Breath-Holding Spells in Children

Desperately unhappy 7 year old boy looks down
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Breath-holding spells typically occur when a child begins crying, either because of a fall or a temper tantrum. Then the child involuntarily holds his or her breath and faints. During a breath-holding spell, a child will become blue and limp and then quickly begin breathing again and wake up.

Some breath-holding spells are considered cyanotic—cyanosis is when the skin turns a blue or purple color due to low oxygen saturation. This is the most common type. Children can also have what are called "pallid" breath-holding spells. This is when something painful happens, and they quickly turn pale and pass out without crying very much.

Breath-holding spells usually begin when a child is between 6 and 18 months old. The good news is that a child tends to outgrow these breath-holding spells when he or she is about 4 to 8 years old. And the spells don't tend to cause any lasting health problems. The bad news is that, until these breath-holding spells are outgrown, they may occur once a year, once a month, or even more frequently. There isn't a known way to treat these spells, so the best strategy is to wait for them to disappear over time. 

Are Breath-Holding Spells the Same Thing as Seizures?

Breath-holding spells are often mistaken for seizures, especially if they occur after a fall and the child makes some jerking movements before waking up. But unlike children who are having seizures, children who are having breath-holding spells will have normal EEG tests. (An EEG stands for an electroencephalogram. During an EEG, a person wears a cap that has electrodes on it and the cap records electrical activity in the brain.)

Do Kids Who Have Breath-Holding Spells Need Special Testing?

Although extensive testing is not necessary for most children who have simple breath-holding spells, since they are associated with iron deficiency anemia, a blood test to check for anemia might be a good idea. An EKG test (also known as an electrocardiogram) is also sometimes done for these children to look for an underlying heart problem. (An EKG test is similar to an EEG test, except it monitors the heart's electrical activity, rather than the brain's.)

How to Handle Breath-Holding Spells

  • Whenever your kid has a spell, keep him or her lying on the ground and try to prevent his or her head, arms, and legs from banging into anything. 
  • Call 911 if your child stops breathing for more than one minute. The operator can talk you through CPR (cardiopulmonary resuscitation) while you wait for emergency help to arrive.
  • Don't reprimand your child after a breath-holding spell. Remember that he or she can't help it and is not doing it on purpose, so be empathetic. 
  • Talk to your child's pediatrician about breath-holding spells. If you are not getting good advice on the topic from the pediatrician, then you may want to get a second opinion from a pediatric neurologist.

Preventing Breath-Holding Spells

Since breath-holding spells usually follow crying and tantrums, you can to try to help your child avoid them by preventing temper tantrums. This doesn't mean giving in to your child's temper tantrums, of course, since that will likely just teach her that tantrums work—and then she will probably have even more. Instead, try to distract her when you see a tantrum coming on, so you can stop it before it starts.

It can also help to keep your child on a regular routine, set limits, and avoid things that are sure to frustrate your child and trigger a tantrum, like allowing her to get hungry or overly tired.

By Vincent Iannelli, MD
Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.