Learning About Breath-Holding in Children

What is breath-holding?

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 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.

What can you do at home?

Home treatment usually is all that is needed for breath-holding spells. You can make breath-holding spells less likely by helping your child get plenty of rest and feel secure.

• Have regular rest times and daily routines for your child. And make sure your child gets enough good sleep at night.
• Keep your home atmosphere calm and set an example for your child about how to deal with feeling angry or frustrated.
• Allow your child to make some simple choices, such as which shirt to wear.
• Praise your child when they learn new tasks and when they do them well.
• Discuss with your child about the normal frustrations of childhood. Help them understand how to deal with their emotions.

Keeping your child safe during a spell

• Lay your child on the floor on their back, facing either upward or to one side.
• Protect your child's head, arms, and legs from hitting something hard or sharp.
• If your child was eating before a spell, open your child's mouth carefully and look for pieces of food, but do not try to remove food with your fingers. Instead, tilt your child's head to the side so the food can come out on its own.
• Touch and talk to your child to help yourself stay calm.
• Time the spell with a watch. Spells usually last less than a minute but seem longer.
• Do not give your child any medicines during a spell.
• Allow your child to wake up on their own after a spell.

Call 911 or emergency care right away if your child does not start breathing within 1 minute. The 911 operator may tell you to give your child rescue breaths while you wait for help to arrive.

After a breath-holding spell

After a spell happens, reassure and comfort your child. Make sure all your child's caregivers understand the cause of breath-holding spells and how to manage them.

Talk to your doctor if:

• Spells become more frequent or more severe or change their pattern.
• You have questions or concerns about the spells.