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Pediatric

Tantrum

Other Names: Temper tantrum and Hissy fit

Definition:
A tantrum is an emotional outburst, usually associated with those in emotional distress, that is typically characterized by stubbornness, crying, screaming, violence, defiance, angry ranting, a resistance to attempts at pacification, and, in some cases, hitting, and other physically violent behavior. Physical control may be lost; the person may be unable to remain still; and even if the “goal” of the person is met, he or she may not be calmed. A tantrum may be expressed in a tirade: a protracted, angry speech.

In tantrum children throw, shout, scream, roll on the ground, kick and beat — when their demands, often unreasonable, are not met. Most of these outbursts occur between the ages of one and three years. Thereafter, they slowly subside in normal children.

Tantrums are usually signs of frustration. They can occur when the child is hungry, in pain, sleepy or denied something. Children who are mentally challenged or have autism are more likely to throw tantrums. They are unable to articulate their problem. Taking care of the immediate need or distracting the child usually works.

Problems arise when others interfere. The child very soon figures out that by screaming and rolling on the floor they can get their way.

Children grow out of tantrums when they go to school. If a child continues this behaviour of biting, kicking or throwing things in school, in front of strangers and in public, it is no longer normal. If it continues into middle school, medical evaluation is required. It may be due to unrecognised ADHD, anxiety or depression.

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Causes:
Tantrums are one of the most common forms of problematic behavior in young children, but tend to decrease in frequency and intensity as the child grows older. For the toddler, tantrums can be considered as normal, even as gauges of a developing strength of character.

While tantrums are sometimes seen as a predictor of future anti-social behaviour, in another sense they are simply an age-appropriate sign of excessive frustration, and will diminish over time given a calm and consistent handling. Parental containment where a child cannot contain itself—rather than what the child is ostensibly demanding—may be what is really required.

Selma Fraiberg warned against “too much pressure or forceful methods of control from the outside” in child-rearing: “if we turn every instance of pants changing, treasure hunting, napping, puddle wading and garbage distribution into a governmental crisis we can easily bring on fierce defiance, tantrums, and all the fireworks of revolt in the nursery”.

Intellectual disabilites:
Some people who have psychiatric disorders such as autism, ADHD, and intellectual disability could be more vulnerable to tantrums than others, although anyone experiencing brain damage (temporary or permanent) can suffer from tantrums. Anyone may be prone to tantrums once in a while, regardless of gender or age. However, a meltdown due to sensory overload (which even neurotypical children can experience) is not the same as a temper tantrum.

Aberrations:
Freud considered that the Wolf Man’s development of temper tantrums was connected with his seduction by his sister: he became “discontented, irritable and violent, took offence on every possible occasion, and then flew into a rage and screamed like a savage”. Freud linked the tantrums to an unconscious need for punishment driven by feelings of guilt—something which he thought could be generalised to many other cases of childhood tantrums.

Heinz Kohut contended that tantrums were narcissistic rages, caused by the thwarting of the infant’s grandiose-exhibitionist core. The blow to the inflated self-image, when a child’s wishes are (however justifiably) refused, creates fury because it strikes at the feeling of omnipotence.

Jealousy over the birth of a sibling, and resulting aggression, may also provoke negativistic tantrums, as the effort at controlling the feelings overloads the child’s system of self-regulation.

Solutions:
If there is no medical reason for the tantrum, and it is not due to an epileptic seizure, these personality traits need to be tackled. Beating the child or shouting is not an answer. A “time out” with the premise that the problems will be tackled later on works with older children. With younger ones, discipline needs to be enforced. A firm “no” should remain just that — a “no”. Once it is changed to a “yes”, the child gets confused and soon figures out that there is a higher court of appeal. Structured sports activities and training in martial arts give a child mental discipline, emotional control, physical endurance and channels aggression.

As children grow, they realise the difference between appropriate and inappropriate anger. Parents have a great deal to do with this, showing the child the limits enforced by society. Physically abusive or alcoholic fathers tend to raise similar children.

Anger is not always bad, it can also be good. It activates the body’s natural defences to a dangerous situation, releasing chemicals that raise the heart rate and blood pressure. The muscles become tense and sweating may occur.

Some adults have not matured enough to realise that anger is a negative emotion. They are chronically angry. It may eventually result in “intermittent explosive disorder” when the reaction is out of proportion to the precipitating event. These episodes of increased energy, racing thoughts and palpitations result in tirades and heated arguments. Society does not accept such behaviour. It may result in the loss of a job and a breakdown in personal relationships. It may lead to alcohol or drug abuse and self-harm. Chronic anger over a long time can result in depression.

To manage anger, lead a disciplined life with regular physical activity, yoga and meditation. If these do not work, professional help may be required. Medication like antidepressants may also help.

We need to rule our mind and control it. This has to be learnt from a young age. Otherwise, we are at the mercy of the caprices of our emotions.

Help to prevent tantrum in children:

Try to prevent tantrums from happening in the first place, whenever possible. Here are some ideas that may help:

  1. Give plenty of positive attention.: Get in the habit of catching your child being good. Reward your little one with praise and attention for positive behavior.

2.Try to give toddlers some control over little things.: Offer minor choices such as “Do you want orange juice or apple juice?” or “Do you want to brush your teeth before or after taking a bath?” This way, you aren’t asking “Do you want to brush your teeth now?” — which inevitably will be answered “no.”

  1. Keep off-limits objects out of sight and out of reach.: This makes struggles less likely. Obviously, this isn’t always possible, especially outside of the home where the environment can’t be controlled.

4.Distract your child.: Take advantage of your little one’s short attention span by offering something else in place of what they can’t have. Start a new activity to replace the frustrating or forbidden one. Or simply change the environment. Take your toddler outside or inside or move to a different room.

5.Help kids learn new skills and succeed.: Help kids learn to do things. Praise them to help them feel proud of what they can do. Also, start with something simple before moving on to more challenging tasks.

5.Consider the request carefully when your child wants something.: Is it outrageous? Maybe it isn’t. Choose your battles.
Know your child’s limits. If you know your toddler is tired, it’s not the best time to go grocery shopping or try to squeeze in one more errand.

Resources:
https://en.wikipedia.org/wiki/Tantrum
https://kidshealth.org/en/parents/tantrums.html
https://www.telegraphindia.com/health/how-to-manage-temper-tantrums/cid/1689765?ref=health_health-page

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