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Breath holding spell


Definition:

Some children have breath holding spells. This is an involuntary stop in breathing that is not in the child’s control.

Causes:

Babies as young as 2 months old and up to 2 years old can start having breath holding spells. Some children have severe spells.

Children can have breath holding spells when they are responding to:

  • Fear
  • Pain
  • Traumatic event
  • Being startled or confronted

Breath holding spells are more common in children with:

  • Genetic conditions, such as Riley-Day syndrome or Rett syndrome
  • Iron deficiency anemia
  • A family history of breath holding spells (parents may have had similar spells when they were children)
Symptoms:

Breath holding spells most often occur when a child becomes suddenly upset or surprised. The child makes a short gasp, exhales and stops breathing. The child's nervous system slows the heart rate or breathing for a short amount of time. Breath holding spells are not thought to be a willful act of defiance, even though they often occur with temper tantrums. Symptoms can include:

  • Blue or pale skin
  • Crying, then no breathing
  • Fainting or loss of alertness (unconsciousness)
  • Jerky movements (short, seizure-like movements)

Normal breathing starts again after a brief period of unconsciousness. The child's color improves with the first breath. This may occur several times per day or only on rare occasions.

Exams and Tests:

The doctor or nurse will perform a physical exam and ask questions about the child's medical history and symptoms.

Blood tests may be done to check for an iron deficiency.

Other tests that may be done include:

  • EKG to check the heart
  • EEG to check for seizures
Treatment:
  • No treatment is usually needed.
  • Iron drops or pills if the child has an iron deficiency.

Breath holding can be a frightening experience for parents. If your child has been diagnosed with breath holding spells, take the following steps:

  • During a spell, make sure your child is in a safe place where he or she will not fall or be hurt.
  • Place a cold cloth on your child's forehead during a spell to help shorten the episode. After the spell, try to be calm. Avoid giving too much attention to the child, as this can reinforce the behaviors that led to the spell.
  • Avoid situations that cause a child's temper tantrums. This can help reduce the number of spells.
  • Ignore breath holding spells that do not cause your child to faint. Ignore the spell in the same way you ignore temper tantrums.
Outlook (Prognosis):

Most children outgrow breath holding spells by the time they are 6 - 8 years old.

Children who have a seizure during a breath holding spell are not at more risk of getting a seizure disorder.

When to Contact a Medical Professional:

Call your health care provider if you think your child is having breath holding spells.

Call your health care provider if your child's breath holding spells are getting worse or happening more often.

Call 911 or your local emergency number if:

  • Your child stops breathing or has trouble breathing
  • Your child has seizures for more than one minute
References:

Walter HJ, DeMaso DR. Age-specific behavioral disturbances. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 27.1.


Review Date: 12/4/2013
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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