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General Information

Studies have shown that medication is effective in treating the symptoms of ADHD alone or in combination with behavioral interventions. There are several types of medications, and they are grouped into 2 major categories: stimulants and non-stimulant medications. Most children are initially treated with stimulants, although there are reasons why your doctor may choose to treat your child with a non-stimulant. Deciding which medication is right for your child may take time. Your doctor may try several different doses or switch to different medications to find the best choice. Discuss any family history of heart disease, high blood pressure, or substance use with your doctor.

Stimulant medications usually work within 15 to 90 minutes, depending on dose and formulation. Stimulant medications come in short-acting preparations that need to be given 2 or 3 times per day and long-acting preparations that are given only once a day. Although the medications are similar, each child may experience different benefits and side effects with different medications.

Stimulant medications should be given at the same time of the day, and you should never give 2 doses at the same time to make up for a missed dose. Non-stimulant medications may take up to 2 or 3 weeks before a beneficial effect is seen.

Follow-up

Currently, there is no way to know which medication will be best for any particular child. To make sure that your child is receiving the dosage that gives the best effect with the least amount of side effects, your doctor will need to start at a low dose and increase the dose until a good effect or fewer side effects are seen. To judge whether the medication is helping, your doctor will obtain completed rating scales of your child's symptoms from you and your child's teachers when your child is at baseline (without medication) and is taking different medication doses. If there is no beneficial effect at the maximum recommended dose, your doctor will usually try another stimulant medication. Approximately 80% to 90% of children will respond to one of the stimulants.

Side Effects

There are several side effects that can be associated with stimulant medications. These include stomachache, headache, decreased appetite, sleep problems, and increased symptoms as the medication wears off (known as rebound). Preschool children may also experience emotional outbursts, repetitive behaviors or thoughts, or irritability. Usually these effects are mild and often decrease after the first 1 to 2 weeks. Your doctor will adjust medications or discuss other strategies at follow-up visits if these side effects continue. It is helpful to observe the time of day when side effects occur. Serious side effects are rare, but you should contact your doctor's office if your child experiences dizziness, fainting, severe irritability, tics, or serious behavioral changes.

Setting a Follow-up Plan

Your child will need to be seen frequently during the initial treatment phase. After a satisfactory dose has been found, your child will be scheduled for a follow-up visit at regular intervals, usually every 2 to 3 months.

At follow-up visits, your doctor will review rating scales from you and your child's teachers and will check weight, blood pressure, and emotional status and review any medication side effects.

Parent's follow-up responsibilities include

  • Discuss your child's treatment program with appropriate school personnel.

  • Bring copies of completed parent and teacher follow-up rating scales to all follow-up visits.

  • Schools may be willing to fax completed follow-up rating scales to your doctor's office.

  • Inform the doctor before the next scheduled visit if your child is experiencing serious medication side effects.

  • Ask your child how he or she feels on the medication.

  • Schedule follow-up visits.

Your doctor will set up an anticipated follow-up schedule with you at the time medication is started. They are more frequent, typically weekly at the beginning since there is the need to increase dose until the most effective dose is achieved. There should be a visit within 14 to 30 days after any change in medication and dosage. Once that stabilization occurs, the frequency of routine follow-up stretches out.

Remember: If you have any questions or if you see side effects that cause concern, do not wait for the next scheduled visit. Call and speak with the doctor, and the doctor will arrange an appropriate immediate or interval follow-up.

The recommendations in this resource do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Original resource included as part of Caring for Children With ADHD: A Practical Resource Toolkit for Clinicians , 3rd Edition.

Inclusion in this resource does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this resource. Website addresses are as current as possible but may change at any time.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this resource and in no event shall the AAP be liable for any such changes.

© 2020 American Academy of Pediatrics. All rights reserved. AAP Feed run on: 9/23/2024 Article information last modified on: 8/6/2023

Temper Tantrums

It’s hard for young children to hold strong feelings inside. When they feel frustrated or angry, they often cry, scream, or stomp up and down. This is a temper tantrum.

Temper tantrums are a normal part of your ­children’s development. They usually begin around 12 to 18 months of age, get worse between 2 and 3 years, and taper off after that, once children are able to use words to communicate their wants and needs.

Here is information from the American Academy of Pediatrics to help parents understand temper tantrums and how best to deal with them.

Why do children have temper tantrums?

During the toddler years, there is a change in how children process information. They suddenly become more aware that their world can change. They realize they won’t always get what they expect or want. Their young minds are easily overwhelmed, and they don’t know how to cope with change or how to deal with not getting their way.

