Breath holding spell

  • Definition
    • Some children have breath holding spells. This is an involuntary stop in breathing that is not in the child's control.

  • Causes
    • Babies as young as 2 months old and up to 2 years old can start having breath holding spells. Some children have severe spells.

      Children can have breath holding spells when they are responding to:

      • Fear
      • Pain
      • Traumatic event
      • Being startled or confronted

      Breath holding spells are more common in children with:

  • Symptoms
    • Breath holding spells most often occur when a child becomes suddenly upset or surprised. The child makes a short gasp, exhales, and stops breathing. The child's nervous system slows the heart rate or breathing for a short amount of time. Breath holding spells are not thought to be a willful act of defiance, even though they often occur with temper tantrums. Symptoms can include:

      • Blue or pale skin
      • Crying, then no breathing
      • Fainting or loss of alertness (unconsciousness)
      • Jerky movements (short, seizure-like movements)

      Normal breathing starts again after a brief period of unconsciousness. The child's color improves with the first breath. This may occur several times per day, or only on rare occasions.

  • Exams and Tests
    • The health care provider will perform a physical exam and ask questions about the child's medical history and symptoms.

      Blood tests may be done to check for an iron deficiency.

      Other tests that may be done include:

      • EKG to check the heart
      • EEG to check for seizures
  • Treatment
    • No treatment is usually needed. But iron drops or pills may be given if the child has an iron deficiency.

      Breath holding can be a frightening experience for parents. If your child has been diagnosed with breath holding spells, take the following steps:

      • During a spell, make sure your child is in a safe place where they will not fall or be hurt.
      • Place a cold cloth on your child's forehead during a spell to help shorten the episode.
      • After the spell, try to be calm. Avoid giving too much attention to the child, as this can reinforce the behaviors that led to the spell.
      • Avoid situations that cause a child's temper tantrums. This can help reduce the number of spells.
      • Ignore breath holding spells that do not cause your child to faint. Ignore the spell in the same way you ignore temper tantrums.
  • Outlook (Prognosis)
    • Most children outgrow breath holding spells by the time they are 4 to 8 years old.

      Children who have a seizure during a breath holding spell are not at higher risk of having seizures otherwise.

  • When to Contact a Medical Professional
    • Call your child's provider if:

      • You think your child is having breath holding spells
      • Your child's breath holding spells are getting worse or happening more often

      Call 911 or your local emergency number if:

      • Your child stops breathing or has trouble breathing
      • Your child has seizures for more than 1 minute
  • References
    • Mikati MA, Obeid MM. Conditions that mimic seizures. In: Kliegman RM, Stanton BF, St Geme JW III, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 594.