Tantrums
Also known as Emotional Storms, Temper Tantrums
by Dr. Alan Greene, MD, FAAP
1. Introduction
2. What is it?
3. Who gets it?
4. What are the symptoms?
5. Is it contagious?
6. How long does it last?
7. How is it diagnosed?
8. How is it treated?
9. How can it be prevented?
10. Related illnesses
Introduction
When your child kicks and screams at not getting his way, the outburst often seems to come at the least opportune times: when you're on the phone, trying to get out the door, or trying to make dinner, or when you're at the grocery store or a family gathering.
What is it?
Temper tantrums are expressions of intense, immediate frustration. They occur most frequently at an age when children's verbal skills are inadequate to express their roiling emotions.
Gradually, after a child has mastered walking, an irresistible urge to make his own choices begins to well up inside him. This is an exciting development. But to make an independent choice, he must disagree with you in order for the choice to be his own. When you ask him to do something, part of him wants to please you, but part of him wants to refuse.
Many people call this important phase of development "the terrible twos." I prefer to call it "the first adolescence." This period begins long before age 2 and actually continues long afterward, but in the majority of children, it's most intensely focused around the period from 1 1/2 to 3 years of age.
The hallmark of this stage is oppositional behavior. Our wonderful children instinctively want to do exactly the opposite of what we want. We have nice, reasonable expectations and they say "NO!" or they simply dissolve into tears. Suppose you have to go someplace in a hurry. Your son has been in a great mood all day. But when you say, "I need you to get into the car right now," he'll want to do anything but that!
As if this weren't enough, children in this phase of development have a great deal of difficulty making the choices they so desperately want to make. You ask your child what he would like for dinner and he says macaroni. You lovingly prepare it for him. Then as soon as it's made he says, "I don't want that!" It's perfectly normal for him to reverse a decision as soon as he has made it, because at this stage he even disagrees with himself.
This phase is difficult for parents but it's also hard for children. When children take a stand that opposes their parents, they experience intense emotions. Although they are driven to become their own unique persons, they also long to please their parents. Even now, when I do something that my parents disagree with, I feel conflicted. I'm an adult, living in a different city, making well thought out choices, and it's still difficult. For a child who is tentatively learning to make choices, who is dependent on his parents for food, shelter, and emotional support, it's even more intense. Dissolving into tears is an appropriate expression of the inner turmoil that is so real for children who are in the midst of this process.
This season of emotional outbursts in children is reminiscent of labor--a series of intense spasms that ushers in a whole new phase of life.
Who gets it?
Children going through this volatile developmental stage are most likely to get frustrated and have a tantrum when the intensity of the immediate situation increases. The excess stimulation may be visual, auditory, tactile, or a combination. It often includes being confronted with a bewildering array of choices, or being unable to get the attention or the desired, chosen outcome.
Let's look at the example of the grocery store. As an adult, you can choose whether you want to go to the grocery store, when to go, and which products you are going to buy. When you are shopping together, your child will see things he wants. To make the situation worse, there are cleverly designed packages up and down the aisles that scream, "Buy me! Buy me! Buy me!" We are largely able to tune that out (although it affects us more than we think). For small children who are just learning to make choices, it's like going to a deafening rock concert. They are visually overwhelmed by high-decibel choices. They are compelled to start wanting multiple attractive items. When they can't have what they want, they dissolve into tears or screams. Of course everybody in the store turns and looks at your child, and worse--at you!
Almost all healthy children will have a number of temper tantrums but will eventually discard them as they find better strategies.
Those with ongoing tantrums often have reasons for ongoing frustration. Or they have discovered that tantrums work! If tantrums result in the desired attention or outcome, they can become a powerful habit. Often tantrums only occur when the parents are present.
What are the symptoms?
A child may be acting "out of sorts" before the tantrum begins. Then he asks for something he can't have, can't make up his mind, or tries to do something but fails. Crying--perhaps screaming--will result. Some kids flail their arms and kick their legs. Some throw themselves on the ground. Some cry hard enough to vomit (making their parents desperately want to give in). Others will hold their breath, even to the point of passing out.
Is it contagious?
Tantrums are not contagious, although the behavior of those around a tantrum can play into it.
How long does it last?
Most children outgrow frequent tantrums by the time their language is mostly understandable to strangers.
How is it diagnosed?
Tantrums are not a diagnosis. They are a normal phase of development, though they may be more prolonged, more frequent, or more intense in some children.
How is it treated?
Realize that tantrums are expression of acute frustration. They deserve a medium amount of attention--children should not feel that they get more of your attention by throwing a fit. Parents may be tempted to be loud or angry, but tantrums are a time to be calm.
First, take a deep breath. As a pediatrician, I've been in a grocery store with one of my own screaming kids, with my patients in the checkout line. My first thought is, "I wish I could drop through the floor so nobody would see me." Many people won't understand, especially people who don't have kids yet. They will look at you and think your child is spoiled or that you are a bad parent. But you probably have a normal child and are a good parent.
When I see a parent whose child is having a tantrum in a store, I am reminded of labor. When I look at a mom in labor, I see something that is heroic, triumphant, and beautiful. Tears come to my eyes when I am privileged to be a part of a birth. So, the next time your child starts flailing and shrieking, take a deep breath and remember: If Dr. Greene were here, he would see something heroic and beautiful.
Next, while you are taking a deep breath, consciously relax. Kids play off your emotions. It's hard to relax in this situation, but just let your muscles go. The more uptight you are, the more energy is available for their tantrums. Kids thrive on attention, even negative attention.
