Toddler tantrums: why they happen, what to do and when to worry

Tantrums are a normal part of toddler development, not a sign of bad parenting or a "naughty" child. The NHS page on temper tantrums says they usually start at around 18 months and are far less common by the age of 4. The American Academy of Pediatrics (AAP) says they happen most between ages 1 and 3 and tend to get better after 3. What helps most is staying calm, keeping everyone safe, holding your limit without a lecture, and planning around the hunger, tiredness and frustration that set many of them off.

Why do toddlers have tantrums?

Toddlers want to do and say far more than they can. The NHS explains that they want to express themselves but find it hard, so frustration comes out as a tantrum. KidsHealth's guide to tantrums adds that toddlers want more independence and control than they can handle, and when they discover they can't do something, a tantrum can follow. As language skills improve, tantrums tend to decrease.

Temperament plays a part too. The Australian Government's Pregnancy, Birth and Baby guide notes that some children are naturally more intense, persistent or active, and their tantrums tend to be bigger. A tantrum can look like whining and crying, or screaming, kicking, hitting and holding their breath.

What triggers toddler tantrums?

The same few triggers come up again and again. Pregnancy, Birth and Baby, the NHS and KidsHealth list:

• being tired, hungry or unwell
• frustration, including trying something that's beyond them
• being told "no", or not getting something they want
• needing attention, or jealousy of another child
• boredom, or anxiety about a new situation
• stress or conflict at home
• too much screen time

Knowing your child's usual triggers is the most useful prevention tool you have. Many families notice tantrums cluster late in the afternoon, before meals or after a short nap.

What should I do during a tantrum?

1. Keep everyone safe. Move your child away from roads, stairs or hard edges. Pregnancy, Birth and Baby suggests picking them up and moving to a quiet, safe place if you're out.
2. Stay calm and stay close. Staying with your child helps them feel secure. The NHS points out that shouting back won't end a tantrum.
3. Don't reason, punish or laugh. Pregnancy, Birth and Baby advises against all three mid-tantrum. Your child can't take in an explanation at this point.
4. Try a distraction early. The NHS suggests sounding surprised and interested in something else ("Look! A cat"), and the AAP suggests changing rooms or singing a song.
5. Hold the limit. The NHS, Pregnancy, Birth and Baby and KidsHealth all advise not giving in to the demand or bribing with treats, because that can teach a tantrum works.
6. Let it pass. The AAP suggests stepping back and letting the tantrum end on its own once your child is safe.
7. Reconnect afterwards. KidsHealth suggests praising your child for calming down, offering a hug, and, if they're old enough, talking about other ways to show they're cross.

KidsHealth suggests matching your response to the cause: comfort, a snack or a nap if your child is tired, hungry or upset, and calmly ignoring the outburst if it's about getting attention. The AAP also suggests handing over to another adult when your own frustration rises.

How can I prevent tantrums?

You can't prevent every tantrum, but the sources agree on what reduces them:

• Plan around triggers. The AAP suggests bringing a snack if hunger is a trigger and protecting naps and sleep if tiredness is. KidsHealth suggests avoiding shopping when your child is tired or hungry. See toddler sleep.
• Offer small choices. Choices between two options you're happy with ("the red cup or the blue cup?") give a sense of control.
• Catch them being good. The AAP and KidsHealth both suggest praising specific behaviour you want to see more of. The CDC's positive parenting tips for toddlers say to respond to wanted behaviour more than you punish unwanted behaviour.
• Show what to do instead. The CDC says to always tell or show your child what they should do instead.
• Keep routines predictable. Pregnancy, Birth and Baby suggests a consistent routine, and the AAP says consistency over time reduces how often and how intensely tantrums happen.
• Name feelings. The NHS suggests saying things like "I know you're feeling angry about…" to help your child recognise emotions. Pregnancy, Birth and Baby suggests teaching words for strong feelings.
• Choose your battles. KidsHealth and the AAP suggest thinking about whether a request really matters before saying no, and keeping off-limits things out of sight.

A clear warning before transitions ("two more slides, then home") and short shopping trips also help many families; the NHS suggests keeping shopping trips as short as possible and letting your child help.

How do I stay calm during a tantrum?

Your calm is what your child borrows. Pregnancy, Birth and Baby suggests breathing slowly and counting to 10, and, if you feel your emotions getting out of control, moving to another room until you're calmer, once your child is somewhere safe. The AAP suggests tagging in another adult when you can.

