When a young child throws a tantrum, holding their breath can be frightening for any parent. This behavior raises the question of whether a child can inflict actual harm upon themselves. The human body is equipped with powerful, involuntary protective mechanisms designed to override any conscious attempt to stop breathing. The body’s survival drive ensures that voluntary control over respiration is temporary and will always be overtaken by the brain’s automatic regulation, preventing self-harm.
The Automatic Override: How the Brain Forces a Breath
Respiratory control is governed by the concentration of carbon dioxide (\(\text{CO}_2\)), not oxygen levels. When a child holds their breath, the body produces \(\text{CO}_2\) as a metabolic byproduct, causing levels to rapidly rise. This buildup makes the blood more acidic, a change immediately detected by specialized chemoreceptors in the brainstem and major arteries.
The brainstem, which controls involuntary bodily functions, is highly sensitive to this increase in acidity. Once the \(\text{CO}_2\) concentration reaches a certain threshold, the brain’s respiratory center sends an immediate, involuntary signal to the diaphragm and other breathing muscles. This signal overrides the child’s conscious attempt to hold their breath, forcing a gasp or an inhale.
In extreme cases, the child may briefly lose consciousness, or faint, before the involuntary breath is forced. This temporary loss of consciousness, known as syncope, is the body’s ultimate safety measure. Once the child loses voluntary muscle control, the brainstem’s automatic mechanisms take over, instantly restoring normal breathing and blood flow to the brain.
Defining Breath-Holding Spells
Involuntary episodes of breath-holding are medically classified as Breath-Holding Spells (BHS). These spells are common, occurring in 1% to 5% of healthy children. BHS typically begin between six months and 18 months of age, and almost always resolve on their own by the time a child reaches five or six years.
BHS are generally divided into two main categories based on the child’s physical appearance during the event. The more common is the cyanotic spell, usually triggered by a tantrum, frustration, or anger. During a cyanotic spell, the child cries out, stops breathing after exhaling, and the lack of oxygen causes the skin, especially around the lips, to turn a bluish or purplish color.
The less common form is the pallid spell, typically provoked by a sudden fright or a minor painful injury. This type involves a strong nerve reflex that causes the heart rate to slow dramatically. This temporary slowing of the heart reduces blood flow to the brain, causing the child to become very pale before losing consciousness.
Why BHS Are Not Physically Dangerous
BHS are considered a benign phenomenon and do not cause any long-term brain damage or cognitive impairment. The brief period of oxygen deprivation that occurs is not sufficient to harm the brain. The involuntary faint acts as a failsafe, immediately resetting the body’s respiratory rhythm and ensuring oxygen-rich blood returns to the brain within seconds.
These episodes are often confused with epileptic seizures, particularly when a child exhibits some stiffening or jerking movements during the brief loss of consciousness. However, BHS are reflex-driven events, whereas epilepsy involves abnormal electrical activity in the brain. If an electroencephalogram (EEG) is performed between episodes, a child with BHS will show normal brain activity.
Behavioral Strategies for Parents
The most effective approach for parents dealing with BHS is to remain calm and treat the spell as a temporary physical event. If your child is having a spell, ensure they are in a safe location, perhaps by gently laying them on their side to prevent injury from a fall. There is no need to shake the child, splash them with water, or interfere; the body will restart breathing on its own.
After the spell, it is important to provide comfort and reassurance without overreacting to the behavior that preceded the event. Giving in to the child’s demand immediately after the spell can inadvertently reinforce the use of breath-holding as a manipulative tool. Maintaining consistent boundaries helps prevent the child from associating the physical episode with getting their way.
While BHS are self-limiting, a medical consultation is warranted if the spells start before six months of age or happen with unusual frequency, such as more than once per week. Parents should also consult a doctor if the child appears excessively confused or drowsy for a prolonged period after the spell, or if the episodes begin suddenly without the usual emotional trigger.