3 year-old screaming at top of lungs

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.

Subscribe for DrGreene’s Newsletter

September 2018 Family Friendly Community Events

October 2018 Family Friendly Community Events

Like it? Share it, or post a comment below!

Toddlers love to hear the sound of their own voices. And yes, as annoying at it is, toddlers love to shriek-often at the top of their little lungs! Often in public places like grocery stores and restaurants, much to their parent’s dismay.

Toddlers may scream for a variety of reasons. Some kids just get louder and squeal because they are excited or happy. Some kids shriek because they are over-stimulated or overwhelmed by a situation or environment. Some little ones yell because they are angry or frustrated. And some toddlers use those loud piercing screams because they are simply trying to get your attention.

So what can you do about your screaming toddler? First, it helps to determine, which of the above reasons is eliciting the screaming episode. Here are a few tips.

• No matter how loud your child is screaming, STAY CALM. If you get agitated yourself (yes, I know it IS AGITATING), and you yell, you’ll simply get into a power struggle of screaming with your toddler!
• Use a calm, neutral, matter of fact voice and if you feel your child is over-stimulated or over-tired, acknowledge their feelings and reassure them with “I know you want to leave, we will be done shopping as soon as Mommy buys the milk and then we’ll go to the car and go home.”
• If your child screams when angry or frustrated, again acknowledge how they feel “I know you’re mad your block tower fell down, it’s ok, let’s build it up again!” or “I know it’s hard to throw the ball in the basket like your big brother, let me help you.”
• Play games at home with “loud” and “quiet”, two concepts that most toddlers still don’t understand. But, toddlers DO like to imitate whispering. So practice things like “The lion is LOUD when he is outside, but he is QUIET when he plays inside.” You can begin to teach, loud/quiet by clapping hands loud, then quiet or stomping feet loud, then quiet. Again reinforce that LOUD activities are for outside when playing and QUIET activities are for inside or when at church, grocery store, restaurants. It takes practice!
• If your child is not overwhelmed by loud, noisy places, then you can try to pick more crowded busy times to shop or eat at loud, noisy restaurants so that when your child screams it can be ignored, not only by you, but by most customers so you aren’t getting the dreaded “can’t you make him stop?” stare from other patrons.
• Most toddlers WANT to be out shopping with you or out at a restaurant with the family, so we want to teach them that screaming is NOT an appropriate behavior in this setting. Pick a practice day when the task of shopping only requires maybe a few items or the stop at McDonald’s is only for a snack. If your child screams, reinforce the quiet voice, and give a warning that if they scream you will leave the store or restaurant. Then, STICK to your guns. If she screams, you LEAVE. You have to mean what you say and toddlers learn pretty quickly that if I scream I do NOT get to eat out or go to the store with Daddy.
• Keep in mind if your child is tired, over-stimulated, hungry or not feeling well, this will contribute to any behavior escalating, even screaming.
• Plan errands for times your child is not hungry, tired or ill and keep them occupied and/or distracted by making them your helper at the grocery store. Your child needs to learn that she will get attention or be rewarded when she does NOT scream. So if you made your 15 minute trip to the store and no screams were involved lavish the praise on her with “You did GREAT, you used your quiet indoor voice the whole time Mommy shopped today. You’re such a big girl!”
• Many toddlers scream because they do not yet have adequate language for their age. If your child is 2 or older and does not have at least 50 single words and/or is not yet putting two words together to get his wants and needs met, consider calling for an Early Intervention speech evaluation.
• If your toddler screams and you respond to the screaming by giving them attention (positive or negative), or by giving them what they want, the screaming will continue. Prompt your child in a matter of fact tone with (again do not resort to yelling back, remain calm) “Use your words” or “Mommy can’t hear you until you use your quiet voice” or “Daddy will play ball with you when you use your inside voice”.
• Use If/Then statements with your toddler. “If you use your quiet voice, then I will turn on your TV show” or “If you use your indoor voice, then I will get you more milk”.

Like it? Share it, or post a comment below!