Pregnancy, Birth and Baby advises seeking help if you worry you might hurt your child or feel stretched beyond your patience. KidsHealth suggests talking to your doctor if you often feel angry or out of control when responding to tantrums, if you keep giving in to avoid them, or if tantrums are causing a lot of bad feeling at home. For support, contact a parenting support service (Tresillian or Karitane in Australia, your health visitor in the UK, your pediatrician's office in the US).

What should I do if my toddler hits or bites?

Most young children bite, hit or push at some point. The NHS says this doesn't mean your child will become aggressive as they grow up. KidsHealth's guide to biting says biting happens most often between the first and second birthdays and should stop by about 3 or 4.

1. Step in straight away. The AAP says not to ignore hitting, kicking, biting or throwing; stop it immediately and make clear it isn't OK.
2. Be calm and firm. Use a few words: "No biting. Biting hurts."
3. Comfort the child who was hurt first. Clean any broken skin with soap and water. KidsHealth says to get medical care if a bite is deep or bleeding.
4. Never hit or bite back. The NHS and KidsHealth are both clear on this.
5. Redirect and teach. Once things are calm, teach words like "stop" and "that's mine", and move on to another activity.

If biting continues, KidsHealth suggests a short time-out, with about 1 minute per year of age as a guide. The CDC also advises using only very brief time-outs at this age. The NHS suggests looking for what might be worrying your child, and giving big feelings another outlet, such as running and shouting in a park.

What are breath-holding spells, and what should I do?

Some toddlers hold their breath during a tantrum, or after a fright or a bump. KidsHealth's page on breath-holding spells says they happen in healthy children from 6 months to 6 years and are most common at 6–18 months. Children don't do it on purpose and can't control it. The Royal Children's Hospital Melbourne in Australia says most children have their first spell before 18 months and grow out of them by 6.

There are two main types:

• Blue spells (most common, per the Royal Children's Hospital): your child cries hard, breathes out, then stops breathing and goes blue around the lips, and may go floppy and faint.
• Pale spells: your child may barely cry, goes very pale and faints, sometimes stiffening briefly.

The Sydney Children's Hospitals Network in Australia says a spell usually lasts 30–60 seconds. KidsHealth and the Royal Children's Hospital say spells don't cause long-term harm, and children start breathing again on their own.

During a spell:

1. Stay calm and stay with your child.
2. Lay them on their side on the floor, away from anything hard or sharp.
3. If they pass out, check their mouth for food or objects, but don't put your fingers or anything else in their mouth.
4. Don't shake your child; the Sydney Children's Hospitals Network warns this can cause serious injuries. Don't splash water on them.
5. Afterwards, comfort them and carry on as normally as you can, without rewarding or punishing the spell.

KidsHealth says to try not to give in to tantrums just to prevent a spell. The Royal Children's Hospital and KidsHealth note that iron deficiency anaemia is more common in children who have spells, and a doctor may check iron levels.

When should I get help for tantrums or breath-holding?

Call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) now if your child:

• turns blue, goes floppy or passes out and doesn't come round quickly
• stays blue or isn't breathing for longer than about a minute (KidsHealth)
• has a seizure, or has trouble breathing

See a doctor promptly if:

• it's your child's first breath-holding spell (KidsHealth advises medical care for a first spell)
• your child is younger than 6 months, or takes a while to recover after a spell (Sydney Children's Hospitals Network)
• spells are very frequent, such as more than once a day or several times a week (Royal Children's Hospital)
• your child knocked their head during a spell and has symptoms afterwards (Royal Children's Hospital)

Talk to your GP or child-health nurse if:

• tantrums are becoming more frequent, more intense or longer (KidsHealth)
• your child often hurts themselves or others, or destroys things during tantrums (Pregnancy, Birth and Baby)
• tantrums come with nightmares, headaches or tummy aches, new wetting or soiling after toilet training, or constant clinging (Pregnancy, Birth and Baby)
• tantrums continue once your child starts school (Pregnancy, Birth and Baby)
• biting is getting worse rather than better, or carries on past about 3 or 4 (KidsHealth)
• you're worried about your child's hearing, speech or development; KidsHealth notes hearing or vision problems and language delays can contribute

The NHS says that if you're seriously concerned about your child's behaviour, talk to your GP or health visitor. For speech milestones, see first words and milestones from 12 to 24 months.

What's worth noting down?

A few quick notes after each big tantrum (time of day, what happened just before, how long since your child last ate or slept, and how long it lasted) often reveal a pattern you can plan around. If you're worried, the same notes help your GP or child-health nurse see how often tantrums or breath-holding spells happen and whether they're changing.