Temper Tantrums – When to Worry

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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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?

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.

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Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

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  1. Ashley

    My 5 year old daughter matches perfectly with every sign listed reguarding possibly being ADHD. Her strong willed tantrums started at age 4 and she’s now 6 months from turning 6 and they have progressively gotten stronger and several times throughout the day. They last anywhere from 1 hour and have gone a little over 2 hours. Simple request like telling her it’s time to get into the bath or telling her to get her school bag can take 15-20 mins and me repeating myself over and over. She’s in kindergarten and her school work is excellent. She does not get into trouble at school but the teacher has a strict schedule that keeps the kids engaged and no time for goofing off. At home is horrible and most of our plans or activities in the last 3 months get canceled or we’re extremely late. I’m ready to call our family doctor but this is my last resort. Please help if possible. Thanks

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  2. Karen

    I am concerned about my grandson’s tantrums. He kicks, screams bloody murder, gets red in the face, throws things and bites. I pick him up while he is kicking and screaming and hold him and pat him on the back to calm him down. He just started this about a month ago. He wakes up in the middle of the night sometimes now doing the same thing. Any advise?

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  3. ashley

    My four old son is a very smart child but he screams and calls people bitches and have fits and Cries to some Times to get attention what do I do

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  4. Tracy

    My 3 year old niece has thrown temper tantrums for as long as I can remember. Though, this past year they’ve gotten worse. Over 15 tantrums daily all lasting longer than 30 minutes, also screams for more than an hour, constantly whines even in what seems normal conversation, can get violent towards others, and during a tantrum nobody can calm her down. We’ve tried being calm, time outs, nothing seems to working.

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  5. Christy

    I have a 3 yr old and he is always so mad he throws everything that’s close to him, he hits things, pinches himself, screams so loud, took a chair into the wall, bites and just gets mad over anything and everything. I need help please I don’t know what else to do

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  6. Julie

    Hello I’m very worried about my Grandaughter whom has been separated from her mother when she was 1yr she is now 2yr she Lives with her father..I’m concerned as she seems very unhappy& has bitten her nails down that far that they almost bleed & constantly Scratches her head! She has nothing I. Her hair as checked..father never praises her & when she has spent the day with us she doesn’t want to go back! She goes all quiet! Why is this happening do you think it’s because she is separated from her mother? & Stress? Please help! Grand mother

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  7. Judeth

    I have a five year old daughter that I’m starting to get concerned about she’s the only child.
    A few weeks back she got in trouble for boring someone in her class I had her make a sorry letter. Then couple of weeks later I had to get her from school because her teacher said she left the classroom and found her in the boys bathroom(no kids were in there) and she was in the back of the stall barking and making noises I think she was seeking attention because she does get it all at home.
    But a week after that happened I had to get her again because she bit a fourth grader they asked her why and she responded with her head told her to do it. I don’t know is this normal? For a only child am I doing something wrong should I get her in to after school programs ?? Please I need help I don’t want my kid to be looked at wrong she’s a awesome kid that loves and cares for people and animals I just don’t understand what she does when this happens !

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  8. Emiy

    My daughter is 5 years old and has thrown tantrums for as long as I can remember. In fact, I can remember her throwing a tantrum when she was just old enough to sit up on her own, over my moving her away from the dishwasher she wanted to climb in. I thought that she would grow out of it, but NOTHING has changed. In fact, they have gotten worse. She is not violent, but these tantrums last for 1-3 hours and occur EVERY day, sometimes twice a day. My husband and I have tried everything and it is becoming more and more difficult for me not to raise my voice at her during these episodes. This past week has been especially challenging as we actually had to leave a restaurant and a daycare at which I volunteer due to her atrocious behaviour. I`ve read every article on the matter I can find, and I have asked advice from absolutely everyone who would give it to me. They all tell me the same thing, stay calm, be firm, keep her safe, and validate her feelings. All of which we have done numerous times but with complete failure. It`s become so bad that I have had to leave the house the last two days during these tantrums and have my husband handle them because the screaming has gotten on my last nerve. Please, I am willing to take any advice under consideration, as long as it is safe and not damaging in any way to my child. We need help!

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    • Joe

      My daughter is the sweetest, smartest little thing. She has tried all kinds of activities and does yard work or laundry. but lately (she’s 4) in the evening after dinner, it’s like she becomes another person. her eyes look different, she growls, swings and kicks and tries to bite. she acts truly like a wild caged animal. she’s destructive and violent and we are so afraid she will hurt herself. we tried holding her down and yelling. and nothing. then all of a sudden out of the clear blue, she changes and will throw herself into our arms and say how sorry she is and she cries like crazy. we’re all sad and confused and tired at this point , our daughter returns and she can’t talk about her actions because she’s sad and starts basically hyperventalating. has this happened to anyone else? i mentioned taking her to a doctor and she freaks even more. we’re at a lose. and she seems as confused about her behaviour as we are.

