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Temper Tantrums - When to Worry
Temper tantrums can be a normal and common part of early childhood, but sometimes they are a sign of a problem that needs to be addressed. Parents often ask me whether their child’s tantrums are beyond what is normal. When is a red-faced preschooler screaming and flailing about normal; when is the tantrum a cause for concern? What’s too often? What’s too long? What’s too extreme? Stay tuned for the top 5 reasons to be concerned. Researchers at Washington University School of Medicine analyzed the tantrums of 279 children from 3 to 6 years old. Their results will be published in the January 2008 Journal of Pediatrics. They divided tantrum behaviors into aggressive-destructive (kicking others, hitting others, throwing objects, breaking objects), self-injurious (hitting self, head banging, holding breath, biting self), non-destructive aggression (non-directed kicking, stamping feet, hitting wall), and oral aggression (biting others, spitting on others). The authors suggest that parents need not worry about isolated or occasional extreme tantrums, especially if the child is hungry, overtired, or ill. Instead, they should pay attention to “tantrum styles” – the overall pattern of tantrums. They identified 5 high risk tantrum styles and suggest that kids over age 3 with any of these deserve further evaluation by a mental health specialist. The results of the study are preliminary, and by no means proven, but at least give parents and pediatricians a place to start.
- Aggressive tantrums. If a child shows aggression toward a caregiver or tries to destroy toys or other objects during most tantrums, the child may have ADHD, oppositional-defiant disorder, or another disruptive disorder. Specifically, if more than half of a series of 10 or 20 tantrums includes aggression to caregivers and/or objects, consider an evaluation. Depressed children may also have a pattern of aggressive tantrums.
- Self-injurious tantrums. By the time a child reaches age 3, a pattern of trying to hurt oneself during a tantrum may be a sign of major depression and should always be evaluated. At this age tantrums that include behaviors such as scratching oneself till the skin bleeds, head-banging, or biting oneself are red flags no matter how long the tantrums last or how often they occur. In this study, they were almost always associated with a psychiatric diagnosis.
- Frequent tantrums. Tantrums at home are more common than tantrums in daycare or school. Having 10 separate tantrums on a single day at home may just be a bad day, but if it happens more than once in a 30 day period, there is a greater risk of a clinical problem. The same goes for more than 5 separate tantrums a day on multiple days at school. In this study, when tantrums occurred at school, or outside of home or school, more than 5 times a day on multiple days, there was a higher risk of ADHD and other disruptive disorders.
- Prolonged tantrums. A normal tantrum in this study averaged about 11 minutes (though I’m sure it seemed a lot longer to parents!). When a child’s typical tantrums last more than 25 minutes each, on average, further evaluation is wise.
- Tantrums requiring external help. Kids who usually require extra help from a caregiver to recover from a tantrum were at higher risk for ADHD, no matter how frequent the tantrums were or how long they lasted. Speaking calmly to your child in the midst of a tantrum, or acting reassuringly, is normal. But if you find you can’t stop a tantrum without giving in or offering a bribe, pay attention. By age 3, kids should be learning how to calm themselves.
It’s normal for healthy preschool kids to have extreme tantrums sometimes, and to lash out at people or things on occasion. Starting to pay attention to tantrum styles rather than individual tantrums may help sort out what’s healthy and what’s not, and how to respond. What’s your experience with tantrums?
Alan Greene MD FAAP
Beldon, AC, Thomson NR, Luby JL. Temper tantrums in health versus depressed and disruptive preschoolers: defining tantrum behaviors associated with clinical problems. Journal of Pediatrics. 10.1016/j.jpeds.2007.06.030. January 2008.
December 13, 2007 in health | Permalink
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Comments
My four year has extreme tantrums at least half the days of the month. I am a working single mother of two girls ages six and four. I am writing this after one of the younger childs' "episodes". Tonight's explosion stemmed from her learning time online (pre-school games) was up and now it's time for out nightime routine. This tantrum lasted about 35 minutes and is something ongoing even now after I've attempted to calm her down. The only way I could get her to calm down was to have her take deep breaths while we counted to ten with a hug afterwards. I shouldn't feel like I have no control over her, although it seems like it. She screams so highpitched I've bought my six year old and myself "special" earplugs to protect our ears. She is defiant & fears nothing, discipline included. I'm at my wits end and I feel like this is a constant battle with my child in which I'm losing. All replies are greatly apppreciated.
Posted by: Ria | Oct 25, 2009 6:25:35 PM
I am now the guardian of my 6 year old granddaughter Jalasia. She has been having tantrums all her life even as an infant. I recently spoke with her other grand mother about it and she told me that Jalasia's mother, her mothers twin brother, her grandfather and all his brothers and sisters have the same tantrums and they have been having them all their life. I have never heard of something like this and she has them several times a week I can tell just by how she acts when she wakes up in the morning if it's going to be a good day or a bad day. What I would like to know what can I do to help her and what kind of tantrums are passed down from one family member to the next.
Posted by: Crystal | Oct 14, 2009 7:21:19 AM
In response to Maria's comment, my son has just started having tantrums exactly like the one you describe. He's only two, so not able to do as much damage as a four-year-old, but it's otherwise exactly the same - in particular the frightening degree to which he's out of control, and the way NOTHING will bring him out of it. (Until he just exhausts himself, 20 minutes later). Unfortunately I have no answers, and live in fear of the next outburst. However, one thing I've found so far (and it's very early days) is that ignoring him sometimes works a bit. Of course he has to be in a safe place, preferably at home, so you can't always try it. But in those situations, he can just cry himself to exhaustion, as opposed to hitting everything around him. It's all very scary, though, so I just wanted to let you know you're not alone.
