Breath-Holding Spells

Topic Overview

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. But the spell is a reflex. It's usually 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 can occur in children between 6 months and 6 years of age. They are most common from 1 to 3 years of age. And 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 doctor 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 doctor 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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Symptoms

The symptoms of breath-holding spells vary depending on whether the spell is cyanotic or pallid. Cyanotic spells are caused by a change in the child's usual breathing pattern, usually resulting from strong emotions, such as anger or frustration. Pallid spells are caused by a slowing of the child's heart rate, which often is a result of pain.

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.

If your child faints (loses consciousness) during a breath-holding spell, it usually lasts for less than 1 minute. He or she will wake up on his or her own and start to breathe again normally. When unconscious, your child may twitch.

Your child may have a seizure during a breath-holding spell. Seizures are more likely to occur if your child has long periods of breath-holding. During a seizure children may vomit or pass urine. Having a seizure as part of a breath-holding spell does not mean your child has epilepsy or another seizure disorder.

But if your child has a breath-holding spell for longer than 1 minute and also has continuous body stiffening and relaxing, he or she needs to be examined by a doctor. These symptoms may point to a seizure disorder or another medical problem.

Other conditions with similar symptoms include seizure disorders and an irregular heartbeat (arrhythmia).

Exams and Tests

Your child's doctor can usually diagnose breath-holding spells by how you describe them and by examining your child. Record your child's symptoms to help you provide the most accurate description. You also may be asked:

• Do you have any concerns about how other people are treating your child?
• Have there been any recent changes in your child's behavior? Are you concerned about them?
• Have there been any recent changes in your child's life, such as a move or the birth of another child?
• Has your child ever been diagnosed with a medical condition?

If the doctor thinks that your child has seizures or another condition, such as a heart irregularity, seizure disorder, or iron deficiency anemia, certain tests may be done. These include:

• Electrocardiogram (ECG, EKG). An electrocardiogram records the pattern of electrical activity in the heart. It is useful for identifying heart rhythm problems and may be performed on children who have the pallid type of breath-holding spell.
• Electroencephalogram (EEG). An electroencephalogram records electrical activity in the brain. It is useful for identifying seizure disorders or other similar conditions.
• A complete blood count. The blood is analyzed to check the size, shape, and number of red blood cells.

Treatment Overview

There is no medical treatment for breath-holding spells. If a doctor thinks that other conditions are causing the spells, treatment may be needed.

Children who do not start breathing again on their own within 1 minute (by the clock) need emergency treatment. Call 911 or other emergency services immediately. Begin rescue breathing to maintain your child's airway for breathing as you wait for the emergency personnel.

Home Treatment

Home treatment usually is all that is needed for breath-holding spells. At home you can:

• Decrease the likelihood of breath-holding spells. Make sure your child gets plenty of rest so he or she is less likely to become overly tired and easily frustrated. Also, help your child to feel secure, such as by giving him or her the chance to make simple choices and by having regular routines.
• Protect your child from injury during a spell. Some basic measures include protecting your child's head, arms, and legs from hitting something hard or sharp, and touching and talking to your child. This may also help you to stay calm. Remind yourself that the spells are not hurting your child and that your child will grow out of them in time.
• Model the anger control you wish to see your child use. Try not to overreact while the spell is going on. Corporal punishment, such as spanking, does not help manage a child's behavior.

After a spell, briefly reassure your child. Keep in mind that your child is not doing this on purpose. Don't punish your child for having a breath-holding spell.

Other children watching your child during a breath-holding spell may feel afraid. Reassure them by saying, "Everything will be okay. It is not your fault."

If your child has breath-holding spells, make sure all caregivers understand their cause and treatment. Adults who see a child during a spell may panic or try inappropriate measures to help a child. Say calmly, "My child is having a breath-holding spell. Everything will be okay in a minute or so."

Keep in mind that breath-holding spells do not:

• Interfere with your child's growth and development.
• Cause permanent brain damage.
• Lead to mental illness or emotional problems.
• Lead to seizure disorders.

Talk with your doctor if:

• Spells become more frequent or more severe or change their pattern.
• You have trouble dealing with your child's breath-holding spells. Counseling may help you handle your concerns and feelings. Do not spank your child or use other types of corporal punishment.

In general, parents who know what to expect from their children at different ages are better able to help their children learn and mature. Helping your child gain independence and self-confidence in the early years is important and may help reduce breath-holding spells. Ask your doctor for information on how to help your child gain a sense of independence, boost his or her self-confidence, and learn to handle frustration. For more information, see:

Growth and development: Helping your child build self-esteem.

Other Places To Get Help

Organization

Related Information

• Growth and Development, Ages 1 to 12 Months
• Growth and Development, Ages 12 to 24 Months
• Growth and Development, Ages 2 to 5 Years
• Helping a Person During a Seizure
• Iron Deficiency Anemia
• Temper Tantrums

References

Other Works Consulted

• Boris NW, Dalton R (2007). Disruptive behavioral disorders. In RM Kliegman et al., eds, Nelson Textbook of Pediatrics, 18th ed., pp. 131-133. Philadelphia: Saunders Elsevier.

• Brazelton TB (2006). Two years. In Touchpoints, Birth to Three: Your Child's Emotional and Behavioral Development, 2nd ed., chap. 12, pp. 179-196. Cambridge, MA: Da Capo Press.

• Johnston MV (2007). Conditions that mimic seizures. In RM Kliegman et al., eds, Nelson Textbook of Pediatrics, 18th ed., pp. 2476-2478. Philadelphia: Saunders Elsevier.

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