Breath holding spell
Some children have breath holding spells. This is an involuntary stop in breathing that is not in the child's control.
Babies as young as 2 months old and up to 2 years old can start having breath holding spells. Some children have severe spells.
Children can have breath holding spells when they are responding to:
- Traumatic event
- Being startled or confronted
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 breath holding spells (parents may have had similar spells when they were children)
Breath holding spells most often occur when a child becomes suddenly upset or surprised. The child makes a short gasp, exhales, and stops breathing. The child's nervous system slows the heart rate or breathing for a short amount of time. Breath holding spells are not thought to be a willful act of defiance, even though they often occur with temper tantrums. Symptoms can include:
- Blue or pale skin
- Crying, then no breathing
- Fainting or loss of alertness (unconsciousness)
- 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. This may occur several times per day, or only on rare occasions.
Exams and Tests
The health care provider 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:
No treatment is usually needed. But iron drops or pills may be given if the child has an iron deficiency.
Breath holding can be a frightening experience for parents. If your child has been diagnosed with breath holding spells, take the following steps:
- During a spell, make sure your child is in a safe place where they 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 spell.
- Avoid situations that cause a child's temper tantrums. This can help reduce the number of spells.
- Ignore breath holding spells that do not cause your child to faint. Ignore the spell in the same way you ignore temper tantrums.
Most children outgrow breath holding spells by the time they are 4 to 8 years old.
Children who have a seizure during a breath holding spell are not at higher risk of having seizures otherwise.
When to Contact a Medical Professional
Call your child's provider if:
- You think your child is having breath holding spells
- Your child's breath holding spells are getting worse or happening more often
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
Mikati MA, Obeid MM. Conditions that mimic seizures. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 594.
Roddy SM. Breath-holding spells and reflex anoxic seizures. In: Swaiman KF, Ashwal S, Ferriero DM, et al, eds. Swaiman's Pediatric Neurology: Principles and Practice. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 85.
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.