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    CH 145 Temper Tantrums

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    The document discusses temper tantrums in children, including their epidemiology, etiology, clinical features, evaluation, management, when to refer to an expert, and further reading. Temper tantrums typically occur between 18 months and 4 years of age and involve crying, screaming or aggressive behavior in response to unmet demands or frustration.

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    CH 145 Temper Tantrums

    Uploaded by

    roshen02
    20 views5 pages
    The document discusses temper tantrums in children, including their epidemiology, etiology, clinical features, evaluation, management, when to refer to an expert, and further reading. Temper tantrums typically occur between 18 months and 4 years of age and involve crying, screaming or aggressive behavior in response to unmet demands or frustration.

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    Ch 145 Temper Tantrums

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    The document discusses temper tantrums in children, including their epidemiology, etiology, clinical features, evaluation, management, when to refer to an expert, and further reading. Temper tantrums typically occur between 18 months and 4 years of age and involve crying, screaming or aggressive behavior in response to unmet demands or frustration.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    20 views5 pages

    CH 145 Temper Tantrums

    Uploaded by

    roshen02
    The document discusses temper tantrums in children, including their epidemiology, etiology, clinical features, evaluation, management, when to refer to an expert, and further reading. Temper tantrums typically occur between 18 months and 4 years of age and involve crying, screaming or aggressive behavior in response to unmet demands or frustration.

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    © All Rights Reserved
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    of 5

    Indian Academy of Pediatrics (IAP)

    STANDARD
    TREATMENT
    GUIDELINES 2022

    Temper
    Tantrums
    Lead Author
    Tilak Chandra
    Co-Authors
    Hrishikesh, Arpita Gupta

    Under the Auspices of the IAP Action Plan 2022


    Remesh Kumar R
    IAP President 2022
    Upendra Kinjawadekar Piyush Gupta
    IAP President-Elect 2022 IAP President 2021
    Vineet Saxena
    IAP HSG 2022–2023
    © Indian Academy of Pediatrics

    IAP Standard Treatment Guidelines Committee

    Chairperson
    Remesh Kumar R
    IAP Coordinator
    Vineet Saxena
    National Coordinators
    SS Kamath, Vinod H Ratageri
    Member Secretaries
    Krishna Mohan R, Vishnu Mohan PT
    Members
    Santanu Deb, Surender Singh Bisht, Prashant Kariya,
    Narmada Ashok, Pawan Kalyan
    1
    145
    Temper Tantrums
    Introduction

    ; Temper tantrums are brief episodes of unpleasant, undesirable, disruptive behaviors or


    emotional outbursts that are extreme and usually disproportionate to the situation.
    ; These are usually seen between the age groups of 18 months and 4 years and signify the
    appearance of autonomy while simultaneous seeking of parental attention.
    ; Although the majority of temper tantrums in toddlers are typical and part of normal behavior,
    atypical tantrums can be a presenting feature of behavioral and developmental disorders,
    e.g., autism.

    Epidemiology
    ; Occurs maximum in toddlers and decreases as age increases.
    ; Only 10% of 4–5 year olds have temper tantrums as compared to 85–90% of 18–36 month
    olds.
    ; Children with speech delay, behavioral disorders and developmental disorders have more
    frequent and aggressive tantrums.
    Temper Tantrums

    ; Commonly occur as a response to unfulfilled demands, frustration, anger or attention seeking


    Etiology

    behavior.
    ; The common physiological triggers are hunger, illness, fatigue, fear or overstimulating
    environment.
    ; Psychosocial factors implicated are inconsistent parenting, failure to set limits, use of corporal
    punishment, maternal depression, and low socioeconomic status.

    Clinical Features
    ; Episodes of crying, screaming, going limp, flailing, hitting, throwing items, pushing, or biting.
    ; Sometimes may lead to breath-holding spells
    ; Usually occur once a day, lasting for approximately 1–3 minutes
    ; In atypical/severe cases: It may occur >5 times/ day and/or lasts for >15 minutes
    ; Normalization of mood and behavior in between the episodes
    ; Severity, frequency, and length of the events decrease with increasing age with the acquisition
    of skills to identify emotions, communicate feelings and implement positive behaviors to
    manage negative feelings or emotions.

    A thorough clinical history including development details and physical examination is mandatory
    for comprehensive evaluation of temper tantrum (Table 1).

    TABLE 1: Physical examination and detailed laboratory tests.


    Evaluation

    Examination Laboratory tests


    ; Physical examination is normal in most of the cases, however, ; No tests are required in most
    neurocutaneous stigmata or dysmorphic facies may indicate cases, however, iron deficiency
    need for further evaluation anemia and lead toxicity
    ; Vision and hearing impairment should always be ruled out as may aggravate tantrums and
    they can exacerbate tantrum behaviors breath holding spells
    ; Neurodevelopmental disorders, e.g., autism should be ruled out ; A complete blood count and
    ; The Child Behavior Checklist and the Preschool Age Psychiatric testing for lead levels may be
    Assessment may be used in children aged 2–5 years to assess required in some cases
    associated behavioral/psychiatric issues

    4
    Temper Tantrums

    Usually nonpharmacological treatment suffice for most of the cases. However, pharmacological
    treatment may be required when tantrums are associated with severe aggression (Table 2).

    TABLE 2: Management of tantrums.


    Nonpharmacological Pharmacological

    Management
    The acronym RIDD can help parents and ; Iron supplementation may be helpful in cases
    caregivers handle a typical tantrum of breath holding spells with anemia
    ; Remain calm, state firmly in neutral tone ; Low dose antipsychotic agents, e.g., risperidone
    ; Ignore the tantrum or aripiprazole for few weeks as an adjuvant
    ; Distract the child. Leave the place taking the to nonpharmacological management may
    child till tantrum stop be helpful to decrease severity especially in
    ; Do not give into unreasonable demands and children with associated developmental or
    unnecessary physical punishments which can psychiatric disorders. (This is to be done only by
    increase undesirable behavior an expert after referral as stated later)
    Parent-child interaction therapy (PC.IT) is one-on-
    one therapy for parents to improve communication
    with child and tackle tantrums
    When to Refer
    to an Expert?

    ; Tantrum episode lasting for >15 minutes.


    ; Very severe tantrum associated with aggression towards others and/or self-injurious
    behavior.
    ; Associated neurodevelopmental disorder or a psychiatric condition.

    ; Belden AC, Thomson NR, Luby JL. Temper tantrums in healthy versus depressed and disruptive preschoolers: Further Reading
    defining tantrum behaviours associated with clinical problems. J Pediatr. 2008;152(1):117-22.
    ; Daniels E, Mandleco B, Luthy KE. Assessment, management, and prevention of childhood temper tantrums.
    J Am Acad Nurse Pract. 2012;24(10):569-73.
    ; Potegal M, Davidson RJ. Temper tantrums in young children: behavioural composition. J Dev Behav Pediatr.
    2003;24(3):140-7.
    ; US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, Barry MJ, Cabana M, Caughey AB, et al.
    Screening for Elevated Blood Lead Levels in Children and Pregnant Women: US Preventive Services Task
    Force Recommendation Statement. JAMA. 2019;321(15):1502-9.

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