Breath-Holding Spells

Key points about breath-holding spells

Breath-holding spells are scary to watch, but your child does not need any treatment.

• breath-holding spells are quite common in children
• children may hold their breath after a fright or becoming upset
• there are 2 types of breath-holding - blue spells and pale spells
• they are scary to watch, but your child does not need any treatment

What is a breath-holding spell?

Toddlers, and sometimes babies, can have breath-holding spells (or attacks). They happen in about 1 in 20 children. A breath-holding spell may happen after a child has been upset or startled - for example, had a minor bump or a fright.

They are scary to watch, but your child does not need any treatment.

Your child may recover quickly or be unresponsive for a short period.

Breath-holding spells often happen as part of toddler tantrums. The spell is an automatic reaction to something unpleasant - it is not a deliberate behaviour on your child's part.

When do breath-holding spells usually start and stop?

Breath-holding spells happen at similar rates in boys and girls. The spells usually happen in children between the ages of 18 months and 6 years. They are rare before 6 months of age.

How often do breath-holding spells happen?

Breath-holding spells are different for different children. They may happen fairly often, sometimes several times a day or only every few weeks or months. They usually happen more often when your child is overtired, upset and irritable (grizzly). Often parents who have seen breath-holding spells can predict when another is likely to happen.

Different types of breath-holding spells

There are 2 types of breath-holding spells. Both types may happen in the same child at different times in their lives.

Neither type has any serious consequences (unless your child hurts themselves if they fall) but they are frightening to see.

Blue spells (cyanotic breath-holding)

Blue spells are the most common. Your child may have hurt themselves or become very upset or frustrated, and they then:

• cry or scream
• breathe out forcefully
• breath-hold and turn blue, especially around the lips - this blueness is caused by a lack of oxygen, and lasts a few seconds
• may become floppy and lose consciousness (faint)

Pale spells (pallid breath-holding)

These are less common. They can happen in young children after a minor injury or if a child is upset. Pale spells are caused by a slow heart rate and are often mistaken for a seizure. Your child will:

• open their mouth as if to cry but no sound comes out
• faint and look very pale
• have a brief period where their arms and legs become stiff or lose control of their bladder/bowel

What causes breath-holding spells?

Breath-holding spells are caused by either a change in a child's usual breathing pattern, a slowing of the heart rate or a combination of the two. Pain or strong emotions, such as fear or frustration can bring on these reactions.

The underlying reason for breath-holding spells is not known. 1 in 3 children with breath-holding spells will have a family history of similar episodes. In some children, breath-holding spells may be related to iron deficiency anaemia. This is a condition where the body does not produce a normal number of red blood cells.

Most children with breath-holding do not have a serious underlying problem.

Does breath-holding mean my child has epilepsy?

No. Children with breath-holding spells do not have epilepsy. As breath-holding spells may look like epileptic seizures, the 2 are often confused. Breath-holding spells happen after your child has been frustrated, startled or hurt. Children with epilepsy have seizures without any of these things happening beforehand.

Breath-holding spells can only happen when your child is awake and usually when they are standing. Epileptic seizures may happen while a child is awake or asleep.

There is no increased risk of children with breath-holding spells later developing epilepsy.

Do breath-holding spells cause any long-term problems?

No. Your child will not have any long-term damage due to the brief period with reduced blood oxygen levels.

Some children with pale spells may be more likely to faint as they grow up.

What should I do during my child's breath-holding spell?

Treat your child normally after a breath-holding spell.

• don't panic
• lie your child on their side and watch them
• don't shake your child, put anything into their mouth, or splash them with water
• keep your child away from anything hard or sharp
• allow the spell to stop by itself
• treat your child normally after the event - do not punish or reward the behaviour

What can doctors do for my child with breath-holding?

Talk with your family doctor about the problem. Your child will need a physical check-up to make sure they do not have any other problems, such as an irregular heartbeat.

Your doctor may suggest a blood test to check your child is not anaemic or low in iron. If they are, your doctor may suggest iron medicine. This can reduce the frequency and severity of breath-holding spells.

Children who have breath-holding spells are usually healthy.

When should I be worried about my child's breath-holding?

Take your child to your family doctor if:

• the spells happen without your child being frustrated, startled or hurt beforehand
• your child with breath-holding spells has stiffening or shaking which goes on more than a minute
• your child takes a long time to recover and needs several hours of sleep, or seems confused for a long period of time
• your child is less than 6 months of age as young babies need checking for other causes - breath-holding spells may still happen in this age group but it is less common

How can I care for my child with breath-holding at home?

No special treatment is necessary.

Make sure your child gets plenty of rest, help your child feel secure and help minimise and manage their frustration.

Don't treat your child differently from their brothers or sisters, or other children. This is because different treatment can lead to behaviour problems which continue once the spell has stopped.