Breath-holding spell
Some children have breath-holding spells. This is an involuntary stop in breathing that is not in the child's control.
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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)
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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 (cyanosis) 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.
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Exams and Tests
Your health care provider will perform a physical exam and ask questions about your child's medical history and symptoms.
Blood tests may be done to check for an iron deficiency.
Other tests that may be done include:
- Electrocardiogram (ECG) to check the heart
- Electroencephalogram (EEG) to check for seizures
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Treatment
No treatment is usually needed. But iron drops or pills may be given if your 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 your 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.
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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 higher risk for having seizures otherwise.
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When to Contact a Medical Professional
Contact 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 the local emergency number if:
- Your child stops breathing or has trouble breathing
- Your child has seizures for more than 1 minute
References
Mikati MA, Obeid MM. Conditions that mimic seizures. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 612.
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.