Breath-holding spells

What are breath-holding spells?

A breath-holding spell happens when a child stops breathing for a short time, from a few seconds to a couple of minutes. The spells can occur often in a single day or only now and then.

Children who experience breath-holding will usually have their first spell before they turn 18 months, although spells can sometimes start from as early as six months. The spells happen most often when a child is around two years of age and normally end when the child turns five or six.

It might seem that a child is holding their breath on purpose, but they actually cannot control this behaviour.

As a parent, you might find breath-holding scary to watch, but the spells are fairly harmless and usually do not do any long-term damage. The child having a breath-holding spell regains their normal colour, level of awareness and breathing pattern within minutes.

Types of breath-holding spells

Breath-holding spells fall into two categories:

• cyanotic
• pallid.

Cyanotic breath-holding

Cyanotic breath-holding is the most common type of spell. It is usually triggered when a child cries after feeling angry, frustrated or frightened. Because the child stops breathing, their bodies receive less oxygen. This can lead to changes in the child's heart rate.

Pallid breath-holding

Pallid breath-holding, which is less common, is triggered after a child experiences pain, for example after falling or hitting their head. This can lead to changes to the child's nervous system, which causes the symptoms such as forced breathing or jerky movements.

It is common for your child to have a breath-holding spell with a temper tantrum. If your child has mild breath-holding spells and does not become faint, it is best to ignore the spell as you would ignore a temper tantrum, while making sure the child is safe.

How can I tell when my child is having a breath-holding spell?

Breath-holding spells usually happen after a child is suddenly startled or upset. They may occur with a moment of extreme crying.

Common steps in a breath-holding spell

1. A brief, shrill cry
2. Forced breathing out, followed by stopped breathing (apnea) and turning red
3. Blue, purple or pale skin (also known as cyanosis)
4. Fainting or loss of consciousness
5. Jerky movements (short, "seizure-like" movements), only in extreme cases

Jerky movements during a breath-holding spell do not usually indicate a true seizure and do not cause any long-term harm. Children who shake with a breath-holding spell do not appear more likely to get a seizure-related disorder.

How to help your child during a breath-holding spell

• Make sure your child is in a safe place where they will not fall or be hurt.
• After the spell, try to be calm. Avoid giving too much attention to the child, as this can reinforce the behaviours that led to the event.
• Discuss the event with your child's doctor. Your child may need a medical exam to make sure that they do not have any other health problems that could be related to the breath-holding spell, such as iron-deficiency anemia or an irregular heartbeat.

When to call 911

Call an ambulance if your child:

• stops breathing or loses consciousness
• has trouble breathing
• has jerky movements or a seizure for more than one minute.