Keywords
tantrum, behavior
Temper tantrums are a very common childhood behavioral condition, which commonly cause concern for parents, prompting presentation to pediatric care providers and referrals to behavioral consultants.
Temper tantrums can be defined as episodes of extreme frustration and anger that manifest in an array of signs ranging from whining, screaming, stomping, hitting, head banging, and falling to more severe actions such as breath holding, vomiting, and aggression, including biting. Tantrums are seen most often when the young child experiences frustration, anger, or simple inability to cope with a situation. The behavior appears very disproportionate to the situation, and the child often appears to be “out of control.”
Epidemiology
Temper tantrums are considered part of typical behavior in 1- to 4-year-old children. In U.S. studies, 50-80% of 2- to 3-year-old children have had regular tantrums, and 20% are reported to have daily tantrums. The behavior appears to peak late in the third year of life; however, approximately 20% of 4-year-olds are still having regular temper tantrums, and 10% of 4-year-old children have tantrums at least once a day. Explosive temper occurs in approximately 5% of school-aged children. Tantrums occur equally in boys and girls during the preschool period.
Clinical Manifestations
It is important to recognize that there is not one set of behaviors that reliably differentiates typical and abnormal temper tantrums. However, some concerning elements that may signal abnormal tantrums are summarized and contrasted with typical tantrum characteristics in Table 12.1 . Atypical tantrums (especially those involving violent, destructive, injurious, or aggressive displays) may be indicative of more serious behavioral, mood, or other medical problems. The frequency of tantrums typically decreases with age ( Fig. 12.1 ), while the mean duration increases with age ( Fig. 12.2 ). However, there is variability within the normal range, and about 5-7% of children between the age of 1 and 3 years have temper tantrums that last more than 15 minutes with a frequency of 3 times or more a week.
| NORMAL TEMPER TANTRUM | ABNORMAL TEMPER TANTRUM | |
|---|---|---|
| Age | 12 months up to age 4 | Continuing past age 4 |
| Behavior during tantrum | Crying, flailing arms or legs, falling to the floor, pushing, pulling, or biting | Injury to themselves or others during the tantrum |
| Duration | Up to 15 min | Lasting longer than 15 min |
| Frequency | Less than five times a day | More than five times a day |
| Mood | Should return to normal between tantrums | Persistent negative mood between tantrums |
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