Let’s Talk about Tantrums Part I: The Basics

If you haven’t yet had the unforgettable experience of having your own child throw a tantrum in a public place, you’ve probably seen your share of tantrums in stores, restaurants, or at the movies. Nearly 90% of both boys and girls between 18 and 36 months of age have tantrums. Even though it seems like they last forever, most tantrums last between 5 and 10 minutes (75% of tantrums last 5 minutes or less). Children may develop their own tantrum “style” but tantrums typically include one more of the following behaviors: screaming, crying, stamping, throwing, running, pushing, or flailing arms and legs. Sometimes children having tantrums will bang their heads, punch, or kick anyone within reach. While we realize there is plenty of advice for parents to help them understand and deal with their children’s tantrums, we’ll offer our own take on this common experience.

Why Tantrums Happen

Why does a sweet happy singing child suddenly melt down into fits of rage? Why do anger, frustration, sadness, and fear become so out of control in older infants? In the past, parents believed that older infants and toddlers chose to kick and scream to get their way. Babies certainly learn quickly that specific cues or behaviors are likely to get desired responses but these discoveries come out of babies’ experimentation to find “cause and effect,” not out of attempts at manipulation.

Older babies’ brains are ready to experience feelings such as anger, disappointment, and frustration but they aren’t able to control those emotions. Think of it like leaving a pot of water on a hot stove and finding that you can’t turn off the burner or move the pot once the water has started bubbling. The water continues to boil, becoming more and more intense until the water evaporates away. Compare this image with that of the toddler shouting with frustration at his mother in a store, getting louder and louder until he bursts into tears and falls exhausted into his mother’s arms.

Jen B got first hand experience with a tantrum just a few days ago returning home with her family from a trip to Grandma’s house. Her daughter, Olivia, happy to take trips throughout the weekend, suddenly became aware that they were headed home. “Where’s the beach?” She asked a little distressed, and then asked if they were going back to Grandma’s house. Of course, she was reassured that they would see her grandparents soon but Olivia was already angry and losing control. The screaming and crying began and lasted all the way home.

Facts about Tantrums

In a 2003 study, researchers studied 335 children to get a better understanding of tantrums in children up to 5 years of age. Some of their findings include:
During tantrums, screaming and crying tend to go on continuously; aggressive behaviors tend to be intermittent
Shorter tantrums (less than 3 minutes) usually include only crying and one other behavior like stamping or dropping to the floor, longer tantrums (3 minutes or more) are more likely to include more behaviors and aggressive actions
Children who are distressed (sad or fearful) will have longer tantrums than those who are angry

We know that tantrums can be exhausting and embarrassing for parents and children. In part 2 of this series, we’ll share some tips to help you cope with tantrums.

Next time: Let’s Talk about Tantrums Part II. Common Triggers

Sources:

Osterman K, Björkqvist K. A cross-sectional study of onset, cessation, frequency, and duration of children's temper tantrums in a nonclinical sample. Psychol Rep. 2010; 106:448-54.

Potegal M, Kosorok MR, Davidson RJ. Temper Tantrums in Young Children 2: Tantrum Duration and Temporal Organization. Dev Behav Pediatr 2003; 24: 148-154.

Potegal M, Davidson RJ. Temper Tantrums in Young Children 1: Behavioral Composition. Dev Behav Pediatr 2003; 24: 140-147.

Cough and Cold Medicines and Antihistamines: Infant "sleep aides"?

All of us (at the UC Davis Human Lactation Center) have been traveling quite a bit. Jane was in Chicago a couple of weeks ago and heard a young father carrying a young baby tell another airline passenger, “She was so good; it must have been the Benedryl.” She’s also heard health professionals and WIC staff talk about parents using cough and cold medicines to get their babies to sleep. Warnings against “off label” use to sedate babies have started to appear on labels of some pediatric over-the-counter medications.

