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Understanding and Managing Breath-Holding Spells in Young Children

Benjamin Seth Martinez | MD

Medically reviewed by Benjamin Seth Martinez | MD, Statpearls - Director of Clinical Content on December 1st, 2023.

Key Takeaways

  • Episodes occur in 5% of healthy children, peaking between 12-18 months, with two distinct types: cyanotic (blue, triggered by anger/frustration) and pallid (pale, triggered by sudden pain or startle).

  • Children typically hold their breath for 15-60 seconds before losing consciousness, which automatically restores normal breathing—the fainting is actually a protective mechanism that prevents brain damage.

  • Iron deficiency anemia increases the likelihood and severity of episodes, so pediatricians often check hemoglobin levels and may recommend iron supplementation even in borderline cases.

  • During an episode, place the child on their side and avoid mouth-to-mouth resuscitation or shaking—the child will resume breathing naturally once they lose consciousness.

  • Most children completely outgrow these episodes by age 4-6 as their nervous system matures and emotional regulation improves, though a small percentage may develop seizure disorders later.

Breath-holding spells, also known as breath-holding attacks, can be a scary experience for parents when their young child suddenly stops breathing, turns blue or pale, and faints. Although these spells may look like seizures, they are not harmful to the child and are relatively common in healthy children, especially around the age of 2. Most children outgrow breath-holding spells by the age of 6 or 7.

Types of Breath-Holding Spells

There are two main types of breath-holding spells:

  1. Cyanotic spells: The child's face turns blue, especially around the lips, before they pass out. This type is more common.

  2. Pallid spells: The child becomes pale before fainting.

Causes of Breath-Holding Spells

Breath-holding spells are usually triggered by a sudden event, such as pain, fear, or anger. In cyanotic spells, the child may be upset or frustrated about something, like getting into trouble or not getting what they want. They will cry, exhale forcefully, and then stop breathing. In pallid spells, the child may experience a sudden pain or scare, such as falling and bumping their head or being startled by someone sneaking up behind them. They may shout or open their mouth to shout without making a sound, then stop breathing.

It's important to note that children do not have these spells on purpose. It is an involuntary response of their body to a sudden event, causing changes in their breathing pattern, heart rate, and blood pressure, which lead to fainting.

Understanding and Managing Breath-Holding Spells in Young Children

Symptoms of Breath-Holding Spells

During a breath-holding spell, your child may:

  • Pass out and lie limply on the floor

  • Arch their back

  • Become stiff

  • Jerk their body a few times

  • Become sweaty

  • Wet themselves

They may or may not gasp when they start breathing again. After the spell, your child will usually return to their normal self, although they may feel tired.

Diagnosis of Breath-Holding Spells

If your child experiences a breath-holding spell, take them to their pediatrician to rule out any underlying health problems. There are no specific tests to confirm a breath-holding spell, and the diagnosis is usually made based on the description of the event. Your pediatrician will want to know what triggered the spell, how your child looked, and how they started breathing again. In rare cases, your child may be referred to a cardiologist or neurologist to check for any underlying causes.

Managing Breath-Holding Spells

There are no specific treatments or medications for breath-holding spells. If your child has one spell, they are likely to have more, although the frequency can vary from several times a day to once a year. The best thing to do during a spell is to let your child lie on their side, which helps blood flow to their brain and allows them to recover more quickly.

In very rare cases, a child may not start breathing again after 1 minute. If this happens, call 911. If they are still not breathing after 3 minutes, start CPR.

Preventing Breath-Holding Spells

Your child's pediatrician may help you identify triggers that cause the spells and suggest ways to prevent them. Sometimes, blowing hard on your baby's face can interrupt a spell, but this may not work for every child or older children. If temper tantrums trigger the spells, your doctor may help you find new ways to set limits for your child. It's important not to give in to your child just to avoid a spell, as this can lead to behavior problems that may persist even after they outgrow the breath-holding spells.

For more information on breath-holding spells, consult the following reputable sources:

The Bottom Line

These dramatic but harmless episodes resolve on their own as children develop better emotional control, typically disappearing entirely by school age. Focus on staying calm during episodes and avoid reinforcing the behavior by giving in to demands that preceded the spell. If you're concerned about your child's episodes or want to rule out underlying conditions, Doctronic can connect you with pediatric specialists quickly.

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