Breath-holding spells usually are triggered by physically painful or emotionally upsetting events.
Typical symptoms include paleness, involuntarily stopping inhaling, loss of consciousness, and seizures.
Despite the dramatic nature of the symptoms, the spells are not dangerous.
Tantrums, often a component of breath-holding spells, may be prevented by distracting the child and avoiding situations known to trigger the spells.
Breath-holding spells occur in less than 1% to about 5% of otherwise healthy children. They usually begin in the first year of life and peak at age 2. They disappear by age 4 in more than 50% of children and by age 8 in almost all children. A small percentage of these children may continue to have spells into adulthood.
Almost all breath-holding spells occur after an event that is either physical, such as an injury, or mental, such as an emotional outburst due to anger or panic.
There are 2 forms of breath-holding spells:
Cyanotic (blue)
Pallid (pale)
Spells of both forms may last for 10 to 60 seconds.
Both the cyanotic and pallid forms are involuntary, which means that children are not holding their breath on purpose and have no control over the spells.
Involuntary breath-holding spells can be distinguished from voluntary breath-holding episodes. Children who voluntarily hold their breath do not lose consciousness and go back to breathing normally when they become uncomfortable.
(See also Overview of Behavioral Problems in Children.)
Cyanotic Breath-Holding Spells
The cyanotic form of breath-holding is the most common. A spell often occurs as part of a temper tantrum or in response to a scolding or other upsetting event. Episodes peak at about age 2 and are rare after age 5.
During a cyanotic breath-holding spell, typically the child cries out (without necessarily being aware they are doing so), breathes out, and then involuntarily does not inhale. Shortly afterward, the skin begins to turn blue ("cyanotic" means "blue"), and the child loses consciousness (becomes unconscious). Rarely, a brief seizure may occur. After a few seconds, breathing resumes and normal skin color and consciousness return. It may be possible to interrupt the episode by placing a cold rag on the child's face when the spell begins.
Despite the frightening nature of the spell, children do not have any dangerous or long-term effects. Parents should try to avoid reinforcing the initiating behavior. At the same time, parents should not avoid providing appropriate structure for children out of fear of causing spells. Distracting children and avoiding situations that lead to tantrums are the best ways of preventing these spells.
A doctor may recommend iron supplements for a child who has cyanotic breath-holding spells, even when the child does not have iron-deficiency anemia, and treatment for obstructive sleep apnea (if the child has it).
Pallid Breath-Holding Spells
The pallid form of breath-holding is rare. A spell typically occurs after a painful experience, such as falling and banging the head, or after being suddenly startled or frightened.
During a pallid breath-holding spell, the child's brain sends out a signal (via the vagus nerve) that severely slows the heart rate, causing loss of consciousness. Thus, in this form, the temporary loss of consciousness and temporary stoppage of breathing result from a nerve response to being injured or startled that leads to slowing of the heart.
During the spell, the child involuntarily does not inhale, rapidly loses consciousness, and becomes pale ("pallid" means "pale") and limp. A seizure and loss of bladder control (urinary incontinence) may occur. The child's heart typically beats very slowly during a spell.
After the spell, the heart speeds up again, breathing restarts, and consciousness returns without any treatment.
Because this form causes symptoms similar to those of certain heart and brain disorders, doctors may need to do tests to rule out those disorders if the spells occur often.
