• Frustration, tiredness, and hunger are the most common causes.
• Children may scream, cry, thrash, and stomp their feet during a tantrum.
• If distraction does not stop the tantrum, the child may have to be removed from the situation.

Temper tantrums are common in childhood. They usually appear toward the end of the first year, are most common between ages 2 and 4, and are typically infrequent after age 5. If tantrums are frequent after age 5, they may persist throughout childhood.

Causes include frustration, tiredness, and hunger. Children also may have temper tantrums to seek attention, obtain something, or avoid doing something. Parents often place the blame on themselves (because of imagined poor parenting) when the real cause is often a combination of the child's personality, immediate circumstances, and developmentally normal behavior. An underlying mental, physical, or social problem may rarely be the cause and is more likely if a tantrum lasts for more than 15 minutes or if tantrums occur multiple times each day.

A child who is having a temper tantrum may shout, scream, cry, thrash about, roll on the floor, stomp, and throw things. Some of the behavior may be rage-like and potentially harmful. The child may become red in the face and hit or kick. Some children may voluntarily hold their breath for a few seconds and then resume normal breathing (unlike breath-holding spells, which also can occur after crying bouts caused by frustration—see Behavioral and Developmental Problems in Young Children: Breath-Holding Spells).

Although providing a safe setting for children to compose themselves in (a time-out) is often effective, many children have difficulty stopping tantrums on their own. In most cases, addressing the source of the tantrum only prolongs it. It is therefore preferable to redirect and distract children by providing an alternative activity on which to focus. The child may benefit from being removed physically from the situation.

The Time-Out Technique
This disciplinary technique is best used when children are aware that their actions are incorrect or unacceptable and when they see withholding of attention as a punishment. Typically, children do not understand that withholding attention is a punishment linked to undesirable behavior until they are 2 years old. Care should be taken when this technique is used in group settings such as day care centers, because it can result in harmful humiliation. The technique can be applied when a child misbehaves in a way that is known to result in a time-out. Usually, the child should receive verbal statements and reminders before the time-out technique is used. The inappropriate behavior is explained to the child, who is told to sit in the time-out chair or is led there if necessary. The child should sit in the chair for 1 minute for each year of age (a maximum of 5 minutes). A child who gets up from the chair before the allotted time is returned to the chair, and the time-out is restarted. Talking and eye contact are avoided. When it is time for the child to get up, the caregiver asks the reason for the time-out without anger and nagging. A child who does not recall the correct reason is briefly reminded. The child does not need to express remorse for the inappropriate behavior as long as it is clear that the child understands the reason for the time-out. As soon as possible after the time-out, the caregiver should make an effort to identify good behavior and praise the child for it. Good behavior may be easier to achieve if the child is redirected to a new activity far from the scene of the inappropriate behavior.

Last full review/revision February 2009 by Stephen Brian Sulkes, MD