.e. increased heart rate, temperature changes, increased respiratory rate, etc.)

The causes for melt-downs vary per child, but may include some of the following: pain, sensory discomfort, an allergic reaction, over-stimulation, negative reaction to medication, lack of sleep, dehydration, and malnutrition or hunger to name a few.

The one thing that parents or caregivers need to understand about melt-downs is that yelling or firmly talking a child down does not usually work; in fact, excessive talking may actually worsen the behavior. With that in mind, here are some basic tips that should be considered when de-escalating a melt-down:

  • Conduct a quick assessment of the immediate environment: Once your child starts a melt-down, you will not be allotted a ton of time for the perfect set-up. Very quickly scan the child’s immediate environment. Are they at home? At school? At the store? Are there other people around? What sensory stimuli can be controlled and what cannot? Assertively ask people to move away from your child and to provide space. Scoot potential objects out of reach that could be used as weapons against the child and against others. Minimize auditory input if at all possible (i.e. turn off music, ask people to stop talking including whispering, etc.). Avoid moving the child to another location because that could worsen behaviors. If you must move the child because they are in immediate danger, do so in a quick manner.
  • Swiftly identify roles: In order to reduce how much verbal instruction the child will receive, figure out which adult will be taking the lead on talking to the child once the child is ready. Once the lead speaker has been identified, it is the responsibility of the other adults in the environment to “shut-up” and to simply observe the child’s behaviors and assist the leader as best as possible.
  • Minimize the need for restraint techniques: If the child confronts others in attempts to attack or to cause physical harm, do the very best to avoid physically restraining the child. Restraints can escalate the behaviors as well as endanger the child if not properly utilized. If your child has a lengthy history of aggressive behavior and frequently threatens or carries out harmful behaviors to others, then some parents may feel that restraints are the best option. If so, seek out specialized training from a professional.
  • Wait it out: One of the hardest parts of melt-downs for parents to come to terms with is the duration. Sometimes, it seems like the child is going through one forever. Melt-downs become especially more difficult when happening in public because now you have bystander attention and try rushing your child in order to avoid negative looks from others. As painful as it can be, parents should wait out the melt-down. Maintain your communication roles, continue to calmly observe the child. The child will let you know through verbal and non-verbal communication when they are ready for you to engage and to help.
  • Introduce calming techniques: The signs that a melt-down is coming to a close may include the following: pupils return to normal size, the child’s breathing starts to slow, and the child starts to cry in a different way (softer, as if remorseful). He or she may reach out to parent and caregivers for help. The leader can now slowly introduce calming techniques or items that the child finds soothing, which is different for each child (i.e. blankets, stuffed animals, water, food, etc.). It’s essential to move slowly and to not bombard the child with stuff and with words in order to avoid triggering another melt-down.

Melt-downs in children can last from several minutes to several hours and can happen multiple times throughout the day. Consult with a specialist about what approaches are right for you and your child in reducing incidences and de-escalating episodes.