Breath-Holding Spells in Toddlers

Young children, when faced with an upsetting situation or sudden pain, can hold their breath, causing them to turn bluish or pale, and pass out. Although this is alarming to parents, breath-holding spells are generally not harmful. Children who experience these episodes typically recover quickly with no lasting effects.

Up to 5% of children experience breath-holding spells. They can occur as early as 6 months and may continue until a child is 6 years old. The peak age for breath-holding spell is 2 years.

Breath-holding spells are a reflex, that is the body’s automatic response to distress. They are not a conscious choice on the part of a child or a behavior problem.

A breath-holding spell will last only one or two minutes from beginning (crying or sobbing) to end (waking from unconsciousness), although they often seem longer to parents who observe them.

Children who lose consciousness as a result of a breath-holding spell generally wake up after less than a minute and are completely normal. Upon awakening, they may be upset and need reassurance.

There are two types of breath-holding, cyanotic and pallid.

• Cyanotic breath-holding spells: This is the most common type of breath-holding spell, accounting for about 85% of occurrences. The cyanotic spell is often a response to frustration, anger, fear, or pain. It usually occurs when the child is crying and becomes unable to draw a breath. Their skin turns bluish, especially around the lips, and they faint. They regain consciousness within a minute.
• Pallid breath-holding spells: In this type of breath-holding spell, often triggered by a sudden pain or fright, the child turns a pale, grayish color, becomes sweaty or clammy, and loses consciousness. The heart rate slows, and the child’s limbs sometimes twitch and the child may urinate on themselves. As with the cyanotic spells, the child wakes up within one minute.

If this is the first time your child has experienced one of these spells, contact your primary care provider. There may be a correlation of breath-holding spells with iron-deficiency anemia, so your child’s primary care provider may check the blood count. It is also important to rule out other more serious conditions that in rare cases may mimic breath holding spell.

During the spell:

• A child who has passed out should be laid flat so that blood can return to the brain.
• Do not shake or slap a child who has passed out.
• Make sure the child’s mouth is clear, removing any food or objects.
• Sometimes blowing hard on the child's face can help prevent an episode or bring it to an early end.
• Placing a cold, wet cloth on a child’s face (while being careful not to obstruct the airway) can sometimes interrupt or shorten an episode.
• Unless the child fails to return to consciousness do not attempt mouth-to-mouth resuscitation or CPR — your child’s breathing and heartbeat will return to normal on their own.
• If the child doesn't respond after two minutes, call 911 as it may not be a breath holding spell.

The parent’s best response to a breath-holding spell is to remain calm, recognize that your child isn’t doing it on purpose, and offer reassurance. Discuss the problem with your child’s primary care provider.