By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My 18-month-old boy is healthy, and our doctor says he is bright. He has a single-word vocabulary of more than 25 words but appears to be verbally frustrated. He imitates everything I do; understands everything I say; repeats words with the appropriate sounds even if the words are too advanced for him to say; and has a wonderful memory.

My question: Why does my son hit people or throw things at them? He’s getting into repeated time-outs at day care that don’t seem to stop him.

My doctor feels he is simply verbally frustrated, but this behavior is unacceptable and worrisome. At home the aggression happens much less often but when it does, I sternly redirect him and explain how hitting hurts. He’s normally loving and affectionate but has frequent outbursts, especially when he’s tired.

A. In young children, limited language often leads to the frustration that boils over into hitting and tantrums.

The pace of language development varies among children. Some 18-month-olds who are exposed to very verbal adults may deploy up to 100 vocabulary words. So your child may indeed be frustrated with the number of words at his command now.

A limited vocabulary may not be the whole story. Along with having too few words to express all their wants and feelings, toddlers have too little impulse control and too few problem-solving and social skills not to explode occasionally.

Over time, you and his child-care providers can help him learn to get along. Time-outs aren’t likely to work if they are offered as punishments: They may teach him to believe he’s a “bad boy,” increasing the chances he’ll act like one – well into the future.

Time-outs that are presented as a chance to take a break, rest and feel better can help a child master the self-control we all need when we can’t make ourselves understood or get our way.

We know one child care teacher who doesn’t give time-outs to her children. Instead, she has a comfy couch for them to sit on when they start to sizzle. When she can, she comes over to cuddle with them. She is not rewarding them for bad behavior. She’ll say, “It’s so tough when you can’t figure out how to play with a friend” or “It isn’t easy to learn you can’t always get what you want.”

Thus she encourages them to work toward the goals of self-control and cooperation.

At 18 months, children want what they want – now. To them, “later” seems so far into the future that it barely exists and is awfully hard to wait for. Often they want one thing and the opposite, all at once. The only solution is a meltdown.

They want to play with other children and to make friends. But they don’t know how to attract another child’s interest, how to tune into the other child or how to take turns, share and compromise. Plenty of adults aren’t terrific at these skills, either. Also, some child care centers may not be realistic in their expectations for toddlers. Undue pressure can trigger hitting and blow-ups.

Some very young children may be hampered by developmental delays. Any interference with processing information can lead to problems.

Subtle difficulties in seeing and hearing may lead to overstimulation and a tendency to tantrums. These difficulties may also interfere with picking up social cues. Missing these cues may cause the child to feel threatened or limit his ability to interact appropriately.

Delays or differences in motor development can be an issue, too. For example, a child with poor muscle tone who has to work harder to hold his head and body straight may make inadequate eye contact with other children, leading to misunderstandings.

These differences may go unnoticed by parents, teachers and pediatricians. But a child under age 3 whose behavioral challenges stand out from his peers should be referred to a specialist for an early-intervention evaluation.

There is little to lose, even if it turns out that development is proceeding on track – and much to gain by starting early to address a challenge.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Prior to his passing, Dr. Brazelton was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center.  Learn more about the Center at

Reprinted with permission from the authors.