Breath-holding spells are common and generally harmless in young children. While alarming, these episodes typically do not lead to lasting harm. Understanding what happens and how to respond can help parents navigate these moments.
What Are Breath-Holding Spells?
Breath-holding spells are involuntary events where a child temporarily stops breathing, sometimes leading to a brief loss of consciousness. They commonly occur in children aged 6 months to 6 years, with a peak incidence around 1 to 3 years. These spells are often triggered by strong emotions such as anger, frustration, fear, or pain from a minor injury.
A typical spell begins with crying or screaming, followed by breath-holding. The child’s skin may turn blue (cyanotic spells) or become very pale (pallid spells). The child may then become limp and lose consciousness, often for less than a minute, before resuming normal breathing and recovering quickly.
The Science Behind the Spells
Breath-holding spells are an involuntary reflex response of an immature nervous system. Cyanotic spells, the more common type, involve a temporary lack of oxygen in the blood due to prolonged breath-holding after crying, leading to a bluish discoloration.
Pallid spells, though less frequent, are often triggered by sudden pain or fright. These spells are linked to an overactivation of the vagal nerve, which can cause a sudden slowing of the heart rate. This decreased heart rate reduces blood flow and oxygen supply to the brain, resulting in paleness and loss of consciousness.
Both types of spells involve transient changes in oxygen and carbon dioxide levels in the blood. When a child holds their breath, oxygen levels may decrease, and carbon dioxide levels can rise, triggering the body’s natural impulse to breathe. The immaturity of the autonomic nervous system in young children means they may not regulate these responses as effectively. Some research also suggests a correlation between breath-holding spells and iron deficiency anemia, indicating that low iron levels might make some children more susceptible.
What to Do When a Spell Occurs
Remaining calm is important during a spell. Gently lay your child on their side on a safe surface, such as the floor or a crib, to prevent injury and improve blood flow to the brain. Ensure no objects nearby could cause harm.
Check your child’s mouth for any food or objects that could pose a choking hazard. Do not attempt mouth-to-mouth resuscitation or CPR unless your child remains unconscious or is not breathing for more than one minute, as normal breathing typically resumes on its own. Do not shake your child, as this can cause harm.
After the spell, offer comfort and reassurance. If the spell was triggered by a tantrum or a limit being set, avoid immediately giving in to the child’s demands, as this might inadvertently reinforce the behavior. Return to your normal routine once the child is calm.
When to Consult a Doctor
While breath-holding spells are usually benign, medical consultation is advisable in specific situations. If your child experiences their first breath-holding spell, consult a doctor to confirm the diagnosis and rule out other conditions.
Seek medical advice if spells occur without a clear trigger, increase in frequency or severity, or if your child remains unconscious for longer than one to two minutes. Other indications for a medical evaluation include unusual movements or seizure-like activity during or after a spell, or if your child appears confused or unusually drowsy afterward. A doctor can assess for underlying issues such as iron deficiency anemia or, in rare cases, cardiac conditions that might mimic these spells.