Introduction

Temper tantrums refer to outbursts of anger which are considered normal during a child’s early development. However, there are understandable difficulties in managing such outbursts, so it stands to reason that caregivers and parents would benefit from the availability of proper guidelines regarding the management of temper tantrums.¹ The following paragraphs present further details on temper tantrums, and management guidelines along with cases where the suggested approach might be insufficient and expert advice should be sought.

Demographic data

The onset of manifestation of temper tantrums may be as early as 12 months of age, though episodes usually start around 18 months. Temper tantrums last for months or years, but they normally gradually cease as the child gets older. More specifically, it appears that about 87% of toddlers at the age of one year and a half to two years exhibit temper tantrum episodes, while the peak is during the third year, as 91% of three-year-olds engage with temper tantrums. From that point on, the proportion of children with temper tantrums decreases. ¹ The frequency and duration of temper tantrums also varies with age.^1,2 At the age of two, frequency is once per day for around 20% of cases and the proportion of children with daily outbursts declines with age.¹ 

A study that measured temper tantrums in children of ages from one to five, offers a detailed report on frequency and duration. Namely, the proportion of children with more than one temper tantrum reported in a week was 16%, 22%, 18%, 19%, and 18% for 1, 2-, 3-, 4-, and 5-year-old children respectively. In most children, temper tantrums last from 1 to 10 minutes, while only 2% of 2- and 1% of 4-year-old children had a tantrum for more than half an hour.²

Behavior profile of temper tantrums

The main behaviors associated with temper tantrums can be roughly divided into two general categories: angry/aggressive and self-harming. Angry/aggressive behaviors include yelling, screaming, crying, kicking, hitting, pushing, throwing things, biting, spitting, and running away. On the other hand, self-harming behaviors are fewer, namely going limp, banging of the head, and breath-holding.^1,2 It has been reported that the first three angry/aggressive symptoms, namely, yelling, screaming, and crying are the most frequent.³

Aetiology

The aetiology (underlying cause) of temper tantrums may vary according to each case and might originate from physical or emotional distress. For example, hunger and fatigue potentially lead to temper tantrum manifestations as does general frustration. Temper tantrums can also be the result of an inner battle of toddlers striving to draw their caregiver’s/parent’s attention while being able to do as they please even though doing so contradicts their caregiver’s/parent’s wishes or orders. Such conflicts are common in toddlers as they gradually get acclimated with their environment, be it physical or social surroundings, and proper behaviors, especially in regards to safety when navigating in it.¹ It should be noted that drawing attention has been reported as the most likely reason that triggers temper tantrums, and that manifestation of episodes usually takes place when visiting another person’s place.³

Seemingly harmless routine tasks can potentially become temper tantrum triggers. Prompting toddlers to go to bed when they want to play is an adequate trigger. The same stands for tasks that hold no interest to a small child, such as getting dressed. Moreover, when it comes to temper tantrums to draw attention, any task that distracts the caregiver’s/parent’s attention from the child, such as talking on the phone or grocery shopping in the presence of the child, can also become a trigger.⁴ Consequently, prevention of temper tantrums can be hard. Despite that, there are a few guidelines regarding habits that contribute to the prevention of temper tantrums.^1,4

Preventing Temper Tantrums

There are measures that can be taken to prevent the manifestation of temper tantrums. Firstly, creating a routine and abiding by it constitutes a solid basis to avoid emotional conflict in toddlers that otherwise unexpected demands from parents could cause. For example, when a kid anticipates performing a task in the morning, then it would be less reluctant to do it. Next, comes the “reminder card”. It is not an actual card, but rather a verbal reminder of the task that follows the current activity of the child. Not all tasks and activities are easy to perform by children, which can also be a frustrating factor that triggers temper tantrums. Consequently, caregivers/parents should allow for some time to help children overcome the challenge and develop the necessary skills to carry out the task.

