<s>[INST] My grand daughter (2yrs) cries when she cannot have what she wants and can work herself up into a sobbing state. Her parents tell me this is a panic attack and are afraid she is hyperventilating. How can you tell if this is just a tantrum or if she is indeed hyperventilating? [/INST] HelloDr.Ervis answeringTemper tantrums are emotional and physical "meltdowns" common among children in the 2- to 4-year-old age range. The toddler may demonstrate a number of characteristic behaviors, including screaming, kicking, lying on the floor, and occasionally holding her breath (rarely to the point of passing out). As a child matures, these manifestations of emotional, developmental, and physical immaturity gradually extinguish themselves. Studies indicate that 23%-85% of children between 2 and 4 years of age will commonly have temper tantrums.Children who still have tantrums after the age of 4 may need help learning to deal with their emotions. Tantrums that continue or start during the school years may be a sign of learning problems or other issues that the child may need help with.Some children have temper tantrums that last longer and are more severe than normal. They may destroy things or hurt themselves or other people. This violent behavior may be a sign of a more serious problem.If you sense that a tantrum is coming, you may be able to stop it.Distract your child. For example, if your child doesn't like to go to bed, talk about something fun that is going to happen the next day.Encourage your child to take a break from a frustrating activity. Or get your child to focus on something he or she already knows how to do.Remove your child from a situation that is likely to cause tantrums. Situations such as a large family dinner or the lights and noise of a carnival may be too much for a young child to handle.After a tantrum starts, ignoring it may work best. Try the following:Walk away. But stay where the child can see you, especially if your child is very young.Keep doing what you were doing. You can observe without focusing all of your attention on your child.Don't talk to the child, if possible. If you do speak, use a neutral tone of voice.After a tantrum is over:Praise your child for calming down.Acknowledge your child's feelings. You might say something like, "I know that you were upset because you couldn't tie your shoes."Comfort your child without giving in to his or her demands.Never punish or make fun of a child who has a temper tantrum. Don't use words like "bad girl" or "bad boy" to describe your child.Teach other ways to handle anger and frustration. For example, encourage your child to use words to express feelings. Or set up a safe place in the home where your child can go to calm down.Be a good role model. Children learn by watching their parents, so let your child see that you can handle your own strong emotions calmly.If your child has a lot of tantrums, time-out may be an option. Time-out works best for children who can understand why it is being used. This is usually around age 2 or 3 years.For a time-out, you send or put your child someplace safe, such as a chair in a hallway, for a few minutes. This gives the child time to calm down. It also teaches the child that having a temper tantrum is not acceptable behavior. </s>