Jane Anderson, MD

Fortunately, it takes little time to relay some important themes of temper tantrums-their causes and appropriate parental response, the importance of the word "no," and the benefits from parental limit setting-during this increasingly important visit.  

One of the questions I ask parents at every 18-month visit is, "Does your child have temper tantrums?" When they respond positively, I always say, "That's great!" Parents are usually startled by my response, so I then ask, "Do you know why I am so pleased that your child is having temper tantrums?" Often, after a brief pause, the parents will acknowledge that this probably shows the child is developing normally, and I can enthusiastically endorse that idea. Temper tantrums, after all, are a child's  way of demonstrating that their brain is indeed  maturing, and that he/she is developing their own ideas.  

2. Begin problem-solving: "If I can't do this activity, what can I do?" 

3. Think creatively about other activities he/she might do to entertain himself/herself 

This process allows the toddler's brain to develop new neuronal pathways-that of stopping one behavior on command, and thinking creatively about new possibilities. Some parents may express concern that saying "no" to their child may inhibit and stifle the child's creativity. Yet the reality is the exact opposite, since saying  "no" actually encourages a child to use his/her  imagination, to think innovatively, and to demon- strate resourcefulness. 

Conversely, parents who hesitate to use the word "no" will often describe their 18-month-old as easily distractible, never having temper tantrums, and never needing time-out (see "Maybe it's time for a time-out"). This is because the child has never had limits placed on his/her behavior, which will only breed problems later on. I have seen this effect first-hand. Parents of 5-year-olds have expressed great consternation that their child is now having temper tantrums at school, going so far as to hit the teacher and/or throw toys in the classroom. These parents invariably state that they are especially surprised, because their child did not have tantrums as a toddler. This scenario is no longer surprising, since I know the reason is because their parents never set limits on their behavior. 

Toddlers usually have temper tantrums for one of three reasons:  

The parental response obviously depends upon the underlying cause for the tantrum. For example, if the child is hungry or tired, the parental response should be to feed the child or provide an opportunity to nap. When a toddler is attempting to do something he or she is not yet capable of (ie, trying to put a puzzle piece in the wrong place or the wrong way), a tantrum born of frustration often results. An appropriate response to this scenario would be for the parents to help the child problem-solve by saying, "Here, let's try this a different way."  

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Parents of 18-month-olds are eager to learn from their pediatricians how to manage behavioral concerns, especially temper tantrums.

Jane Anderson, MD

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