Breath-holding spell

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

  Riley-Day syndrome

  Familial dysautonomia (FD) is an inherited disorder that affects nerves throughout the body.

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  Rett syndrome

  Rett syndrome (RTT) is a disorder of the nervous system. This condition leads to developmental problems in children. It mostly affects language ski...

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• Iron deficiency anemia

  Iron deficiency anemia

  Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. There are man...

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• 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 (cyanosis) 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

Your health care provider will perform a physical exam and ask questions about your child's medical history and symptoms.

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

Other tests that may be done include:

• Electrocardiogram (ECG) to check the heart

  Electrocardiogram

  An electrocardiogram (ECG) is a test that records the electrical activity of the heart.

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• Electroencephalogram (EEG) to check for seizures

  Electroencephalogram

  An electroencephalogram (EEG) is a test to measure the electrical activity of the brain.

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Treatment

No treatment is usually needed. But iron drops or pills may be given if your 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 they 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 your 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 4 to 8 years old.

Children who have a seizure during a breath-holding spell are not at higher risk for having seizures otherwise.

When to Contact a Medical Professional

Contact your child's provider if:

• You think your child is having breath-holding spells
• Your child's breath-holding spells are getting worse or happening more often

Call 911 or the local emergency number if:

• Your child stops breathing or has trouble breathing
• Your child has seizures for more than 1 minute