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Breath-Holding Spells in Children: What to Know

Medically Reviewed by Renee A. Alli, MD on December 07, 2019

If your young child reacts to sudden pain or upset by not breathing, turning blue or pale, and then fainting, they may have just had a breath-holding spell.

When this happens, it can be scary and can cause a parent to worry. Also called breath-holding attacks, these spells are somewhat common and can happen in healthy children. They can look like seizures, but they’re not. The spells don’t hurt the children, and many outgrow them by age 6 or 7. They are most common in 2-year-olds.

Breath-holding spells come in two types. With cyanotic spells, a child’s face turns blue. With pallid spells, they become pale. Cyanotic spells are more common.

Causes

Often, a breath-holding attack starts with crying in reaction to pain, fear, or anger.

If your child has a cyanotic spell, they're probably upset or frustrated about something. May be they got into trouble or wants something they can’t have. They’ll cry, exhale very hard, but not breathe in again. Their face, especially around their lips, quickly will turn blue, and they’ll pass out.

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With a pallid spell, they likely felt a sudden pain or scare. They may have fallen backwards and bumped their head or been spooked when someone snuck up behind them. They may shout in hurt or surprise, or they may open their mouth to shout but no sounds comes out. They’ll then stop breathing, color will drain from their face, and they’ll be out.

In both cases, your child will start to breathe again within a minute and come to on their own. They may be tired, but other than that, they’ll be their normal self.

Your child doesn’t have these spells on purpose. It’s their body’s involuntary response to a sudden event. The reflexes change your child’s breathing pattern, heart rate, and blood pressure levels, which make your child faint.

Symptoms

After your child passes out, they’ll lie limply on the floor. They may also:

  • Arch their back
  • Become stiff
  • Jerk their body a few times
  • Turn sweaty
  • Wet themself

They may or may not gasp when they start to breathe again.

Diagnosis

After your child’s first breath-holding spell, take them to their doctor to rule out any health problems.

There are no tests to confirm a breath-holding spell. Your pediatrician usually can diagnose it after hearing what happened. They’ll want to know what set it off, how your child looked, and how they started to breathe again.

Rarely, the pediatrician may refer your child to a heart doctor, called a cardiologist, or to a neurologist, who specializes in the brain and the nervous system, to check for any underlying causes.

Treatment

If your child has one breath-holding spell, they’ll likely have more. Some children have them several times a day, while others may have just one in a year.

There are no drugs or other treatments for these spells. Some studies suggest that anemia, or low levels of red blood cells, may be a culprit and that iron supplements may help. But more research is needed. The best thing to do is let your child lie on their side while they're out. That helps the blood flow to their brain and gives them a chance to recover more quickly.

In very rare cases, a child may not start breathing again after 1 minute. If this happens, call 911. If they're still not breathing after 3 minutes, start CPR.

Prevention

Your child’s doctor may teach you how to spot triggers that cause the spells, so you may prevent them. Sometimes, blowing hard on your baby’s face can interrupt a breath-holding spell. But this won’t work for every baby, and it may not work for older children.

If temper tantrums set off breath-holding attacks, your doctor may help you figure out a new way to set limits for your child. Take care not to give in to your child just to avoid a spell. This can lead to behavior problems that may last even after they're outgrown their breath-holding spells.

WebMD Medical Reference

Sources

SOURCES:

Child Neurology Foundation: “Breath-holding spells.”

Cochrane Database of Systematic Reviews: “Iron supplementation for breath-holding attacks in children.”

Canadian Family Physician: “Breath-holding spells in infants.”

Nemours Foundation: “Breath-holding spells.”

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