Breath holding spell

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A breath holding spell is an involuntary pause in breathing that occurs in some children.
Involuntary means it is not in the child's control.

Causes
Breath holding spells may start at 2 months old, but may not begin until the child is age 2.

Some children have severe spells. They usually stop by the time the child reaches ages 6-8.

Breath holding spells appear to be a response to:

Fear

Pain or traumatic even

Being startled or confronted confronted

These events can cause a reaction in the child's nervous system, which slows the heart rate or
breathing for a short amount of time.
Breath holding spells are not thought to be a willful act of defiaince, even though they often
occur with temper tantrums.
Breath holding spells are more common in children with:

Genetic conditions, such as Riley-Day syndrome or Rett syndrome

Iron deficiency anemia

A family history of breat holding spells (parents may have had similar spells when
they were kids)

Symptoms

Involuntary breathing spells most often occur when a child becomes suddenly upset or
surprised. After being startled or becoming upset, the child may make a short gasp and then
exhale and stop breathing.

Symptoms can include:

 Blue or pale skin

Crying then no breathing

Fainting or loss of alertness (consciousness)

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 and the event ends. This may occur several times per day, or
only on rare occasions.

Exams and Tests

The doctor or nurse 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, unless there is an iron deficiency or other medical condition
causing the spells. Children with an iron deficiency will be given iron supplements.

Breath holding can be a frightening experience for parents. But once the doctor has diagnosed
your child with breath holding spells, you can take the following steps:

During a spell, make sure your child is in a safe place where he or she 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 event.

Avoid situations that cause a child's temper tantrums. This can help reduce the number
of spells.

Breath holding spells that do not cause the child to become faint are best ignored, in the same
way temper tantrums are ignored. See also: Temper tantrums
Outlook (Prognosis)
Most children outgrow breath holding spells by ages 4 - 8.

Cildren who have a seizure after losing consciousness during a breath holding spell do not
appear to be more likely to get a seizure disorder.

When to Contact a Medical Professional

Call your doctor or nurse if your child seems to be having breath holding spells.

If your child has already been diagnosed with breath holding spells, call they seem to occur
more often breath holding spells.

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

Walter HJ, DeMaso DR. Age-specific behavioral disturbances. In: Kliegman RM,Behrman
RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics.19th ed. Philadelphia, Pa:
Saunders Elsevier; 2011:chap 27.1.

Update Date: 11/7/2011

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics,
University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA,
Medical Director, A.D.A.M., Inc.