Breath-Holding Spells

What are breath-holding spells?

Breath-holding spells are brief periods when young children stop breathing. They usually last for less than 1 minute. These spells may cause a child to pass out (lose consciousness). Breath-holding spells usually occur when a young child is angry, frustrated, in pain, or scared.

There are two types of breath-holding spells:

• A cyanotic spell, which usually is in response to feeling angry or frustrated. It's the most common type.
• A pallid spell, which usually is in response to pain or feeling scared.

Some children may have both types of spells at one time or another.

Breath-holding spells can occur in children 6 months through 6 years of age. Some children have them often, and some have them only once in a while.

Breath-holding spells are usually not serious and with time they go away on their own.

What causes a spell?

Breath-holding spells are usually caused by either a change in the child's breathing or a slowing of the heart rate. These reactions may be brought on by anger, frustration, being startled, or having pain.

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

What are the symptoms?

In general, breath-holding spells may cause a child to faint. A spell may sometimes cause the muscles to twitch or the body to stiffen. Your child will wake up on their own and start to breathe again normally.

Symptoms of spells (cyanotic) brought on by emotions like anger or frustration include:

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

Symptoms of spells (pallid) brought on by fear, pain, or injury include:

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

Some children also have seizures during breath-holding spells. This does not mean they have a seizure disorder. Seizures are different from mild twitching, and they may cause a child to vomit or pass urine. They are more likely to occur in children who have long periods of breath-holding.

How are they diagnosed?

Doctors can usually diagnose breath-holding spells based on what happens during a spell. The doctor will examine your child and ask you to describe the spells. It may help for you to keep a record of what happens during each spell.

If your doctor thinks that your child has a seizure disorder or another condition, such as iron deficiency anemia, your child may need other tests.

How are breath-holding spells treated?

Most children don't need treatment for breath-holding spells. Spells will go away as your child gets older. If your doctor thinks that a medical condition is causing the spells, your child may need treatment.

To decrease the chance of more spells, make sure that your child gets plenty of rest, and try to help your child feel secure. Be sure to tell your child's doctor if your child starts to have spells more often or if they seem worse or different than before.

Breath-holding spells can be frustrating for parents. If you have trouble dealing with your child's spells or find yourself getting angry, talk with your doctor or a counselor. Try to keep in mind that these spells usually happen when children are angry, frustrated, in pain, or scared.

What can you do if your child has a breath-holding spell?

To protect your child during a spell, lay your child on the floor and keep their arms, legs, and head from hitting anything hard or sharp.

Your child may stop breathing for up to 1 minute (60 seconds) during a spell. If your child doesn't wake up quickly and start breathing again, call 911 or other emergency services. The 911 operator may tell you to give your child rescue breaths while you wait for help to arrive.

After the spell, reassure and comfort your child.