Temper Tantrums – When to Worry

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.

Dr. Alan Greene

Article written by

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.



  • 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?

    • 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

    • 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!

  • 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?

    • 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.

    • 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

  • 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. :(

  • 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…

    • 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.

    • 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

  • 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

  • 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

  • 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

  • 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 :(