Temper tantrums are a frequent occurrence in the developing child. As a child starts to establish his or her independence from parents and caretakers and attempts more complex tasks, the child is likely to have episodes of being overwhelmed emotionally to the point of a tantrum. Pediatricians often are consulted about how to manage the tantrum.First and foremost, it is critical to determine that there is no organic cause of the tantrums. A thorough history and evaluation for developmental, psychological, and physiological explanations for the tantrums are necessary. The frequency of the tantrums and the causal factors are critical to determine whether the parents are placing unreasonable expectations on the child. This can be especially true for children who have developmental delays or for children who are large for their age.Regardless of the cause, the pediatrician should work with the family to develop a plan on which all persons involved in the care of the child can agree. Today, children have many different caretakers, who have different expectations in different environments, which can lead to tantrums due to a child’s lack of understanding of differing rules. The easiest step is to standardize the expectations placed on the child, thus allowing the child to “learn the rules.” In addition, families need to prioritize what rules are important to them and develop consequences that are reasonable for the child’s developmental level.Once the basic steps of managing tantrums have been put in place, the challenge becomes how to deter the tantrums from continuing. Parents may employ multiple possibilities to extinguish tantrums: positive reinforcement, planned ignoring, negative reinforcement, or punishment.Positive reinforcements during time periods without tantrums are important to extinguish the behavior. Positive reinforcements can range from time alone with a parent to material objects. In general, the key to its success is ensuring that the reward is developmentally appropriate.Planned ignoring will not yield instantaneous changes in the child’s behavior. It requires all caretakers to be consistent in their response to the tantrums. It is particularly difficult for families to maintain this practice if they are not warned that the tantrums initially may worsen.Negative reinforcement may result in an increase in tantrum frequency, especially if the caretaker is providing the negative reinforcement by giving into the child or threatening or hitting the child. However, a parent may use negative reinforcement to avoid a battle with a child who insists on wearing a summer dress in the middle of winter, thereby allowing the cold to reinforce more appropriate choices in the future. Most behavior specialists try to avoid the use of punishments and recommend use of positive reinforcement as a primary toolOverall, the critical factors for pediatricians to emphasize to any caretaker are the need for consistency and developmentally appropriate expectations and rewards. With the support and guidance of the pediatrician, most parents will not require referral to a behavioral therapist for tantrums.Tantrums are nearly universal between 12 and 36 months of age. When the caregiver’s story points to recognizable reasons for tantrums and there are not more than about two per day, no medical evaluation is needed beyond screening of developmental skills for gaps. The most likely “medical” reasons for excessive tantrums are inadequate sleep and immediate need for food. Fortunately for us all, children tend to adapt to the rules of each setting. Thus, although consistency among caregivers is ideal in decreasing confusion and testing by the child, it is not essential to managing tantrums. Instead, the focus should be on consistency for each caregiver or, at the very least, avoidance of giving in as a result of tantrums. Probably the most important points for pediatricians coaching parents about tantrums is to empathize and let the parents know how uniformly hard this is, acknowledge how upset it makes them feel, and help them to find some way not to let those feelings show to the child or lead them to either give in or punish in anger.