There are two modes, hard mode and easy mode. To use the easy mode, use your fingers to shoot elmo. To use hard mode use your mouse. Click or touch elmo to kill him, and once you get 101 score you win. The score is displayed in the top right corner. He will become increasigly harder the more score you have. If he becomed too big, you lose.
@elton_cool_guyTWO8 helped me with this :)