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Breath-holding Spell

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Definition

  • A spell that involves holding the breath, then turning blue and passing out
  • Breath-holding spells were diagnosed by your child's doctor

Symptoms of a Breath-Holding Spell

  • An upsetting event happens right before the spell. A common trigger is being angry about parents setting limits (temper tantrums). Another is getting scared. Some spells are triggered by a sudden injury, such as falling down.
  • The child gives out 1 or 2 long cries
  • Then holds his breath until the lips and face become bluish
  • Then passes out and falls to the floor
  • Then often becomes stiff. May also have a few muscle jerks.
  • Normal breathing starts again in less than 1 minute. Becomes fully alert in less than 2 minutes.
  • Only happens when child is awake, never when asleep

Cause

  • A reflex response to strong feelings. This reflex allows some children to hold their breath long enough to pass out. Spells do not happen on purpose.
  • This happens in 5% of healthy children. Breath-holding spells can run in families.
  • Starts between 6 months and 2 years of age. Goes away by age 6.
  • Many young children hold their breath when upset, turn blue, but don't pass out. This is common and normal.
  • Frequent spells can happen in children who have anemia (low red blood count). This can happen if your child doesn't eat enough foods with iron. If your child is a picky eater, your doctor may order a blood test.
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When To Call

Call 911 Now

  • Breathing stopped for more than 1 minute and hasn't returned
  • You think your child has a life-threatening emergency

Go to ER Now

  • Trouble breathing after spell ends

Call Doctor or Seek Care Now

  • Age less than 6 months old
  • Passed out more than 2 minutes by the clock and normal breathing now
  • First breath-holding spell
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor During Office Hours

  • Never been checked by a doctor for the spells
  • Spells happen without a reason (no triggers)
  • Muscle jerks during spell
  • Picky eater (especially for meats)
  • Lots of tantrums trigger the spells
  • Spells happen more than once a week
  • You think your child needs to be seen, but the problem is not urgent
  • You have other questions or concerns

Self Care at Home

  • Normal breath-holding spell
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Care Advice

What You Should Know About Breath-Holding Spells:

  • While breath-holding spells are scary for parents, they are harmless.
  • Normal breathing always returns on its own.
  • The spells don't lead to seizures (epilepsy).
  • Here is some care advice that should help.

Lie Down:

  • During the spell, have your child lie down.
  • This will increase blood flow to the brain.
  • Remove any food from his mouth.
  • Do not hold your child upright. It decreases blood flow to the brain. This could cause some jerking of body muscles.

Cold Washcloth to Forehead:

  • Put a cold, wet washcloth on your child's forehead. Keep it on until he or she starts breathing again.
  • That's the only care your child needs.

Time the Length of Not Breathing:

  • These spells always seem to last longer than they really do.
  • Time the length of a few spells. Use a watch with a second hand.
  • Breathing almost always returns by 60 seconds.
  • It's hard to guess at the length of a spell and get it right.

Stay Calm:

  • Don't start mouth-to-mouth breathing. Don't call 911.
  • Don't put anything in your child's mouth. It could cause choking or vomiting.
  • Never shake your baby. It can cause bleeding in the brain.

Don't Give In After the Spell:

  • Some breath-holding spells start with a temper tantrum. Example: your child wanted something and you said "No." Don't give in to your child before or after the attack.
  • After spells, give your child a brief hug and go about your normal routine.

What to Expect:

  • Spells happen from 1 or 2 times a day to 1 or 2 times a month.
  • Kids outgrow them by age 6.

Call Your Doctor If:

  • Spells become more frequent
  • Spells change
  • You think your child needs to be seen
  • Your child becomes worse

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Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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