Commentary

Tips for assessing, managing temper tantrums


 

References

While standing by silently ignoring tantrums is usually the fastest way to reduce them, some children calm down faster if held. This does not reinforce the fits as long as the child’s demand is not fulfilled. Instead, it lends adult “ego support” to reassure the child that all is well and life goes on. Children quickly go from angry to sad; older children are even embarrassed by their loss of control. Comfort is appropriate and kind, as long as at least one parent can do this authentically.

Point out that frustrations in small doses are crucial for learning frustration tolerance. Parents who overprotect their child from any little stress to avoid fits is doing him a disservice. Instead, attention, praise, or marks for little bits of self-control effort or for “using your words” builds self-control over time. Times of transitions such as coming for dinner or going to brush teeth are often times of tantrums; these deserve a 2-minute warning and praise or marks for success in “moving on.”(Stopping electronics without a fit is another . Hint: If the child has a fit, he gets no electronics the next day.)

Adult management may be reinforcing tantrums. When parents give the child what she was screaming for, or remove a demand – such as to take a bath – that had sparked a fit, they can count on having an even worse reaction the next time.

I coach parents to think together about the six main things that set off their child’s tantrums and decide in advance on which ones they will hold their ground. Then, when the child just begins to beg for that snack, the parent should decide instantly if this is a “yes” or a “no” (aiming for more yeses). Parental “giving in” before a tantrum starts models positive flexibility for the child and avoids reinforcement. When an event on the “no” list comes up, both parents are then better able to have an unequivocal response and then walk away.

“But when should we teach him a lesson?” parents often ask. If parents interpret a tantrum as manipulative, a moral failing, or an evil tendency, they tend to react with anger and even loss of control themselves. Be alert for risks of excessive punishment in these cases. Not only is their response a poor model and scary for the child, it can even become an exciting, reinforcing display. If parents are depressed or tend to ignore the child as a norm, it may be worth it to the child to throw a fit to bring them to life. You can emphasize that positive attention to good behavior and silent ignoring of fits is more effective and avoids these side effects.

Parents may experience tantrums as a battle of wills that they are not willing to lose, imagining a future rebellious teen. They need education on the normal imbalances of childhood and on both prevention and intervention strategies. What they can lose in the present is their child’s confidence in adult kindness, the opportunity to model flexibility and self-control, and a relationship with their child that conveys acceptance.

Dr. Howard is assistant professor of pediatrics at the Johns Hopkins University School of Medicine, Baltimore, and creator of CHADIS (www.CHADIS.com). She has no other relevant disclosures. Dr. Howard’s contribution to this publication was as a paid expert to Frontline Medical Communications.

Pages

Recommended Reading

PAS: Use high-dose acyclovir to treat HSV-infected infants
MDedge Family Medicine
Delayed cord clamping linked to better neurodevelopmental outcomes
MDedge Family Medicine
Community-level interventions increase HPV immunization rates
MDedge Family Medicine
Youth sports
MDedge Family Medicine
ADHD diagnosis less common in Hispanics
MDedge Family Medicine
Treatment of preschool ADHD
MDedge Family Medicine
Slower teen reaction times may increase anxiety and depression risk later in life
MDedge Family Medicine
Exercise-induced anaphylaxis
MDedge Family Medicine
Automatic counseling failed to improve adolescent acne
MDedge Family Medicine
Report IDs insurance barriers to breastfeeding services
MDedge Family Medicine