Temper Tantrums and

Behavioral Management
Michelle Vo, MD PGY-2

Triple Board Morning Report

March 15, 2010

Developmental Factors related to Temper
Tantrums
Anticipatory Guidance Related to Temper
Tantrums and Behavior Management
Helping Parents Anticipate Disciplinary
Problems
Dealing with Temper Tantrums
Time-in and Time-out
Why do temper tantrums happen?
Young toddlers work towards independence/autonomy
but still need security and nurturance

Greater awareness of the external world

Language (especially receptive language) emerging

Limited skills
 Attention span
 Cooperation with playmates
 Motor dexterity
 Frustration tolerance
Tug-O-War
 Problem Tantrums and Possible
Contributing Factors
Normal Development

Temperment

Medical Problems

Developmental Disabilities

Environment

Parenting
 Anticipatory Guidance: 15-18
months
We expect the development of negative behavior in the
form of emotional outbursts at this age

Help parents view struggles for independence and

mastery as a positive sign of a child’s emotional and
social development

Help parents anticipate disciplinary problems

Anticipating Discipline Problems
Some parents find it difficult to understand toddler
behavior and accept the “push-pull” nature of the
struggle for independence and mastery

What am I trying to teach?

Why is this important to me?

How am I trying to teach it?

What is my child learning?

 Parents of Toddlers Should
Believe in the No-Win Scenario
 Anticipating and Short-Circuiting
Excessive Frustration

Help parents see temporal and situational patterns in

which tantrums occur

For example: excessive sensory stimulation, certain

times of the day (morning? Dinner?)

Toddlers require consistency in all aspects of life (too

much variability is confusing)

For toddlers to understand consequences of an action,

parental reaction/response must be immediate
 Dealing with Tantrums:
Distraction
Distracting the toddler from the situation may diffuse
the frustration

Most tantrums in a toddler-age child result from acute

frustration

Physically remove the child and place him in a safe

place

Offer an alternative activity with loving touch (body

contact from someone familiar is often settling and
reassuring)
 An Attachment-based Way to
Diffuse a Temper Tantrum:
Remove the toddler from the frustrating situation,
settle her in a quiet place

Hold the child closely and talk gently.

Ask a question or make a statement reflecting the

child’s feelings at the moment

Try using this approach at a well-child check. Not only is

it often effective for negative behavior, but it is also a
potential foundation for parent-child communication
about feelings.
 Time-Out (And Time-In!)
Time out was initially called “time out from positive
reinforcement”

Depending on the child’s developmental state, Time-In

and Time-Out can be effective from 1 year-early
adolescence

In the absence of good Time-In, Time-Out is

suboptimally effective
 Effectiveness of Time-Out
Depends On:
 Time-Out must be presented immediately after the negative
behavior

 Time-Out must occur consistently after every instance of the

negative behavior

 Time-Out must be in contrast to Time-In

 Time-Out should not be considered “over” until the child has

quieted down

 All warnings about using Time-Out should be carried out

 Completely ignore the child during Time-Out regardless of

how outrageous the behavior might become
 Advantages of Time-In and Time-
Out:

Provides the parents an effective alternative to nagging,

yelling, or spanking

Consistent use of Time-In and Time-Out also encourages

children to develop self-quieting skills
 Troubleshooting Time-Out:
Common Mistakes
Talking or arguing with the child after placing him in
time-out

Talking or arguing with the child before placing him in

time-out

Make the child apologize or promise to be good after

time-out is over

Threatening to use time-out instead of actually using it

Trying to shame or frighten a child with time-out

Other Things to Consider with
Behavioral Modification:
Extinction, Selective
Attention, Active Ignoring
Positive Reinforcement
Job Grounding for older
children
Discuss Corporeal
Punishment and Spanking
 Resources

For Parents:

 SOS Help for Parents. Lynn

Clark, Ph.D.

 http://www.healthychildren.org

For You:

• Parker et al. Developmental

Behavioral Pediatrics: a
Handbook for Primary Care. 2nd
edition. 2005.

• Dixon, S. and M. Stein.

Encounters With Children. 4th
edition. Mosby: 2006.