Breath-Holding Spells

What are breath-holding spells?

Breath-holding spells are brief periods when young children stop breathing for up to 1 minute. These spells often cause a child to pass out (lose consciousness). Breath-holding spells usually occur when a young child is angry, frustrated, in pain, or afraid. However, the spell is a reflex, not a deliberate behavior on the child’s part.

Breath-holding spells are categorized as either cyanotic or pallid.

  • Cyanotic breath-holding spells, the most common type, usually occur in response to anger or frustration. A child’s skin typically turns red or blue-purple.
  • Pallid breath-holding spells produce a pale appearance to a child’s skin. These spells usually occur in response to fear, pain, or injury, especially after an unexpected blow to the head.

Some children have both cyanotic and pallid spells at one time or another in their lives.

Breath-holding spells are most common in children between 6 months and 4 years of age. Their frequency varies; some children have a spell once a year, while others have spells several times a day.

Breath-holding spells are usually not serious, do not cause permanent damage or affect a child’s future health, and gradually go away on their own.

What causes breath-holding spells?

Breath-holding spells are usually caused by either a change in the usual breathing pattern or a slowing of the heart rate. These reactions may be brought on by pain or by strong emotions, such as fear or frustration.

In some children, breath-holding spells may be related to iron deficiency anemia, a condition in which the body does not produce a normal number of red blood cells.

What are the symptoms?

In general, breath-holding spells cause a child to faint and may sometimes cause the muscles to twitch or the body to stiffen.

Specific symptoms of cyanotic spells include:

  • A short burst of rigorous crying lasting less than 30 seconds.
  • Hyperventilating (overbreathing).
  • A pause in breathing after exhaling.
  • Red or blue-purple skin color, especially around the lips.

Specific symptoms of pallid spells include:

  • A single cry or no cry at all.
  • Slowing of the heart.
  • Pale skin color.
  • Sweating.
  • Sleepiness or fatigue after the episode.

Some children also have seizures during breath-holding spells, which does not mean they have a seizure disorder. Seizures are different from mild twitching. They are more likely to occur in children who have long periods of breath-holding.

How are breath-holding spells diagnosed?

Breath-holding spells usually are diagnosed by a report of the symptoms observed during a spell. The health professional will examine your child and ask you to describe the spells. Recording the symptoms will help you describe them more accurately.

If your doctor thinks your child has a seizure disorder or another condition, such as iron deficiency anemia, certain tests may be done.

How are they treated?

There is no medical treatment for breath-holding spells, unless a health professional determines that a health problem, such as a heart irregularity, is the cause.

Help protect your child from injury during a spell by laying him or her on the floor and keeping the arms, legs, and head from hitting anything hard or sharp.

You can help decrease the chance of breath-holding spells by making sure your child gets plenty of rest, helping him or her feel secure, and helping minimize and manage his or her frustration.


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