What is Temper Tantrums?
Temper tantrums are short moments when a child exhibits intense, unenjoyable, and sometimes violent behavior due to frustration or anger. When older kids have these incidents, they are often referred to as “rages.” The behavior shown during a tantrum typically goes beyond what you would expect for the situation. In young children, tantrums often involve crying, screaming, becoming limp, flailing about, hitting, throwing things, holding their breath, pushing, or biting.
On average, tantrums happen about once a day and usually last about three minutes in kids between 18 to 60 months old. However, the most common tantrum duration is less than a minute. Also, children generally return to their normal mood and behavior quickly after a tantrum ends. The severity, frequency, and how long the tantrums last naturally reduce as a child grows up.
While most kids go through stages of having temper tantrums, and it’s a typical part of a toddler’s behavior, unusual tantrums can sometimes indicate behavioral and psychiatric disorders.
What Causes Temper Tantrums?
Toddlers often have tantrums or sudden outbursts of anger for various reasons. One common cause can be physical triggers like being tired or hungry, or feeling unwell. Another common reason is frustration.
Toddlers are in a stage where they’re trying to balance their need for attention from their parents with their growing desire to do things on their own. However, at this age, they’re still learning how to deal with strong emotions in a mature way.
Sometimes, toddlers may also use tantrums as a way to get what they want or to avoid something they don’t want. For instance, toddlers are naturally curious and enjoy exploring their surroundings, so they might become upset if an adult stops them for safety reasons.
The good news is, as children grow older and learn to recognize, name, and express their feelings, as well as develop positive ways to deal with negative emotions, they will likely have fewer tantrums.
Risk Factors and Frequency for Temper Tantrums
Tantrums are common among toddlers aged two and three, but they can even happen in children as young as 12 months. Studies have found that tantrums occur in the majority of 18 to 48-month-olds. It’s not unusual for toddlers to have tantrums regularly – in fact, daily tantrums are experienced by 20% of two-year-olds, 18% of three-year-olds, and 10% of four-year-olds. A small percentage (5-7%) of one-to-three-year-olds have tantrums that last 15 minutes or more at least three times per week.
Children who have difficulty expressing themselves due to language deficits or autism, may have more frequent and intense tantrums. These tantrums may also include breath-holding events that affect a small percentage of otherwise healthy children. These breath-holding spells generally start between six months and 18 months of age and disappear by the time the child turns five years old. Finally, it’s worth noting that tantrums are not more common in any particular gender or racial/ethnic group.
- Tantrums are most common in toddlers aged two and three, but can happen as early as 12 months.
- Around 87-91% of 18 to 36-month-olds, and 59% of 42 to 48-month-olds, experience tantrums.
- Daily tantrums are experienced by 20% of two-year-olds, 18% of three-year-olds, and 10% of four-year-olds.
- About 5-7% of one-to-three-year-olds have tantrums that last at least 15 minutes, three or more times a week.
- More frequent and intense tantrums may occur in children with language deficits or autism.
- Breath-holding spells, which may accompany tantrums, usually begin between six and 18 months and stop by the time the child is five.
- There is no difference in tantrum prevalence based on gender or racial/ethnic group.
Signs and Symptoms of Temper Tantrums
Understanding why a child is having tantrums can help parents and doctors come up with effective solutions. The reasons behind these outbursts could be due to developmental stages, emotional stress, or certain physiological conditions. Unusually severe or frequent tantrums might need further investigation by a specialist.
To get a clear picture, doctors usually ask open-ended questions about the tantrums such as “tell me all about the tantrums”. This helps doctors to understand the family dynamics and if there are any changes that can be made to handle the child’s behaviour differently.
Keeping a record of the tantrums can also help to reveal patterns. Here are a few questions that doctors might ask to get a clearer understanding:
- What time do the tantrums usually happen?
- What events or circumstances lead to a tantrum?
- How does the child behave and react during a tantrum?
- How long do these tantrums usually last?
- How do caregivers react and handle the tantrum?
- What is the child’s mood like between tantrums?
- Have there been any recent changes in their home or school, a move, or confilict in the family?
- Have there been any other concerning behaviours like sleep issues or anxiety?
If a child older than five years has regular tantrums, or tantrums that last over 15 minutes, it is generally unusual. Extreme aggression, destruction of property, harm to the child or others during tantrums, or presence of sleep disorders could indicate a need for further medical, psychological, or developmental evaluation.
Providers should also review any existing health records for the history of tantrums, developmental milestones, other health issues, and family history. Social history like the child’s living conditions, experiences of trauma, etc should also be considered. Often tantrums are discussed during regular health check-ups.
During a physical exam, the child is usually found to be normal. However, in cases where the child holds their breath during a tantrum, doctors might check for signs of anemia like paleness or rapid heartbeat.
Testing for Temper Tantrums
If your child is having frequent tantrums, doctors typically don’t need to order lab tests to diagnose the issue. Often, the physical check-up of a child throwing tantrums would be perfectly normal.
However, if tantrums might be caused by a child not being able to see or hear properly, the doctor may suggest tests to check your child’s vision and hearing. Yet, testing devices for this purpose are not usually recommended for children under three years old.
It’s also important to note that high levels of lead in the bloodstream can result in aggressive behavior in children. So, if you live in an area where there is a high risk of lead exposure, your doctor might suggest a lead screening test when your child is around one year old. If your child’s tantrums are accompanied by breath-holding, or there are other signs of anemia (a condition that means your body doesn’t have enough red blood cells), a blood test might be needed to check for this.
