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 18th, 2007 at 10:35 am
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.
| March 20th, 2008 at 1:48 pm
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
| April 14th, 2008 at 8:25 am
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.
| June 6th, 2008 at 12:39 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.
| June 21st, 2008 at 5:47 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.
| June 27th, 2008 at 11:51 am
Hi, P. Fitz! Tantrums are often much worse when kids are not able to communicate clearly. Addressing his communication issues may be a great place to start.
By age 4, we usually look for children to 1) have a vocabulary of at least 600 words, 2) speak in complete sentences, and 3) have at least 80% of their speech clear and easy to understand by others.
By age 3, we usually look for children to 1) have a vocabulary of at least 400 words, 2) speak in short sentences, and 3) have at least 50% of their speech clear and easy to understand by others.
If they are missing even one of these three milestones, I recommend at least having their hearing tested (if it hasn’t been since the speech problems were suspected) and having a speech and language evaluation. Speech therapy may be very important, both for learning and for reducing tantrums.
In addition, all kids should be screened for autism (for one simple screening tool, see http://www.drgreene.com/21_2199.html). Evaluating for possible autism is even more urgent when someone who knows the child has raised the concern.
It sounds like these issues will all be important to address with your pediatrician. I recommend addressing issues like this quickly, rather than waiting for the birthday to come around.
| November 9th, 2008 at 9:30 pm
Dr. Green, Please Help! I don’t know what to do about my two year olds severe temper tantrums. They last sometimes up to an hour and she screams at the top of her lungs, hits, wants one thing and then wants something else. Nothing calms her or makes her happy diuring these outbursts. I have been tracking them and generally they do occur around naptime or at bedtime. You can’t hold her or hug her during these outbursts because she flings herself out of your arms or goes totally limp. Her face truns completely reddish purple and she will sometimes throw herself into the floor and try banging her head on a wall of the floor. Sometimes she just runs in circles screaming or will run back and forth. We do have a lot going on right now as I gave birth to a micro-preemie who has been in NICU for the last 3 months. These outbursts started while I was in the hospital for 2 1/2 weeks trying to keep the pregnancy going and have continued to get worse now that her baby sister iis still in the hospital. We do everything we can to assure her that she is loved, and we try to involve her with her baby sister by frequently taking her to the hsopital to see her baby sister and having her hold her sisters hand or touch her head. When she is not having these outbursts, she is a sweet, mild mannered child who is incredibly loving and aware of people’s feelings. But when she has these tantrums (which occur almost daily sometimes up to times a day), I am scared she has gone off the deep end and we need to get her evaluated. She goes to pre-school 3 days a week and her teachers tell us she has no such episodes at school. What are we doing wrong and how can we help her?
| November 17th, 2008 at 8:54 pm
HI, Dr. Green, my 17 month old is attending a nursery school. he is a well-adjusted, well-developed child. However, the nursery school has informed me that he bites other children. He does not replicate that behavior at home, so we are at quite a loss as to what to do. He does not bite his older brother (5 yrs) or us, his parents, nor is he extreme in his temper tantrums. His attempts to bite other kids were getting so frequent, that the schoold had to get him into a different class of slightly older children in the hopes that the behavior would change. they mentioned that he is now doing it less, but I still worry, and don’t want him kicked out of nursery school for biting. Help! Is there anything we can do in cooperation with his teachers to stop him from biting? thank you very much in advance.
| November 24th, 2008 at 10:42 pm
Hi Dr. Greene,
I am at stay-at-home mom to my 11 yr old triplets and my 2.5 yr old son Max. Recently, Max has been having huge, prolonged tantrums regarding wanting something and then changing his mind. (For example: “I want to get down!” (from highchair.) Then when I start to get him down, “I don’t want to get down!!!” He changes his mind about almost everything — from what DVD he wants to watch, book to read, toy to play with, when he’s done eating, to whether he wants the lights on or off, you name it. When he’s out of control and we’re in a parking lot, I give him a choice to stop crying and hold my hand, or be carried. Whatever choice he makes, he wants the opposite one, then the previous one, blah blah, and this goes on and on. I usually make the choice for him and he has a huge meltdown, complete with gagging, coughing, face turning red/purple, the whole works. I try to ignore this most of the time, but it upsets the entire household. They occur at least 6-7 times a day and it is almost always over the “I want it/I don’t want it” thing.
Max is a happy, sweet, loving child most of the time, and he goes to a Mother’s Day Out program three mornings a week, which he loves. He is never a behavior problem at all. In fact, the teachers have told me he is one of the calmest kids in the classroom and he just loves to learn.
Having had triplets, Max is the only child I’ve been able to experience as a singleton. I breastfed him for 7 months (couldn’t bf the triplets), have had lots of time to bond with and interact with him, and we have a very loving and close relationship.
I can’t think of anything that has changed in our household lately. No new animals, people, no change in the status quo.
I could manage my triplets fine at age 2, and they had the normal tantrums, but Max is more difficult than all three put together!
Please advise. I’m at the end of my rope. He doesn’t do this with my husband, so he thinks I’m just a failure as a mom. He works 6 days a week and on his day off is usually doing some project around the house. I get very little help between the triplets, Max, and my two stepdaughters, ages 13 and 15. Please help before I quit my job!!!!