Springdale Mason Pediatrics

Breath-Holding Spell

Definition

  • A spell that includes holding the breath, then turning blue and passing out

Call or Return If

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

About This Topic

Symptoms

  • Triggered by an upsetting event such as being angry about limit-setting. Also triggered by being frightened or being injured. Examples are falling down or bumping the head.
  • The child gives out 1 or 2 long cries
  • Then holds his breath until the lips and face become bluish
  • Then passes out
  • Then often becomes stiff or rigid. Sometimes, children progress to having a few twitches or muscle jerks. This happens in about 30% of children.
  • Then resumes normal breathing in less than 1 minute.
  • Becomes fully alert in less than 2 minutes
  • Onset between 6 months and 2 years of age. Stop by age 6.
  • Only occurs 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.
  • They occur in 5% of healthy children. Breath-holding spells can run in families.
  • Start 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.

After Care Advice

Overview:
  • 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 muscle jerking.
Cold Pack:
  • Use a cold, wet washcloth to your child's forehead. Do this until they start to breathe again.
  • That's the only treatment your child should need.
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.
Don't Overreact:
  • Don't start mouth-to-mouth breathing or call 911. It's not needed.
  • 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 attacks, give your child a brief hug. Then, go about your business.
  • If your child has a temper tantrum, don't give in after the attack.
Prevention of Injuries:
  • The main injury risk of a breath-holding spell is a head injury. Try to prevent this if possible.
  • If your child is standing near a hard surface, go to him quickly. In case of an attack, help lower him to the floor.
Prevention of Future Attacks:
  • Once started, most attacks can't be stopped. They have to run their course.
  • However, some children can be distracted if you intervene before they become blue.
  • Tell your child to come to you for a hug. Another option is to look at something interesting with them. Ask him if he wants a drink of juice or his favorite fluid. It's worth a try.
What to Expect:
  • The attacks occur from 1 or 2 times a day to 1 or 2 times a month.
  • Kids outgrow them by age 6.

Author: Barton Schmitt MD, FAAP
Copyright 2000-2020 Schmitt Pediatric Guidelines LLC
Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it.
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