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    • a

      I’m in the same boat!! Hate to go to a specialist if it’s normal, but it doesn’t feel normal. Maybe it’s us, not the kids. I don’t know how to help her soothe herself. Nothing works. 2 hours at least to get mine to bed. She just gets so upset and can’t help herself feel better. I hate seeing it! And hearing it :-X I wonder if mine has a fear of abandonment or if she’s just learned that saying certain heartbreaking things gets me to cave. Hope they grow out of this…

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    • Ashley

      Hi I read your story about your daughter and mine is acting exactly the same way! My husband and I are exhausted most days due to her defiance and 1-2 hour temper tantrums. She’s the sweetest little girl and does not get into trouble at school and has play dates and no problems there but at home is horrible. It breaks my heart to see her do this especially today when she threw one of her little wooden chairs on the floor from her reading table in her room. We have also done the same things you mentioned you and your husband were advised to do but its getting worse and interfering with everything we want to do. Has anything changed for yall since this post or have you gotten any more advice? Thanks

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      • Joe

        She’s the same. I hurt myself recently and she’s TRYING at night to be really good because my husband is doing everything. but she still has her moments and it still hurts us so bad that there is nothing we can do until she falls or hurts us and then she still is sorry. I don’t see the light at the end of the tunnel. (sigh)

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  9. Tiffany Zebaneh

    My 5 year old doesn’t listen to anything I tell him when it comes to cleaning up after himself. He throws a tantrums when he doesn’t get his way he kicks screams an cries longer then a hour. It’s hard to restrain him when he doesn’t listen to put him in a time out. He holds his body really tight he kicks me and scratches me and bites me. I just don’t know what to do anymore I’ve tried every thing. He’s punished through out the whole day. I’m constantly having to yell at him. Also, when he’s throwing tantrums and makes crying noises there are no tears. When he goes to the store and he doesn’t get his way he’ll stop in the middle of the walk way and stay there and completely shut me out. If I try and grab his hand, he screams so loud and holds his body where he’s litteraly dragging himself on the floor.

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  10. clarisa marcote

    My daughter started to act odd yesterday… & before bed her cousins came over for a play date… started fist fighting her cousins punching her tia being aggressive. .. so i put her in time out. Explained why she was in there wouldnt stop crying until 30min later… told her to watch tv she started to got really happy. ..then her nose dripped a drop of blood…. it was so awkward please help…

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  11. Kaitlynne Lopez-Santucci

    me and my brothers are going through a very terrible divorce between my parents. me and my 3 brothers live with my mom. since everything has gone down, my two littlest brothers who are 12 and 9 always fight. the youngest one who is 9, throws outrageous tantrums. he throws things, hes slapped me and my mom, he spits everywhere, and yells really loud in my apartment. my mom will discipline and hell get worse and hell start spitting on her and yell for the cops. hes never acted like this when he would get angry. hell bite himself, hell scratch himself, and hell bite his tongue. sometimes i want to break down and cry because before all this hes gotten worse. i dont know what to do and neither does my mom. we’ve taken him to a psychiatrist and they told he has ODD and tell us to ignore the fits. how can we ignore these outrageous fits ?! we don’t know what to do anymore and it breaks my hearts :(

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    • Sara

      I have a 4 year old son and am a single mom.

      My son hits me all time, grabs my hair, pushes me and screams at me. Does not listen nothing at all. He also breaks things and he tries to push some kids. I feel so bad and don’t know what to do. I do not know what it is. I try to talk to him. I try to give the best out of me nothing.

      He stays up till late hours. Does not sleep. He always runs. Does not sit much and is always doing something. He loves dinosaurs. Sometimes I think this is out of normal.

      Please can someone give me advice? I feel as if I am a terrible mother and I feel sad to see him that way.

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  12. slack91

    My son is not even 2 yet and no matter what the tantrum he always smacks, kicks, pulls hair, headbutts (every time) or throws whatever is near to hand. It could be over the slightest little thing! He is also getting more violent toward his older sister, just hitting or hair pulling while she watches tele or plays nicely on her own. He is slow in development and has to put his face to the walls too. I know this all sounds weird but im at the end of my tether now especially as he wakes me up at 5am the latest every morning. Anyone help please

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  13. Sinead Butt

    My 2.5 year old son is delayed in speech and understanding he doesn’t say much words at all he doesn’t get on with any of the kids at playschool, he hits others and screams alot. He likes to play alone in school. At home he also likes to pay alone but also with his brothers and sister but also lashes out on them, he likes to wounder off and has no concept of danger. He loves getting phased and also loves afection. He hates the words NO or WAITING or even getting his face cleaned or nails cut. He loves to play with water. I need help dose anyone know Wat I can do to help him