The aforementioned measures to prevent temper tantrums can be applied both at home and at school.⁴ However, these recommendations do not guarantee completely tantrum-free years while raising a child. For this reason, caregivers must obtain proper knowledge of behavioral approaches that serve as means to manage temper tantrums when the need arises.

Managing Temper Tantrums

There are general guidelines that aid the management of temper tantrums. The acronym R.I.D.D. refers to these guidelines and stands for Remain (calm), Ignore, Distract, and Do. More specifically, the first guideline urges parents and caregivers to remain calm. Not only is there no need for someone else’s outburst on top of the temper tantrum, but a calm and firm stand with clear, brief wording expressing denial to meet demands might be effective.¹ Caregivers/parents shouldn't try to reason with the child.⁴

The second advice is to ignore the tantrum.¹ However, this might be a challenge, since ignoring the tantrum should not lead to the child getting what they wanted. For example, if a child wants to do something that puts their safety at risk, then ignoring the tantrum completely, might harm the child. As a result, parents and caregivers should aim to ignore the tantrum by staying calm and not addressing the matter, while also preventing the child from acting on their demands. Generally, the time when the caregiver/parents pay attention to the child is a factor that might contribute to the management of temper tantrums. The caregiver/parent should be evidently more attentive when the child is calm and compliant, but less attentive than normal during a tantrum.⁴

The next guideline prompts caregivers/parents to distract the child. Changing the child’s surroundings by removing it from its current environment may be effective in distracting them.¹ Another way this approach can be even more effective is if the parent informs the child that their decision to leave is because of the tantrum and that once it calms down, they will go back. However, managing the tantrum does not end here. As soon as the child calms down and returns to the previous environment it should not be released from the task or the factors that triggered the tantrum, but, if necessary, face them instead, so that it doesn’t associate leaving with a successful result of the tantrum.⁴

Finally, the last part of the acronym R.I.D.D. points out that caregivers/parents should eagerly attend to the needs of the child, but not give in to their demands.¹

When to Seek Professional Help

Caregivers/parents should seek professional help when temper tantrums are persistent and more frequent than normal, or when they are dangerous to the child’s health or the people around them. At older ages, temper tantrums may be associated with depressive emotional states that affect the child’s life, so professional help is necessary.⁴

Assessment of temper tantrums

Diagnosis of temper tantrums normally does not involve biochemical testing. Usually, physical tests are carried out to determine physical factors that may trigger episodes. However, further tests may be deemed appropriate if the child lives in an area with a risk of high lead exposure since neurotoxicity caused by lead is associated with temper tantrums. Moreover, in case temper tantrums are characterized by breath-holding, anemia assessment is recommended.¹

Health conditions associated with temper tantrums

Temper tantrums have been reported in some developmental and psychiatric conditions.¹ For example, temper tantrums often manifest in children with autism spectrum disorder (ASD), and may be reduced by behavioral and cognitive psychological approaches.⁵ Temper tantrums have also been associated with attention deficit hyperactivity disorder (ADHD) and depression.^1.4,6 Furthermore, temper tantrums have been reported in cases of Down Syndrome⁴, Smith-Magenis Syndrome⁷, and Prader-Willi Syndrome.⁸

Summary

All in all, the first thing that should be pointed out regarding temper tantrums is that they constitute normal behavior that manifests during the early developmental years of a child, from around two to five years old. They are usually characterized by the child yelling, screaming, or crying in an effort to get what they want. Such expression of demands might be disconcerting, especially if it takes place in public. Despite that, giving in to the demand is inadvisable, as it would teach the child that the temper tantrum is effective, and this might promote an increase of future episodes. There are guidelines on how to manage a tantrum which require a firm stand by the caregiver/parent during the episodes, but there are also measures that can be taken to help prevent tantrums. On a final note, even though temper tantrums are usually normal, there are cases which professional help in managing them is necessary, especially when the child exhibits self-harming behaviors during the tantrum or their aggressive behavior is dangerous.^1,4