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Breath holding spell

Some children have breath holding spells. This is an involuntary stop in breathing that is not in the child’s control.

Causes

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:

  • Fear
  • Pain
  • 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)

Symptoms

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 doctor or nurse 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:

  • EKG  to check the heart
  • EEG to check for seizures

Treatment

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 he or she 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 .

Outlook (Prognosis)

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 more risk of getting a seizure disorder.

When to Contact a Medical Professional

If you think your child is having breath holding spells

If 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 one minute

References

Walter HJ, DeMaso DR. Age-specific behavioral disturbances. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 27.1.

Updated: 12/4/2013

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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