Definition

A breath-holding spell is a period during which a child temporarily stops breathing, typically lasting up to one minute. This usually happens after the child experiences strong emotions like anger, frustration, surprise, or pain. These episodes can lead to fainting, and they are involuntary, meaning the child cannot control them. Around 5% of otherwise healthy children are affected by breath-holding spells, and in some cases, they can be inherited.

During a breath-holding spell, the episode typically lasts about one minute, and the child may lose consciousness for 1–2 minutes before regaining awareness. It's important to note that breath-holding spells are not a form of epileptic seizure.

Breath-holding spells are most common in children between 6 months and 2 years of age. In some cases, the spells can be more severe, but they are generally not dangerous. Most children outgrow breath-holding spells by the time they reach 4 to 8 years old. However, if this is your child's first breath-holding spell, it’s advisable to consult with a doctor to confirm the diagnosis.

Causes

Breath-holding spells typically occur as a response to strong emotional reactions. These involuntary reflexes cause the child to hold their breath for a period of time until they faint. The child cannot control the reflex, which leads to the cessation of breathing. Children with iron deficiency anemia may experience more frequent episodes of breath-holding spells, and treating the anemia can help reduce these occurrences. If your child is a selective eater, especially avoiding protein-rich foods such as meat, it’s a good idea to have their iron levels checked by a doctor.

There are two main types of breath-holding spells:

• Cyanotic breath-holding spells: These spells begin after a child cries intensely. During the spell, the child’s face turns blue. This type of spell is commonly triggered by anger or frustration.

• Pallid breath-holding spells: These episodes occur without much crying or with brief crying, followed by the child’s face turning pale. These spells are often triggered by shock or pain.

Risk Factor

Breath-holding spells are more commonly observed in children who have:

• Genetic conditions, such as Rett syndrome or Riley-Day syndrome.

• Iron deficiency anemia, results from a lack of sufficient iron, leading to a low blood count.

• A family history of breath-holding spells.

Symptoms

Breath-holding spells occur after a child is startled, frightened, or angry. The child may rapidly inhale and exhale before suddenly stopping their breath. During a spell, the nervous system slows the child’s heart rate and breathing for a brief period. While these spells are involuntary, they often occur during tantrums.

During a breath-holding spell, your child may show the following symptoms:

• Crying, followed by becoming silent and not breathing

• Opening the mouth as though about to cry but making no sound

• Turning blue or pale

• Becoming stiff, limp, or moving in a manner similar to a seizure

• Fainting for 1–2 minutes

Once the episode ends, your child may appear drowsy or confused. Normal breathing typically returns after the spell, and it may happen multiple times a day or in response to certain emotional triggers.

Diagnosis

To diagnose breath-holding spells, the doctor will conduct a physical test and inquire about your child’s medical history, symptoms, and other relevant information. The primary goal is to rule out other potential causes for the symptoms, such as epilepsy or other medical conditions. If anemia is suspected, a blood test will be recommended. Additionally, the doctor may order an electrocardiogram (EKG) or an electroencephalogram (EEG) to differentiate breath-holding spells from epileptic seizures.

Management

There is no specific treatment required for breath-holding spells, as they generally resolve on their own as the child grows. Most children will naturally outgrow these episodes between the ages of 4 and 8. However, if the breath-holding spells are linked to an underlying medical condition, addressing that condition may help reduce the frequency of the episodes.

If your child experiences a breath-holding spell, here are the steps you should follow:

• Remain calm, breath-holding spells typically last for just about one minute, so it’s important to stay composed.

• Stay close to your child, but avoid picking them up.

• Laying your child down helps improve blood flow to the brain.

• Remain by their side until the spell has passed.

• Ensure that your child does not hit their head, arms, or legs during the episode.

• Make sure the cessation of breathing isn’t due to choking.

• Place a cool, damp cloth on your child’s forehead to help them start breathing again.

• Stay calm after the episode. Avoid showing excessive concern, as this could provoke further breath-holding episodes if your child becomes upset.

You should also avoid:

• • Shaking your child or using water to rouse them.

  • Placing anything in their mouth, including your fingers.

  • Administering basic life support.

  • Scolding your child: Remember, they have no control over the spell.

Complications

Current literature suggests that breath-holding spells do not result in any dangerous complications for children. The long-term effects are not yet fully understood, but as long as the spells occur in a safe environment where the child is not at risk of injury (such as choking or hitting their head), they are generally not harmful.

Prevention

While you can't completely prevent breath-holding spells, there are steps you can take to reduce their occurrence:

• Consult with a doctor to discuss potential ways to minimize the frequency of your child’s breath-holding episodes.

• If your child tends to experience these spells after crying, ensure they are not overly tired or hungry, as these factors can increase the likelihood of a spell.

• Consider implementing calm and consistent discipline techniques to help your child regulate their emotions.

Although watching your child experience a breath-holding spell can be distressing, try not to overly accommodate their desires to avoid triggering a spell. It’s important to discuss any concerns with your doctor or a child psychologist about appropriate ways to discipline your child without causing emotional distress.

During a breath-holding spell, stay calm, as the episode is typically not harmful.

When to See a Doctor?

You should contact a healthcare provider if:

• Your child is experiencing breath-holding spells, but a doctor has not yet confirmed the diagnosis.

• The frequency or severity of the breath-holding spells increases.

If you observe any of the following signs, seek emergency medical attention immediately:

• Your child stops breathing or has difficulty breathing.

• This is your child's first breath-holding spell.

• Your child doesn’t regain consciousness after the episode.

• The child remains unconscious even after being woken.

• Your child’s skin turns pale or blue.

• The spell is followed by a seizure lasting longer than 1 minute.

• Your child appears very ill after the spell.

Although these symptoms might indicate a breath-holding spell, they could also be a sign of other more serious conditions. If a doctor hasn’t confirmed the diagnosis of a breath-holding spell, it’s critical to take your child to the hospital for a thorough evaluation and treatment.

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