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  14. Natalie

    My son bites scratches himself and bangs his heads on walls …he is really hypper and happy kid but if u sai no to him or say or do something he doesn’t want them the aggression starts he is only 6 he has an appt.on mondai idk what’s wrong with him this lasts up to 1 hour noone or nothing can control him

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  15. Bryanna

    My daughter is now 5, and her fits started awhile back. Probably by the age of 3, they were horrible… Now, she just turned 5, and her fits result in me getting puched accross the face, and her saying she does want to fight with me. I try and put her into a safe place (the bathroom) and try to get a breath of fresh air to chill out, but she does not give in. Also with a 2 and a half year old little boy, who protects mommy, does not help anything. He has got physical with her numerous times because she hurt me. When my daughter hurts me, she does not care at all, and will continue with her fit. She throws things at me, screams, hits, kicks, and will stop until I get her into the bathroom, and wait until she is crying and saying sorry (which can take an hour to 3 hours for it all to end) I do not know what to do, and need the abuse to stop :( I’m a single mom, doing what I can. On top of it all, I have a mother who ‘helps’ by spoiling her, and treating her like she is perfect and giving in to whatever she wants. I don’t know what to do anymore… Someone help me please…

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    • Tzedek_Tzedek

      I don’t have the answer, just well wishes. I landed on this site looking for guidance about my own 5-year-old daughter’s increasingly extreme tantrums. It’s wearing my husband and I down, frightening her younger brother (also 2.5, like your son), and I can’t make heads or tails over why they’ve gotten so much worse (even though they were really bad before). In any case–if it’s wearing us down and there are two of us, I can imagine how challenging it must be for you. I really wish you the best. Hang in there.

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    • carlee

      I definitely know how you feel my 5 year old is my youngest and he scares me and my oldest three all the time with his abuse doing the same things as you have listed and more I am also a single mom doing the best I can and being pushed from one supposed professional to another everytime I turn around its getting very old

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  16. Megan Elizabeth Dennis

    My son get into these fits where he screams so loud and so high pitched it makes ME want to just break down and cry..Not only that but he punches himself in the face or slaps himself in the face. He has taken a lot of swings at me and everyone else around him, he throws thing at my face he used to bite me…He sits there and stares at me if I ask him to do something compleatly ignoring me and wont even blink. I am so at the end, I cant handle this and it it pretty much all day long. :(

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  17. Stephanie O

    Okay so what does it mean when my 9 month old daughter is throwing herself backward hitting her head, pulling her hair and biting herself?

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    • Megan Elizabeth Dennis

      I never hear that about a child that small but if you are concernd…take her in and talk to someone about it.

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    • Natalie

      That is normal all babys throw them self back and pull the back of theyr hair as it’s the only thing the do lol no worryes lol

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  18. colette

    my 6 year olds school reckon that although uncommon my sons behaviour is within normal range however i dont. it started at 18 mths and has got worse as he has got older. kicking, hitting, screaming, swearing, spitting, biting, throwing things etc in the last 12 mths school have exluded him 3 times and are currently having to restrain him during these ‘tantrums’ he can take between a few minutes to calm down but the longest it has taken and that school have had to physically restrain him has been a few hours. the smallest thing can be responsible for setting him off such has being asked to come inside at the end of play time. obviously reward charts and time outs have been tried but using such things or distraction techniques when a ‘tantrum’ begins has absolutely no effect and he is ultimately unable to calm him self it is literally a case of sitting him down, restraining and waiting for it to pass. I’m fed up with professsionals passing it off as bad parenting etc especially since he still presents major issue in school I am fed up with being told it iss wihtin normal range especially when he is sent to his room to cool off and replies with fine but i wont wake up in the morning :-( trying to get professionals to sit up and listen is like standing in a room full of people and screaming at the top of your voice but no one turns around to look. If so called professionals dont listen and take it seriously where else is left to turn?

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    • carlee

      I know how you feel my 5 year old son does all of this stuff and it seems like his aim when hes in his moods are to hurt either himself or others but yet the professionals have passed us around hes been hospitalized twice already and children services from DHR is wanting to put him in a residential hospital for 6 months to get him proper treatment for daily function…the current doctor just prescribed him new meds a few weeks ago and of course they have made him more hyper active and a whole lot more aggressive like he doesn’t have enough aggression without the stupid meds but anyway you are not alone just know that and good luck to you. I hope they figure it out for you soon

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    • Laura Elizabeth Isbell-beavers

      I know this is an old post but the school is breaking the law on many levels and could be part of his frustration. Call mpact in kc mo you’ll have to call information and get the number, they can direct you about the laws in your area, they’ll send a mentor to attend conferences with you to make sure the school is not doing anything illegal ect, if u aren’t from mo they can direct you to any advocacy groups in your area. Huge help!

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