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Pediatrics/Concern on Uncontrollable crying of my 19 months old daugther

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QUESTION: Dear Dr. Sahib,
My daughter is 19 months old.  She cries frequently and when she does it is really uncontrollable.  She throws her body on floor and then cries.  To me this is more behavioural problem as at that time, she is not sleepy or hungry.  I am working and when I come back, she does not go to my in-laws even for a second.  This adds to my miseries as I have to look after my other child also.  In fact, he also used to cry too much till 5 years or so.   I have a question.  Is there any medical name for such problems.     Rgds

ANSWER: Hi Mini,

This is called "temper tantrum".

Following write-up would help you:

Temper Tantrums


When your lovable, adorable cutie pie throws his first tantrum, the usual reaction is, “He is getting spoilt!!” However, that is not true. Temper tantrum signifies that the toddler has finally discovered a sense of his own individuality, and is asserting that. It is an immature way of expressing anger and is normal in the toddler age-group. No matter how calm and gentle a parent you are, your child will probably throw some tantrums. They generally begin around age 12-18 months, get worse between 2 and 3 years and then decrease rapidly until age 4, after which they should be seldom seen.

What causes temper tantrums?

As a young child learns more and becomes more independent, he wants to do more than he can physically and emotionally manage. Moreover, at this age he may not have the vocabulary to adequately express his feelings. Thus, although he is old enough to assert his individuality, he is too young to express his frustration/strong emotions in socially acceptable way. This manifests as a temper tantrum. Being tired, hungry, or sick can make tantrums worse or more frequent.
Can we prevent temper tantrums?
Yes, preventing situations which can precipitate temper tantrum can help.
Avoid over-exertion
Don’t expect more from your child that he can handle. For example, don’t expect your toddler to “cooperate” with you while you are waiting in a long queue. Try visiting bank/departmental store during lean hours. If that is not possible, then don’t forget to carry his favorite toys/ snacks to keep him busy.

Avoid over-reacting
Toddlers are very inquisitive and learn by exploring surroundings. Thus, things like spilling glass of water, throwing a spoon on the floor are just his ways of gathering information. If you over-react (e.g., shout at him/lose your temper), you are creating a perfect setting for temper tantrum. Basically, you have to imagine yourself to be in his shoes and try to understand his point of view. Be patient and help him learn.

Minimize use of “no!”
Toddlers pick up everything from their environment. Those who hear “no” often tend to say it a lot! Some toddlers simply get frustrated by hearing “no” all the time from the adults around him. As far as possible, try to make positive statements and be surprised to see positive change in your baby. For example, “Yes, let me finish folding the clothes and then we'll go out” is better than “No! We can’t go out now”. It is equally important to allow reasonable requests, ignore some “minor” misbehavior and let him explore this fantastic world!



Prepare in advance
If you know you are going for a long drive or visiting relatives, it helps if you are prepared and know what to expect. Carry snacks if you feel your toddler might get hungry, let his nap beforehand if he has had a tiring day, carry crayons and a colouring book or a book to keep him occupied. If you go shopping it may be best to avoid, if possible, the toy-shop and things that you know may trigger off a tantrum. If he accompanies you to a departmental store, let him select a couple of things that he may want.

Positive reinforcement
It is basic human nature that we respond better to appreciation and encouragement than corrective diktats. That’s true for your little one also. Thus, rather than simply reacting to your toddler’s misbehavior, appreciate his good behaviour and see the difference. Your baby prizes your approval above all else. Kiss him when he is behaving well. Never forget to say, “Very Good!!” when he has done something good, for example, putting his toys back into basket. This will build his confidence and encourage him to keep up the acts of good behaviour.

Best wishes,

Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India

www.KumarChildClinic.com

+91-9818356846

---------- FOLLOW-UP ----------

QUESTION: Dear Dr Sahib,  
Thank you so much for your reply.  So my next question is when the child cries uncontrollably at that time, should we leave him alone or give him the thing (which is not meant for him) that he is crying for.   Rgds

Answer
Hi Mini,

I have partly answered this in my last reply too: You have to Avoid over-reacting, Minimize use of “no!”, Prepare in advance and continue Positive reinforcement.

If you give the thing AFTER he has thrown a tantrum, he would throw a tantrum for everything!
Remain calm, try to distract or leave him alone and give him a message that his crying does not let him get what he desires!

Best wishes,

Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India

www.KumarChildClinic.com

+91-9818356846

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Dr. Puneet Kumar

Expertise

I would be happy to answer general queries on prevention and treatment of ailments in newborn, infant, toddler, child or an adolescent. Needless to say, it will not be possible to answer any query requiring specific diagnosis of a particular subject.

Experience

I have worked in various capacities (medical officer, resident, senior resident, consultant) in public as well as private sector in Pediatrics and Neonatology. Today, I have over 15 years of experience in the field.

Organizations
Currently, I am running my own clinic (Kumar Child Clinic) in Dwarka, New Delhi and am attached to Lifeline Hospital, Dwarka as consultant pediatrics and neonatology. I am also developing my clinic website into a comprehensive child health/ parenting website (http://www.kumarchildclinic.com)

Publications
(a) Chapter "National Immunization Schedule" in Frontiers of Social Pediatrics, Jaypee Publishers: 2nd edition, 2016. (b) Article, "All about Pertussis vaccines" in special issue of Indian Journal of Practical Pediatrics, July-Sept 2015 (c) Three chapters (DTP vaccines, Pneumococcal vaccines and Poliovirus vaccines) in "Textbook of Pediatrics for Post-graduates" First edition: 2015. (c) Chapter: "Alternative delivery methods of vaccines" in IAP textbook of Vaccines, First edition, 2014 (published by IAP/ Jaypee Brothers) (d) Special Article: "50 years of Immunization in India: Progress and Future" in January 2013 issue of Indian Pediatrics (e) Four chapters in "FAQ: Book on Vaccines and Immunization Practices" First edition, 2011 AND 2nd edition, 2015 published by Jaypee Brothers. (f) Three articles in special issue of Journal of Pediatric Sciences on “Controversies and Challenges in Pediatric Vaccination Today" in Sept, 2010. Co-edited the series also. http://www.pediatricsciences.com/issue/view/1050000010 (f) Regular column, “How do I treat” in Pediascene (www.pediascene.com) (g) Review article, “Role of Anti-Poliovirus Agents in Polio eradication and beyond” in Polio Pulse, April, 2008. (h) Chapter on “Acute Infectious Diarrhea” in Textbook of Infectious Diseases in Children. (An IAP Publication), 2007. 2nd edition in 2011. (i) Book-Review (IAP Pediatric Drug Formulary, 2004) in Pediascene, March 2005 (http://www.pediascene.com/page.php?cid=6&catid=9&id=132 ) (j) Case-report on Osteopetrosis. Jharkhand Journal of Pediatrics, Dec-2002.

Education/Credentials
After MBBS, I have done DNB residency in Pediatrics.

Awards and Honors
Winner of IAP practising pediatrician's quiz in 2001.

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