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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.

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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:

Breath-holding spells are more common in children with:

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:

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:

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:

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.

When to Contact a Medical Professional

Contact your child's provider if:

Call 911 or your local emergency number if:

Related Information

Seizures
Unconsciousness - first aid
Familial dysautonomia

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.

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Review Date: 12/12/2021  

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.

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