Tantrums in Early Childhood

What are tantrums?

Tantrums come in all shapes and sizes.

They can involve spectacular explosions of anger, frustration and disorganised behaviour – when a child ‘loses it’.

We might see screaming, stiffening limbs, an arched back, kicking, falling down, flailing about or running away. In some cases, children hold their breath, vomit, break things or hurt themselves or other people as part of a tantrum.

Is it normal??????

Is it normal for a child to have a tantrum? Yes! Tantrums are a normal and expected part of a child’s development. They start happening from around 18 months, and they are actually quite useful in terms of child development.

Epidemiology of tantrums

Tantrums most commonly occur between the ages of two and three but may occur as young as 12 months. Researchers have found that tantrums occur in 87% of 18 to 24-month-olds, 91% of 30 to 36-month-olds, and 59% of 42 to 48-month-olds. It is common for toddlers to have a tantrum at least once per day, as is the case for 20% of two-year-olds, 18% of three-year-olds, and 10% of four-year-olds. Five to seven percent of one-to three-year-olds have tantrums lasting at least fifteen minutes three or more times per week. Children with language deficits or autism may have more frequent and aggressive tantrum behaviors because of the additional frustration associated with difficulty expressing themselves. Breath-holding events may occur during tantrums and affect 0.1 to 4.6% of otherwise healthy children. Breath-holding spells typically occur between six months and five years of age, with onset between 6 and 18 months, and disappear by five years of age. There are no documented differences in the prevalence of temper tantrums by gender or race/ethnicity.

History and Physical

A thorough history and physical will help distinguish developmental, psychological, or physiological explanations for the tantrum(s) and determine whether the outbursts are atypical, warranting referral to a specialist. The provider should take a thorough history of the tantrums, beginning with an open-ended question such as, “tell me all about the tantrums.” A complete history may provide insight into family dynamics, allowing the provider to address parental behaviors that may be adjusted to manage the child’s behavior. The provider may also recommend that caregivers keep a record of the tantrums, which may help to elucidate patterns. The following is a list of questions the provider can ask for understanding the events before, during, and after the tantrum.

  • When do the tantrums occur (at what times of the day)?
  • What circumstances precede the tantrum?
  • What behavior(s) does the child demonstrate during the event?
  • How long do the troublesome or undesirable behaviors last during the episode?
  • What is the caregiver’s emotional reaction to the tantrum?
  • How does the caregiver handle the tantrum?
  • What are the child’s mood and behavior between tantrum episodes?
  • Have there been any changes to the child’s home or school circumstances?
  • Has there been a recent move, change in family structure, or family conflict?
  • Has anything scary or upsetting happened to your child or member of your family?
  • Are there other behaviors that concern the caregiver or affect the child’s functioning, such as behavioral issues, sleep issues, anxiety, or loss of bladder control?

It is atypical for children older than five years to have a repeated pattern of tantrums. It is also unusual for a tantrum to last more than 15 minutes, or occur regularly more than five times per day. Extreme aggression is not typical of routine toddler tantrums. Consider a referral if the child or others are physically injured or the child destroys property during the outburst. If the child also has a sleep disorder, enuresis, or negative mood behaviors between tantrums, the child may benefit from a further medical, psychological, or developmental evaluation.

In addition to the history of present illness for tantrums, a thorough health history, including a developmental assessment, review of systems, and family history of behavioral and developmental disorders, should be obtained. Social history should include screening for social determinants of health and the identification of any trauma. Providers should discuss tantrums in the context of a health supervision exam, which is most pertinent at the ages of 12, 15, and 18 months and at two years when tantrums are frequent.

Physical examination of the toddler with tantrums is often normal. If the child has breath-holding spells during the tantrum, look for signs of anemia, such as mucosal pallor or tachycardia.

Are there different types of tantrums?
  • Fatigue or frustration tantrums-He’s hungry, tired, or confounded by something he’s doing
  • Attention-seeking or demanding tantrums-The child wants us to play with him even though we have guests over for dinner.
  • Refusal or avoidance tantrums.
  • Disruptive tantrums.
  • Rage tantrums.


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Tantrums in Early Childhood

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