Condition Basics

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. Children don't have breath-holding spells on purpose.

There are two types of breath-holding spells:

• A cyanotic spell is caused by a change in the child's usual breathing pattern, usually in response to feeling angry or frustrated. It's the most common type.
• A pallid spell is caused by a slowing of the child's heart rate, usually in response to pain.

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. They are most common from 1 to 3 years of age. Some children have them every day, and some have them only once in a while.

Breath-holding spells are usually not serious and don't cause lasting damage. 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 pain or by strong emotions.

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?

A breath-holding spell may cause:

• Fainting. It usually lasts for less than a minute.
• Twitching muscles, a stiff body, or a seizure.
• Changes in breathing and heartbeat.
  • In a cyanotic spell: The child may breathe too fast or too hard. When the child breathes out, there may be a long pause before the child takes another breath.
  • In a pallid spell: The heartbeat may slow down.
• Changes in skin color.
  • In a cyanotic spell: The skin may turn red or blue-purple, especially around the lips.
  • In a pallid spell: The skin may be pale and sweaty.
• Crying.
  • In a cyanotic spell: There may be a short burst of intense crying.
  • In a pallid spell: There may be a single cry or no cry at all.

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 your child isn't having spells on purpose.

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 your child. Don't punish your child for having the spell.