Could your child's tantrums be a sign of mental illness?

We have all seen it: a child screaming at the top of their voices, rolling on the ground, determined to get their way. Often, this happens in a public place like a supermarket or playground. Most onlookers take it to be indiscipline.

Although a child may seem out of control, temper tantrums are a normal part of childhood development. It is a way in which they learn to express and manage anger and practise coping skills.

For this reason, it is important for caregivers and parents to effectively manage these episodes.

Is it a mental illness?

Although tantrums are a way in which a child communicates his/her feelings, they can, sometimes, be a manifestation of a mental health problem. Most people are unaware of this, but children, too, can have mental health disorders.

Red flags

Self-injury: Children who deliberately hurt themselves during tantrums should raise alarm bells. Banging their heads against the wall, biting or scratching themselves or deliberately kicking objects in an attempt to hurt themselves are behaviours that are not normal tantrums.

Aggression toward parents, caregivers and pets: If your child is constantly hitting or kicking you during a temper tantrum (to a point that you have to physically protect yourself against the blows), it is not part of normal tantrum behaviour. Turning aggression towards pets/animals is also a danger sign.

Destruction of toys and property: If your child repeatedly destroys toys or household objects (utensils, electronics, mirrors etc) or if they destroy other children’s/siblings’ items during a tantrum, then there may be more to their state of mind than meets the eye.

Frequent tantrums: Although there is no exact number of tantrums that are considered ‘normal’, if your child is having 15 to 20 tantrums a month, then your child may be having a problem.

Older children with tantrums: Most tantrums occur at ages 2-4 years after which the child slowly learns to control his/her emotions. If a child continues to have regular tantrums (or if they increase in frequency) after this age, there may be a mental health challenge.

Inability to calm oneself after a tantrum: Children gradually calm themselves down after a tantrum (even if the parent does not try and soothe them). If your child cannot self-soothe and requires you to constantly physically calm them down, there may be a mental health issue.

Very long tantrums: Most tantrums last less than 10 minutes (although it often feels like 10 years to a parent). Children whose tantrums almost always last more than 25 minutes may have an underlying mental health issue.

Tantrums occur in a variety of settings with different people: Almost all tantrums occur whilst the parents are present. Often, they tend to occur at home and occasionally in unfamiliar places.

If your child is constantly having tantrums in the presence of secondary caregivers, teachers, grandparents (even when you are not there), you may need to have them assessed for possible mental health problems.

Tantrum without a reason: Most children have a trigger that has resulted in a tantrum. If your child cannot explain why he or she is upset during (or after) a tantrum, then there may be a problem.

Mood swings between tantrums: Most children tend to cheer up after they have calmed down from a tantrum episode.

If your child is consistently moody, angry, sad, has no interest in playing, or is excessively sleepy or tired, they will need medical review.

Who can parents turn to if they are worried?

Kenya has several child psychiatrists, psychologists and counsellors. We also have child development centres where one’s child can be assessed for possible mental health issues. Talk to your child’s paediatrician to guide you on the best approach for your young one.

Do not wait for them to ‘grow out of it’

If your child fell down the stairs and injured his elbow, you would not wait to see if the elbow will heal on its own with time. You would likely seek immediate medical advice to avoid complications. The same attitude needs to be used when dealing with mental health issues. If you are worried, seek help now.

How to prevent and deal with temper tantrums.

•Stick to routines: Try and keep meal time and sleep time fixed. Avoid long outings, delayed meals and overdue naps.

•Be consistent with rules: Your child needs to understand that rules are important and that they must stick to them. Do not be tempted to break the rules in to stop a tantrum.

•Ignore the tantrum: Unless putting himself or herself in physical danger, do not give undue attention to a child who is throwing a tantrum. Show them that their behaviour does not merit any attention.

•Avoid hitting/smacking the child: This is not easy – especially since most of us were smacked for inappropriate behaviour as children.

•Do not ‘negotiate’ with the child: If your child is having a tantrum, they are not in a rational state. Cajoling them, bribing them and even trying to reason with them is inappropriate. Bribing them to stop acting up teaches the child that they can get rewards for inappropriate behaviour.

•Give them time: After a child has had a tantrum, give them time to calm down. Once they are calm, you can then talk to them about the situation that led to the tantrum. You can use that opportunity to explain why their behaviour was unacceptable and how they should behave in future. You may have to do this repeatedly in the first few months but with time, the child will understand.

•Prepare your child: If you are going somewhere, explain to your child where you are going and let them know what is unacceptable behaviour in that scenario.

For example, ‘we are going shopping and there are lots of nice things in the supermarket. Since you are a good boy/girl, I will allow you to pick one treat only. If you see something else you want, we can buy it next time we go shopping. If you start crying for a second item, I will not let you carry anything. Is that clear?’ Make sure that the child has understood this clearly and let them repeat it to you on the way to the supermarket (re-enforce the concept).

• Manage boredom: Some children will fuss and fight when they are bored. Keep them distracted with books, toys and play.

• Pay attention to good behaviour: Praise your child when they are good. Let them understand that good behaviour warrants praise whilst bad behaviour (tantrums) will be ignored.