A lot of things can trigger a tantrum. For example, children may have a temper tantrum because they

  • Do not understand what you are saying or asking

  • Are upset when others cannot understand them

  • Do not know how to tell you how they feel or what they need

  • Do not know how to solve problems on their own

  • Have an illness or other problem that keeps them from expressing how they feel

  • Are hungry

  • Are tired

  • Are anxious or uncomfortable

  • Are reacting to stress or changes at home

  • Are jealous, want what other children have, or want the attention others receive

  • Are not be able to do as much as they think they can, such as walking, running, climbing, drawing, or making toys work

How to prevent temper tantrums

Temper tantrums are a normal part of growing up, but you may be able to prevent some from happening.

What you can do

  • Encourage your children to use words to tell you how they are feeling. Try to suggest words they can use to describe their feelings.

  • Set reasonable limits, and don’t expect your children to be perfect. Give simple reasons for the rules, and don’t change them.

  • Keep to a daily routine as much as possible so your children know what to expect.

  • Distract your children. Try a new game, book, or toy. Sometimes a change in location can prevent a tantrum. For example, if you are indoors, go outside to look for birds in the sky.

  • Avoid situations that frustrate your children, such as playing with toys that are too advanced.

  • Avoid long outings during which your children have to sit still or cannot play. If you have to take a trip, bring along a favorite book or toy.

  • Have healthy snacks ready for when your children get hungry.

  • Make sure your children are well rested.

  • Be choosy about saying no. When you say no to everything, it can frustrate your children. Consider saying yes sometimes. Of course, if your children’s safety is at stake, don’t say yes just to avoid a tantrum. Praise your children when they do something good that otherwise might have led to frustration.

  • Give choices. For example, make it clear that while they have to take a bath, they can make some choices on their own. Try saying, “It’s time for your bath. Would you like to walk upstairs or have me carry you?” Be sure the choices you offer are also acceptable to you.

  • Set a good example. Avoid arguing or yelling in front of your children.

How to handle tantrums

What you can do

  • Let the tantrum end itself. Once children begin a tantrum, only they can end it. Allow them the time and space to be left alone (in a safe place) to let the tantrum run its course. All tantrums end, almost always by a child’s path to resolution. Trying to end one early usually delays the child’s resolution.

  • Try to stay calm. If you shout or get angry, it can make things worse. If you can’t stay calm, leave the room. Wait a minute or two, or until the crying stops, before returning.

  • Offer a cooling down time. During a tantrum, it’s helpful for parents to let children not only manage their tantrum but also know there is a safe place and safe time for them to do so. It can be called a cooling-down time and place or a time-out.

  • Ignore minor displays of anger, such as crying, screaming, or kicking. Try touching or holding your children to calm them. Or, try standing nearby without talking until they calm down. If your children have tantrums in a public place, take them home or to the car.

Some behaviors are not OK and should not be ignored, such as

  • Hitting or kicking people

  • Throwing things that might hurt someone or break something

  • Screaming or yelling for a long time

If these things happen, take your children away from the problem. Say firmly, “No hitting,” or “No throwing,” to make sure your children know these behaviors are not OK.

What not to do

  • Never punish your children for temper tantrums. They may start to keep their anger or frustration inside, which can be unhealthy. Keep in mind that as your children grow, they will learn to deal with their strong emotions.

  • Do not give in to your children just to stop a tantrum. This teaches your children that temper tantrums get them what they want. Also, don’t feel guilty about saying no to your children. Set the rules and stick with them. When parents change the rules, it is harder for children to understand which rules are firm and which ones are not. Discuss with those who care for your children which rules are really needed and how to be firm about them.

When temper tantrums are serious

Your children should have fewer temper tantrums by 3½ years of age. Between tantrums, their behavior should seem normal and healthy. If the outbursts are severe or happen too often, they may be an early sign of emotional problems. Talk with your children’s doctor if your children seem to have difficulty expressing themselves with words (compared with other children the same age), cause harm to themselves or others, or hold their breath and faint, or if tantrums get worse after 4 years of age. Your children’s doctor will make sure no physical or emotional problems are causing the tantrums. He or she can also give you advice to help you deal with these outbursts.

It is important to realize that temper tantrums are a normal part of growing up. While tantrums are not always easy to deal with, a loving and understanding approach will help you and your children get through them.

Breath-holding spells

Some children, when upset and crying very hard, hold their breath after taking a big breath. They can even hold their breath to the point of passing out. It is not done on purpose but may happen when children are upset, such as during a temper tantrum. While these episodes can be scary for parents, rest assured that they are usually harmless and your children will grow out of them. If you are concerned about your children’s behavior, talk with your children’s doctor.

Keeping your children safe

Many times you will have to tell your children no to protect them from harm or injury. For example, the kitchen and bathroom can be dangerous places for your children. They may not understand why you will not let them play there. This can cause a tantrum. However, it’s more important to keep your children safe.

Childproof your home, and make dangerous areas or objects off-limits. Keep an eye on your children at all times. Never leave them alone in a situation that could be hazardous. Take away dangerous objects and replace them with something safe. It is up to you to keep your children safe.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Copyright © American Academy of Pediatrics Date Updated: Jan 12 2025 05:21 Version 0.1

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