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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. 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 breath-holding spells?

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 breath-holding spells 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.

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