Behavior scales, like the Child Behavior Checklist or the Preschool Age Psychiatric Assessment, are tools that can provide valuable information about your child’s behavior. However, they’re typically only used in research or clinical evaluations and are not usually needed in a regular pediatrician’s office. The ‘Preschool Feelings Checklist’ is another tool that might be used to decide whether a mental health check-up is required.
Treatment Options for Temper Tantrums
For children, tantrums can be a normal part of their development. Their primary healthcare provider can reassure parents of this and provide advice on how to handle tantrums effectively. In some rare cases, medication may be suggested for severe behaviors like breath-holding fits or aggression. The key to managing tantrums is prevention, since they’re often triggered by common issues like tiredness, hunger, or feeling unwell. Iron treatment can be beneficial for children with iron deficiency, as it could reduce the frequency of breath-holding episodes.
There will be moments when parents can’t prevent a tantrum, but they can lessen their own stress by adopting consistent strategies for handling these outbursts. A useful acronym to remember is R.I.D.D.:
- Remain calm. Saying something like “no biting” in a calm tone can effectively redirect the child’s behavior.
- Ignore the tantrum.
- Distract the child. Sometimes, caregivers might need to take the child to a different room or even leave the area until the tantrum subsides.
- Do cater to the child’s physical and safety needs but avoid giving in to their demands, which might encourage the undesired behavior.
“Time-out” can be a useful tool, but over-relying on it might diminish its effectiveness. Children require positive reinforcement frequently. The American Academy of Pediatrics advises a “time-out” duration of one minute per year of the child’s age. Physical punishment is not recommended, as it can escalate tantrum behaviors and send the wrong message to the child about dealing with anger or frustration.
Some children’s tantrum styles, like displaying consistent aggression, purposefully harming themselves, being unable to calm down, or having tantrums lasting longer than 25 minutes, may signal a higher likelihood of a mental health condition. In such cases, it might be beneficial to consult a developmental pediatrician, child psychologist, or child psychiatrist.
Healthcare providers caring for young children should be aware of parent training programs and resources in their community. As these programs offer ways for parents to handle challenging behavior better, participation can be very advantageous. An example is the Parent-Child Interaction Therapy, a evidence-based intervention helping parents to build positive interactions with their children and improve their disciplinary skills. This therapy usually runs for 14 to 17 weekly sessions and involves one-on-one coaching from a therapist while the parents interact with their child.
What else can Temper Tantrums be?
Many behavioral, developmental, and psychiatric conditions can cause unusual and extreme temper tantrums. These conditions may include:
- Disruptive, impulse-control, and conduct disorders like oppositional defiant disorder
- Trauma-related disorders such as posttraumatic stress disorder
- Neurodevelopmental disorders like attention deficit hyperactivity disorder, autism, learning disabilities, and vision or hearing problems
What to expect with Temper Tantrums
The outlook for typical toddler tantrums is very positive. Doctors should let parents know that these tantrums are a normal part of growing up. Most children stop having these tantrums by the time they start school.
Possible Complications When Diagnosed with Temper Tantrums
Temper tantrums don’t lead to mental or developmental issues in a child. Sometimes, it’s common for kids to hold their breath during a tantrum, but this is generally harmless. However, frequent tantrums might cause disruptions at home or school, leading to stress for parents or caregivers.
If tantrums interfere with school activities, parents should collaborate with teachers to create a plan to manage the child’s behavior.
In case a child bites someone during a tantrum, the bite wound is usually minor. However, it’s important to clean these bite wounds with soap and water. If the bite breaks the skin, it should be examined by a medical professional. The wound should usually be left open to prevent the risk of getting an infection.
If a bite wound breaks the skin, it may need antibiotic treatment to prevent an infection. This typically involves taking a medication like amoxicillin-clavulanate for three to five days to treat any human and skin bacteria that might be present. The child should then have a follow-up appointment with a healthcare provider to make sure the wound is healing properly.
Preventing Temper Tantrums
The best way to deal with frequent and recurring temper tantrums in children is to prevent them. That’s easier said than done, right? Don’t worry, we’ve got a simple way for you to remember how to do this. Just remember the acronym C.A.L.M., which stands for Communicate well, Attend to the child’s needs, Let the child share their feelings, and Make routines.
Communicate well: It’s important to talk well to your child and show them how to use words to express how they feel. Try not to shout or argue in front of your kid. Help your child understand their feelings by using words like “angry”, “sad”, “tired”, or “hungry”. You could also use pictures of happy, sad, or angry faces for your toddler to show what they feel. Older children can be encouraged to use words to express feelings.
Attend to the child’s needs: Try to give your child some positive attention. This could be reading to them, playing games with them or even involving them in everyday activities at home like cooking or cleaning. Keeping the home childproof and having toys that are suitable for kids their age can help them not get frustrated. It’s also important to keep any exposure they may have to violent content on television to a minimum as this can influence them negatively.
Let the child share their feelings and listen: Allow your child to make decisions, offer them choices that you are okay with. Try to avoid saying “no” too much. Depending upon the situation, you might allow your child to make small mistakes, like wearing mismatched clothes, unless it’s a matter of safety. Your child’s safety, as well as others’, is very important and should not be compromised.
Make routines: Having daily routines for meals and naps can be very helpful. Always carry simple, healthy snacks like dried fruit or crackers, just in case you’re away from home or miss regular meal times. You could also prepare your child for when, for example, bedtime will be, or there will be a change in activities. This will help in reducing their frustration and the chances of tantrums.
