Breath holding spells involve a child holding their breath, turning flushed or pale in the face, or losing consciousness. They usually have a trigger, such as anger or frustration.
Breath holding spells occur in
Breath holding may occur as part of a pattern or as a one-off. There are several causes, but they usually involve children experiencing a strong emotion before holding their breath.
This article outlines the different types of breath holding spells, their causes, and what caregivers can do when they happen.
A breath holding spell is where a young child
Breath holding spells often follow strong emotions, such as anger, frustration, pain, or fear. They are common following temper tantrums. A painful or frightening experience may also be the trigger.
Breath holding spells do not indicate a health issue and do not harm the child. However, they can be distressing to witness.
Breath holding spells are similar to sleep apnea, where a person stops breathing for a few seconds before starting again.
There are two types of breath holding spells: cyanotic and pallid. Both types can be frightening to witness, but they are not harmful. Below is an outline of both types.
Cyanotic breath holding spells
Doctors also call cyanotic breath holding spells “blue spells.” They often result from anger or frustration. The child may:
- cry or scream
- exhale deeply
- hold their breath and turn blue, especially around the lips
- become rigid or floppy
- briefly lose consciousness
- recover quickly or feel drowsy for a while
Pallid breath holding spells
Pallid breath holding spells are also called “pale spells” and are less common than blue spells. A slow heart rate causes them, and people may mistake them for a seizure.
Children may experience a pale spell after a minor injury or shock. The child may:
- lose consciousness and turn pale
- open their mouth to cry but be unable to make a sound
- have stiff limbs or lose bladder or bowel control
- become sweaty
- have body jerks
Children who experience breath holding spells do not choose to hold their breath to seek attention, even though it might appear that way. Breath holding spells are involuntary.
When a child chooses to hold their breath to get what they want, they do not lose consciousness and begin breathing as usual when they perceive they have won.
Triggers for breath holding spells may include:
- a temper tantrum
- the child feeling upset, angry, or frustrated
- a caregiver reprimanding a child
- the child feeling frightened
- the child being in pain
Experts do not know the exact cause of breath holding spells. There may be a genetic component as
- iron deficiency anemia
- autonomic nervous system dysfunction, where the bodily systems that control automatic functions, including the heartbeat and breathing, may not work correctly
Parents and caregivers should respond to a child having a breath holding spell by:
- staying calm
- expecting the spell to pass in less than 1 minute
- lying the child on their side and remove anything hard or sharp away from their reach
- staying with them
- giving them reassurance and rest after the episode
- acting as usual when the child regains consciousness, avoiding making a fuss
Actions that are not helpful to a child having a breath holding spell include:
- reprimanding them
- shaking them or splashing them with water
- performing CPR
A child that regularly has breath holding spells should have a checkup with a healthcare professional to rule out medical conditions.
Doctors do not recommend treatments for breath holding spells as most children outgrow the condition. However, according to a
There are several strategies caregivers can try that may prevent breath holding spells. They include:
- distracting the child in situations that may trigger breath holding
- giving the child plenty of warning when things are about to change
- comforting the child when they are frightened or having a difficult experience
- helping older children learn to recognize emotions such as anger and frustration by naming them and exploring how they feel in the body
- trying to prevent the child from becoming overtired or hungry if those situations trigger episodes
Most children will grow out of breath holding by the time they are 6 years old. The episodes are usually harmless and do not need medical investigation. However, caregivers should consult a doctor in the following circumstances:
- the child is younger than 6 months
- spells happen more than once per week
- breath holding begins suddenly
- the child looks confused and excessively drowsy after holding their breath
- the child shakes and goes rigid for longer than 1 minute, and they take a while to recover
- the child falls and hits their head during a spell
Caregivers should talk with a doctor if a child has a breath holding spell for the first time. The doctor can check for signs of more serious conditions, such as epilepsy.
Breath holding spells should become less frequent as a child matures. In most cases, the spells do not cause long-term damage, although some people experience fainting episodes in adolescence.
Breath holding spells are most common in children between 6 months and 6 years. Most children have their first episode before 18 months.
Strong emotions, such as anger, fear, pain, or frustration, usually precede breath holding spells. Temper tantrums are common triggers.
There are two types of breath holding spells. The cyanotic type is the most common, and children usually turn blue in the face, particularly around the lips.
The pallid type results from a drop in heart rate. The child may experience a minor injury or shock before turning pale. Children may lose consciousness for a few seconds, but they will recover without needing medical help.
Although they can be distressing to watch, caregivers should stay calm if their child has a breath holding spell. They should reassure their child but avoid making a fuss or reprimanding them.
If a child holds their breath frequently or an episode happens before they are 6 months old, caregivers should consult a doctor.