Breath-Holding Spells (Child)

A breath-holding spell is frightening for a parent to witness, but its isn't harmful to your child. These spells can take place as early as age 6 months and up to about age 6. They're most common in toddlers ages 1 to 3. 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 take place during a temper tantrum. Please know that your child isn't doing this on purpose, and these spells aren't harmful to them. Don’t hit or punish the child during or after the tantrum.

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

Cause and types

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

There are two types of breath-holding spells. Both are involuntary. 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, a minor injury, or a frightening event

  • May be caused by a heart rate that's much slower than normal

Signs and symptoms

During a cyanotic breath-holding spell, the following steps may happen:

  • The child will often cry for a short or long time.

  • There's silence as breathing stops, usually after the child exhales.

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

  • The child loses consciousness.

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

During a pallid breath-holding spell, the following steps may happen:

  • The child may or may not cry.

  • The child stops breathing.

  • They then lose consciousness.

  • The child's skin color turns pale and they may become sweaty.

  • The child becomes limp.

  • Their 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. Don't force your child to return to their prior activities. They may need to rest for a while to recover.

Home care

  • If your child has a temper tantrum, make reasonable efforts to calm them. If this doesn't work, let the tantrum happen but keep your child from getting injured.

  • If the child has a breath-holding spell and goes limp, turn the child on their 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. Do this by carefully sweeping the mouth to remove the food. Be careful not to push anything into the child's throat.

  • Your child won't be able to swallow their tongue during a breath-holding spell. Don't put anything in your child's mouth.

  • 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 tell them about this event. It's very important to tell your child's provider the following information:

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

    • How long did the event last?

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

    • Did your child's color change before they 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 happens each time. Include the date, time, length of the tantrum, length of the breath-holding spell, and the physical symptoms you saw. Bring this log with you to your healthcare appointments.

Follow-up care

Follow up with your child's provider or as advised. Talk to your child's provider if tantrums or breath-holding episodes become longer or more frequent or intense. Consult the provider if you need more advice on how to manage a tantrum without losing control yourself.

When to get medical advice

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

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

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

  • Your child is sleeping when limpness and color change or shaking movements happen.

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

  • Their skin shows color changes (blue, red-purple, blotchy, or 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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