This document discusses temper tantrums in children between 18 months and 4 years old. It covers the epidemiology, etiology, clinical features, examination, laboratory tests, and management of temper tantrums. Temper tantrums typically occur once a day and last 1-3 minutes, but in some cases can occur more than 5 times a day and last over 15 minutes. Management involves nonpharmacological approaches like remaining calm, ignoring the tantrum, and distracting the child, as well as potential pharmacological interventions for conditions exacerbating tantrums.

1. Temper
Tantrums
By: Dr. V. K. Pathak
MD (Ayu. Pediatrics)

2. Introduction
1. Episodes of unpleasant,
undesirable, disruptive behavior.
2. 18 months and 4 years.
3. Atypical tantrums can be a
presenting feature of behavioral
and developmental disorders,
e.g., autism.

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

4. Etiology
• Occur as a response to unfulfilled
demands, frustration, anger or
attention seeking behavior.
• Physiological triggers are hunger,
illness, fatigue, fear or overstimulating
environment.

5. 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.

6. Examination
• Physical examination is normal in
most of the cases,
• Vision and hearing impairment
should always be ruled out
• Neurodevelopmental disorders, e.g.,
autism should be ruled out

7. Laboratory tests
• No tests are required in most
cases.
• Iron deficiency anemia and
lead toxicity may aggravate
tantrums and breath holding
spells.

8. Management
Nonpharmacological
The acronym RIDD can help parents and
caregivers handle a typical tantrum
• Remain calm, state firmly in neutral tone
• Ignore the tantrum
• Distract the child.
• Do not give unnecessary physical
punishments which can increase
undesirable behavior.

9. Pharmacological
• Iron supplementation may be helpful
in cases of breath holding spells with
anemia
• Low dose antipsychotic agents.

10. THANK YOU
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