Breath-Holding Spells (Child)

A breath-holding spell is frightening for a parent to witness, but it is not harmful to your child. These spells can occur as early as 6 months old through 6 years of age. They are most commonly seen in toddlers from 1 to 3 years of age. Newborns rarely have breath-holding spells.

Episodes of breath-holding spells can range from one to several times a day, or happen only once in a while. Breath-holding spells often occur during a temper tantrum. Be reassured, though, that your child is not doing this on purpose, and these spells will not be harmful or cause permanent effects. Don’t hit or punish the child during or after the tantrum.

Half of children get over this by age 4, and almost all (more than 80%) are over these spells by age 8 years of age. There may be a history of other family members having this same problem as babies. Some children continue to have breath-holding spells as adults.

Cause and types

Although it is was once thought of as a willful act by the child with emotional problems, it is not. It is now believed to be a reflex response of the involuntary nervous system triggered by physical pain or emotionally upsetting events.

There are 2 types of breath-holding spells. Both are involuntary (not under the child’s control). However, they have different causes and characteristics:

Cyanotic (the most common type)

  • Triggered by temper tantrums, being scolded, or an upsetting event.

  • May include a brief seizure

  • May respond to treatment with iron supplements.

Pallid (less common)

  • Triggered by physical pain, minor injury, or frightening event.

  • Heart rate is much slower than normal.

Signs and symptoms

During a cyanotic breath-holding spell, after an upset or minor injury, the following may occur:

  • A crying spell, which may be short or long, usually occurs.

  • There is a silence as breathing stops (usually after the child exhales).

  • Skin color (especially around the lips) changes to red-purple, blue, or mottled.

  • The child loses consciousness.

  • After a few seconds the child starts breathing normally and becomes conscious again.

During a pallid breath-holding spell, after a child is startled or has a minor injury, the following may occur:

  • The child may or may not cry.

  • The child stops breathing.

  • He or she then loses consciousness.

  • Skin color turns pale and the child may become sweaty.

  • The child becomes limp.

  • The heart rate increases suddenly and the child begins to breathe again.

  • The child becomes conscious again.

Please note: The child may become limp and fall to the ground. Muscles may jerk or twitch. There may even be general body stiffening. After the spell is over, your child may be drowsy for a few minutes before returning to usual activities.

Home care

  • If your child has a temper tantrum, make reasonable efforts to calm him or her. If this doesn't work, let the tantrum happen but prevent your child from injuring him- or herself.

  • If the child has a breath-holding spell and goes limp, turn the child on his or her side to prevent choking on spit or vomit. If the child was eating when the breath-holding spell occurred, be sure the mouth is free of food.

  • Breath-holding spells can be more frightening to the parent than the child. Don't show extreme worry or fear to the child.

  • A breath-holding spell can look like a seizure or fainting. Please contact your child's healthcare provider immediately to describe what happened during this event. It is very important to tell your child's healthcare provider the following information:

    • What did the event look like—a seizure or breath-holding spell?

    • Did your child turn blue? If so, when did your child's color change? Was it before, during, or after he or she began shaking or their muscles began to jerk or twitch?

    • Did your child's color change before he or she went limp or lost consciousness?

Remember: Watch closely each time your child has a spell. Note whether the spell is the same, different, or worse as previous ones. (For example, did it last longer? Are spells becoming more frequent? ) To help your memory, write down what happened each time. Include the date, time, length of the tantrum, and the physical symptoms you saw.

Follow-up care

Follow up with your healthcare provider, or as advised. Talk to your healthcare provider if tantrums become longer or more frequent or intense. Consult your healthcare provider if you need more advice on how to manage a tantrum without losing control yourself.

When to seek medical advice

Call your child's healthcare provider right away if any of these occur:

  • Breath-holding spells become worse or different than usual.

  • Shaking movements during a breath-holding spell last longer than usual.

  • Limpness and color change or shaking movements occur while your child is sleeping.

  • Shaking movements occur before your child turns blue. (This may be a seizure.)

  • Skin shows color changes (blue, red-purple, pale) that continue after the child wakes up.

Call 911

Call 911 if any of these occur:

  • Your child has trouble breathing or stops breathing.

  • Your child shows confusion or no response when you speak to them.

  • Your child has trouble waking up.

  • Your child loses consciousness for longer than 1 minute.

  • Your child has a seizure that lasts longer than 1 minute.

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