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?
Top Five Reasons to be Concerned about Temper Tantrums
Researchers at Washington University School of Medicine analyzed the tantrums of 279 children from 3 to 6 years old. Their results were 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 Temper 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 aggression.
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 episodes 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 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 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 temper tantrums sometimes, and to lash out at people or things on occasion. Starting to pay attention to tantrum styles rather than individual outbreaks may help sort out what’s healthy and what’s not, and how to respond.
References and Resources
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.
Alan Greene MD
Our goal is to improve children's health by inspiring parents to become knowledgable partners who can work with their children's physicians in new and rich ways.
Hello,
I have a 5 year old grandson that throws aggressive tantrums several times a day. He hits only the females in the family. He screams loudly when angry for an hour( I timed him). Drops down on floor. He scratches himself. He growls at us. Covers his ears or puts fingers in ears when we try to talk to him. He is fine when is getting what he wants. But tell him no then all hell breaks loose. Please help!
Hi, I have 3 year old son, there was a time that he cried so much and lie on the floor, when he see me in the kitchen. And when I move to living room, he follows me and cried again and lay down on the floor, and when I move again, he will again follow me and cry again and lay down the floor. IK have some questions that need to be answered, because I am worried:
1. What could be the function of my son’s behavior? ( is this Sensory? or Escape? or Attention? or Tangible?
2. What does he want? How do I know what does he want?
3. Can you describe how my sons’ behavior would be different if his behavior had a different function? (Can you choose one of the four functions listed above.) Choose one example.
Thank you so much for reading this.
My five year old has almost daily temper tantrums at home. Never at school but always at home. “you didn’t bring home fried rice for dinner” (we never even had a conversation about this) tantrum; I can’t have cupcakes for breakfast? Tantrum. Time to take a nap? Tantrum; go get dressed? Tantrum; I can’t sleep in mom’s room? Tantrum…I tend to ignore him or repeat myself over and over until he gives up but my husband is not so lucky. Any suggestions?
I hope this is helpful I reaised my grandson who is 25yrs old he still lives with me and almost 3 yrs ago he had a child a boy he is not married and still lives with me his ex girlfriend is basically raising the boy however he stays with me some of the time he is aggressive mean at times refuses to listen and refuses to use the potty like to make in his diaper and wont let anyone change it what can I do to help him become well adjusted
Hi,
My baby is 2.5 years old. We are observing some weird behaviour in afternoon whenever we make her to sleep. She cry, bit uncontrollably. She used to sleep with breast feeding earlier but now her mother is not feeding here. I don’t know why she is behaving like this.
Could you please suggest me here?
Thanks
My daughter-in-law slapped her two-year-old son in the mall repeatedly because he screams uncontrollably. My grandson is extremely aggressive has probably 10 to 15 tantrums a day. My daughter in law will do nothing about it other than slap him and that’s usually after she’s warned him 10 times . I was babysitting for them but refuse to any longer as his aggressive behavior is just getting worse and worse and her idea of discipline is to slap him or beat his ass instead of timeout or actually being a parent.
I’m surprised no one has called child protective services. Have you considered making the call?
My 2.5 year old has extreme meltdowns, but the doctor suspects they are sensory related. He is extremely intelligent; it’s safe to assume he will test profoundly gifted when we decide to get that done. But he doesn’t understand when he’s hungry. It’s like he feels something other than hunger and will refuse food. This can go on for an hour or longer, just screaming. Any thoughts?
I am experiencing a very similar situation. My son is 3.5, has extreme meltdowns, throws toys and is also extremely intelligent. I have never had him tested though. He doesn’t like eating, refuses meat, only drinks milk (we mix with water a few times a day to get him more fluids), doesn’t care about consequences, rage screams on timeout and won’t listen to anything we say. He refuses to do anything we ask him and won’t accept “no”. I just want to get through to him and help him transition. Before he started these tantrums our house was peaceful, we don’t argue in front of him, yell or anything. I feel like my 1.5 year old daughter is being raised in a war zone now. We want peace again. What should I do?
Hello,
i have a daughter who now now 20 months old, she doesn’t have frequent tantrums and might have a tantrum every two weeks, however yesterday she had a tantrum which made me concerned. Her tantrum lasted for over an hour and during the entire time she kept screaming her lungs out, sometimes pulling her tongue out, gasping air and once pulled her hair and hit her hand. I have never experienced such a tantrum. When she normally had it, it would last maximum 10 minutes and she would eventually calm her self down but yesterday all my attempts during the entire hour didn’t calm her down. when her tantrum finished she drank her milk so fast although i am positive she wasn’t very hungry because she ate an hour earlier.
should i be concerned or is this a normal behavior?