Breath-holding spells (BHS) are involuntary episodes common in early childhood, typically affecting children between six months and six years of age. They are often triggered by emotional upset, frustration, anger, or a sudden painful experience. While the sight of a child suddenly stopping breathing and losing consciousness can be terrifying for parents and caregivers, these events are a reflex and not a sign of a serious medical problem. Understanding BHS is the first step in managing the anxiety they cause, as most children outgrow this temporary condition.
Why Breath-Holding Spells Are Not Dangerous
Breath-holding spells pose no long-term health risks to the child. The brief loss of consciousness that can occur during a spell is actually a protective, involuntary reflex that causes the child to begin breathing again on their own. This unconscious state is momentary and prevents any risk of voluntary, sustained breath-holding.
The short period of reduced oxygen or blood flow to the brain is insufficient to cause lasting neurological damage or brain injury. Children who experience breath-holding spells have normal developmental and intellectual outcomes. Even when a spell causes brief, self-limited seizure or twitching movements, this is due to the temporary lack of oxygen. It does not mean the child has epilepsy or a seizure disorder. The episodes are a form of syncope, or brief fainting, related to the child’s immature autonomic nervous system.
The Physiological Differences Between Spell Types
Breath-holding spells are divided into two primary types based on the physiological mechanism and the child’s appearance during the episode. The cyanotic spell is the more common type, often accounting for over two-thirds of cases, and is typically triggered by anger, frustration, or a temper tantrum. During a cyanotic spell, the child cries out, forcibly exhales, and then involuntarily fails to inhale, causing the skin to turn blue or purple, especially around the lips. This blueness, or cyanosis, is due to a temporary reduction in blood oxygen levels.
The pallid spell is less frequent and is usually precipitated by a sudden pain, fright, or minor injury. This type involves a physiological reaction mediated by the vagus nerve, which abruptly slows the heart rate. The resulting drop in blood flow to the brain causes the child to become very pale or grayish (pallor). They may lose consciousness quickly, sometimes without a preceding cry. While the triggers and visible symptoms differ, both types of spells are involuntary and typically resolve within a minute, with the child regaining consciousness.
What to Do When a Spell Occurs
The most important step during a breath-holding spell is to prioritize the child’s physical safety and to remain calm. If the child begins to lose consciousness, gently lay them flat on the floor or in a crib to help blood return to the brain. Quickly scan the immediate area and remove any hard or sharp objects the child might hit during a fall.
Parents should resist the urge to shake the child or put anything into their mouth, which could cause injury or choking. The child will start breathing on their own within a minute or so, as the body’s reflexes automatically kick in. After the episode has passed, comfort the child without giving excessive attention or reward to the behavior that triggered the spell.
When to Consult a Healthcare Provider
While most breath-holding spells are harmless, parents should consult a healthcare provider, especially after the first occurrence, to confirm the diagnosis. The provider may check for iron deficiency anemia, a common co-factor found in many children who experience these spells. Iron supplementation can sometimes help reduce the frequency and severity of the episodes, even if the anemia is mild.
Medical consultation is also necessary to distinguish BHS from other conditions that can mimic them, such as a true seizure disorder or a cardiac issue. A healthcare provider should be contacted if a spell lasts longer than one minute, if the child does not quickly return to normal consciousness afterward, or if the spells occur frequently without an obvious emotional or painful trigger, particularly during sleep. These “red flags” may warrant additional testing, such as an electroencephalogram (EEG) or an electrocardiogram (EKG), to rule out less common underlying conditions.