Some parents may give cough and cold medicines (CCM) or antihistamines to infants and young children to deal with their behavior. An Australian study interviewed 40 parents of young children and reasons stated for “treatment” with CCMs included behaviors such as “she wasn’t her normal self,” he was “grumpy,” she “was generally unhappy,” or he was “whining” and “cranky.” CCMs also were given to help children calm down or sleep. One parent said: “To keep functioning, my wife and I have to have a good night’s sleep. So we trade off giving the drug to have a good night’s sleep.” I’m sure our readers will not be surprised that we find this practice particularly scary. 1

One of the most commonly used antihistamines is diphenhydramine hydrochloride, the active ingredient found in Benadryl. Only one study has tested the safety of the use of this antihistamine in children, and those children were aged 2-12. 2 There are no published studies of the safety or effectiveness of diphenhydramine in children younger than 2 years; however, according to one study of pediatricians in the US, 1/2 reported they had recommended antihistamines (at least once in the past 6 months) be given to children aged 0 to 2 years for “sleep problems.”3 According to another study, less than 10% of children under 2 years had been given antihistamines. Though use of CCM to sedate young children may not be widespread, it is indeed dangerous. So, we wanted to share some information with you just in case you know anyone who has decided to use these medications to get their children to sleep.3

Safety Warnings
The Centers for Disease Control and Prevention (CDC) has linked cough and cold medicines (including antihistamines) to >1500 emergency department visits and 3 deaths in 2004–2005 among children under 2 years of age. In 2004, the US Food and Drug Administration (FDA) added a warning to the label of promethazine, an antihistamine similar to Benadryl, which contraindicated their use in children under 2 years of age. 4 The warnings were based on “continued reports of serious adverse events, such as respiratory depression and central nervous system reactions, including seizures.” The FDA recently enforced measures against unapproved marketing of the antihistamine carbinoxamine to young children because of reports of 21 deaths that were associated with use of this drug in children who were younger than 2 years. Many antihistamines cross the blood-brain barrier, affecting the central nervous system (CNS) and potentially causing sedation. In some infants and children, antihistamines can have the opposite effect of sedation by stimulating the CNS resulting in irritability, nervousness or insomnia. Another negative “side effect” of antihistamine or CCM use in children is that parents may delay seeking medical care because the medication masks the symptoms of an underlying illness.

They aren’t safe, but are they effective?
One study, ironically named the “TIRED study” was designed to examine how infants respond to diphenhydramine. Not only did the study results show no improvement in infant sleep problems at the commonly used dose, the trial was stopped early because of lack of effectiveness of diphenhydramine over placebo. 3

What if children need these medications?
When children are ill or have severe allergies, pediatric formulations of cough and cold medications may be very useful. These medications were intended for intermittent use in children who are under a doctor’s care. But parents need to be told that these medications are not supposed to be used daily by anyone and they might be particularly dangerous to infants. Parents should talk to their pediatricians before using any medications with their babies.

A Final Note
Please don’t think we don’t understand how exhausting and challenging it is to have an older infant or toddler that is not “sleeping through the night.” We ALL have been in that sleep deprived haziness at one time or another. We've shared our experience along with a few tips for sleepy parents in our previous posts “Thoughts from a Sleep Deprived Mom” and Tips from the Trenches: Surviving Sleep Deprivation. Thanks to all of you for passing these words along and please continue to send us your feedback!

Next time: Let’s Talk about Tantrums

References
1. Allotey, P., Reidpath, D.D., & Elisha, D. "Social Medication" and the Control of Children: A Qualitative Study of Over-the-Counter Medication Among Australian Children. (2004). Pediatrics. 114, e378-383.
2. Vernacchio, L., et al. Cough and cold medication use by US children, 1999-2006: results from the slone survey. (2008). Pediatrics, 122, e323-329.
3. Merenstein, D., et al. The Trial of Infant Response to Diphenhydramine The TIRED Study—A Randomized, Controlled, Patient-Oriented Trial. (2006). Arch Pediatr Adolesc Med. 160, 707-712.
4. Simons, F.E.R. Diphenhydramine in Infants. (2007). Arch Pediatr Adolesc Med. 161, 105.