Where you go from here depends on your child. Some children will calm down if you pick them up and hold them. My first son was like that. His storm would dissolve if you just gave him a big hug and told him it would be all right. If you picked up my second son during a storm, he would hit you--there were different ways to get him to calm down. Each child is unique.
Handle tantrums with a light touch. Seasoning the interaction with understanding, humor, and distractions can save the day. One thing that often works very well is to try to voice to the child what he is going through. "You really want to get this, don't you?" Then he may melt and say, "Uh-huh."
You'll have to experiment to find out what helps your child understand that everything is okay, that these bad feelings will pass, and that it's all a normal part of growing up.
Whatever you do, if your child has a temper tantrum to try to get something, don't give it to him, even if you would have ordinarily done so. Giving in to tantrums is what spoils a child. Giving in is the easiest, quickest solution in the short run. But it damages your child, prolongs this phase, and ultimately creates far more discomfort for you. Choosing your child's long-term gain over such dramatic short-term relief is part of what makes properly handling temper tantrums so heroic.
How can it be prevented?
Children are most susceptible to storms when they are tired, hungry, uncomfortable, bored, or overstimulated.
Be creative at orchestrating life to minimize tantrum weather. You may want a toy basket that only comes out when you are on the phone or online. A great time for your child to watch an entertaining video is when you're preparing dinner.
When possible, plan shopping for times when your child is rested, fed, and healthy. Interact with him throughout shopping and/or bring along stimulating toys or books.
Remember the situation from your child's perspective. You are going along making choice after choice, but when he tries to make a choice, he doesn't get what he wants. How frustrating! It's often helpful to let your child pick out one or two things when at the store. When a child asks for something, instead of saying "no" (which will immediately make him say "yes"), try saying, "Let's write that down." Then write it down. When your child asks for something else, write that down too. Then when you are all done, read back a few of the things on the list that you think would be good choices, and let him pick one or two of the things on the list. If children can make some choices, they will learn more and feel better.
Another worthwhile technique is to make a list before you go to the store. That way it won't look so arbitrary when you pick what you want while your child doesn't get his choice. As you shop, whenever you put something in your basket, check it off your list. Even if it's not on your list, check it off. The list is to teach that each item has a purpose, not that you had thought of it previously.
His task during this time is to gain skill at making appropriate choices. To help him accomplish this, offer limited choices at every opportunity. He will be demonstratively frustrated if he is given direct commands with no options. He will decompensate if he has too many alternatives. Two or three options generally work best.
Make sure the choices you offer fall within an appropriate agenda. Your son still needs the security of knowing that he's not calling all the shots. When it's time to eat, say something like, "Would you rather have a slice of apple or a banana?" He feels both the reassuring limits that you set and the freedom to exercise his power within those limits. If there are two things he needs to do, let him decide which to do first, when appropriate.
Related illnesses:
Attention Deficit Hyperactivity Disorder (ADHD)
Breath Holding
Head Banging
Nightmares
Separation Anxiety
Toddler Tamers
Practical discipline tactics for the Terrible Twos
Toddler discipline seems almost an oxymoron to any mom who's tried to exert even minimal control over her tantruming 2-year-old. But even at this nonverbal stage, a child can easily distinguish between a parent's pleasure and displeasure. When she learns not to touch the stove, it's because she's afraid of losing your love -- not because she understands she'll get burned (she won't understand cause and effect until age 5 or 6) -- but that's all you need to lay the groundwork for discipline. Once you've childproofed your home from top to bottom and set a few simple rules, follow these techniques to stem the tide of your toddler's bad behavior:
Little scribblers
Does your child love to draw on the walls? Give her another choice. You can say, "No, we don't draw on the walls. But here's some paper you can write on." If she's unhappy with the suggestion, distract her with something else: A look at a board book and a quick snuggle can do the trick.
Meltdown defusion
How to show her you're in charge when she has a meltdown? Most experts agree that before age 2, a time-out isn't useful. But you might try the "lap hold," a modified version of it. Just sitting with your child in your arms for a few moments can often defuse an out-of-control situation.
Helpful concessions
Toddlers crave control, and if you give them a little, they tend to be happier. So let your child make decisions over such unimportant matters as what to wear or what she wants for breakfast (but you do need to stand your ground when it comes to making her sit in her car seat or get her shots.).
The magic word
Save the word "no" for when it's really necessary -- when your toddler's about to bite his playmate, for instance. Otherwise, the more you use the word, the more you dilute its impact, making it more likely he won't listen to you.
Lots of lovin'
As important as the discipline itself is the notion of kissing and making up afterward, which tells her you still love her, even when you don't love her behavior. After you and your child have had it out, share a big hug before you move on.
Catch her being good
The most powerful form of discipline? Positive reinforcement -- and that goes for any age. The more positive attention you give your toddler, the fewer reasons she'll have to go after the negative kind. So every time she breaks a rule ("Don't dump Mommy's purse!"), offer an alternative ("Let's dump these blocks instead"); and counter every infraction ("We don't hit!") with encouragement ("You're petting the dog so gently").
Pacify public tantrums
Anyone who's taken a toddler anywhere knows that mortification waits around every corner. Meltdowns generally start around 18 months. Things to keep in mind:
Try to preempt common tantrum triggers (fatigue, hunger, boredom, frustration) by doing errands in the morning or after naptime, and bringing snacks and an unfamiliar toy.
If prevention fails, ignore the tantrum. Pretend the screaming doesn't upset, impress, or affect you, and he'll realize there's little point in continuing.
If all else fails, get out of there! Leave the grocery cart, grab your child, and head for your car. His meltdown may simply be a plea for a hug or some undivided attention, so give him both when he's calmed down.
-- Abby Margolis Newman
More on this topic:
What Makes a Toddler Tick - www.parenting.com