Posted by: Chris | Sep 1, 2009 4:01:14 AM
I have a 4 year old son. He rarely has temper tantrums but when he does he is uncontrolable. Today he scared me. He refused to leave his aunts house and threw the biggest temper tantrum ever. He hit me, spit, at me, and cussed me out. He got so much strength out of no where, there was no way i could put him in my car so that we could leave. He picked up his sister's car seat and threw it to the car, kicked my seats in the car and almost broke my car windows with his bare hands. I tried everything giving in, bribing, scolding, yelling, spanking his but and nothing worked. He fell asleep because he was so exhausted from the tantrum, that was the only way I got him to stop. Please help me what if my child has some mental dissorder, or something that requires medication. I really don't want that. If your child has acted this way and you were able to control his/her behavior please let me know...
Posted by: Maria | May 26, 2009 5:08:49 PM
My son is going to be 3 on May 25th. The tantrums he is giving is mostly when he does not get his way. He will hit other kids while playing with them. If he’s mad, he does not care if he doesn’t know the person, he will hit who ever is standing near him. My son has this deep voice already and he yells so loud as if he knows he has one. If a child or a grown adult spanks him or as for a child they hit him, he will not let it go until he hits back. I have tried everything that has to do with disciplining him. I tried sitting him down for time outs, I have tried spanking him on the butt, I have tried taking the things he loves from him. Nothing is working, all it does is make him more angrier and he seems to lash out more. Sometimes my sister will come over to visit and my son will be playing by himself and my nephew would sit and play to him self. Everything will be ok until my son notices my nephew is there and playing, he will get up and hit him as hard as he could for no typical reason at all. I don’t even know if that’s a tantrum or not. What do I do? He has hit me, he has hit his uncles aunties his grandparents and even his father. there is know controlling the hits he brings upon us.
Posted by: Angelita | Apr 19, 2009 11:06:18 AM
my daughter will be 5 after 2 months,lately she is having a horrid temper,throwing objects,slaming doors,screaming and shouting that last for more than half an hour and take place at home only,i am very worried about her,and sometimes these tantrums make her refuse to go school,please answer me.
Posted by: sherine | Mar 26, 2009 2:58:13 PM
My daughter will be 4 in November, and although her tantrums are as frequent as the study i've just read,she has an aggressive nature and will scream and go red in the face with rage when she doesn't get her own way.It is more frequent at home and is usually begins if she is asked to do/not do something.She is quite oppositional.Outside of home she can be quite confrontational towards other kids and has a tendency to want to dominate situations. Is this normal for behaviour,if not how do I help improve it?
Posted by: melly moo | Jul 3, 2008 4:16:01 PM
My son will be 4 in december of this year. He needs speech theraphy, he says some words but mostly grunts and growls most of the time. He gets mad when you tell him no, or even try to talk to him. but he also throws tantrums all the time. his grandparents say that he doesn't throw fits when he's with them, and he acts good in daycare, but he does it alot when i'm around where he throws toys and knocks things off the table and throws pillows and grunts all the time. His grandmother thinks maybe he has Autism, or some kind of ADHD behavioral problem. I don't know what to do anymore.. any advice.
Posted by: P. Fitz | Jun 21, 2008 5:47:58 PM
My 5 years old daughter has a horrid temper. She is always yelling and screaming. She will send herself into hysterics and hyperventilation. She is loaded with irational fears, and it seems that we are having to walk on eggshells to keep her from going off. She will hit, scream, slam doors and throw things. It is hard to find that balance between understanding and disapline. Her behavior is unexeptable, but trying to relay that in a way that does not aggrivate the situation is hard.
Posted by: Johnni | Jun 6, 2008 12:39:15 PM
My grandson who was three last January has a history of tatrums, bitting, hitting his mother or anyone who is the caregiver when having a tatrum, head banging, throwing toys. He doesn't seem to be getting any better. Do you think my daughter should seek medical help? She and her husband just see passive about it for the most part.
Posted by: Ruthellen | Apr 14, 2008 8:25:25 AM
my grandson who lives with a distant cousin hits and bites himself when he's with our cousin but i have only once seen this behavior and he now knows that i don't and won't tolerate it the only problem i have is he "thinks" at bedtime which he hates he can tell me i am going to lay down which does not go over very well either i believe that this is due to them allowing him to behave however he chooses and he does still at 2 1/2 still sleep with them i am just wondering if i am any where close to right and if so how can i change these people thoughts they don't seem to believe in setting any boundries and unless i get him through the court which i intend on trying to do i am really and truly worried about his future i was also wondering is it true the biggest impacts are made on children by age 5
Posted by: anna brewer | Mar 20, 2008 1:48:08 PM
I've got a crab of a 28 month old and 19 month old. They feed off of eachothers tantrums and my parents encourage me to give in and give them what they want to hush them up. 28 month old bites herself and 18 month old holds her breath. I disagree with them, but wonder myself if my children have ADHD after reading this... I wouldn't be surprised if it were the case as I believe my spouse has ADHD as an adult.
Posted by: Snow White | Dec 18, 2007 10:35:44 AM
