A healthy living blog from Marshfield Clinic Health System

The truth about terrifying toddler breath-holding spells

Two young kids holding their breath and laying on the lawn - Breath-holding spells

Breath-holding spells usually happen when children 6 months to 6 years old hold their breath during tantrums until they lose consciousness.

Your child is in the middle of a tantrum. Suddenly he’s silent and next thing you know, he’s passed out on the ground.

This scenario is scary, but more common than you might think.

Breath-holding spells usually happen in children 6 months to 6 years old who become upset or injured. They’re most common in children younger than 18 months. Most children lose consciousness for a very short time and start breathing again right after passing out, said Dr. David Holz, a Marshfield Clinic pediatrician.

Although they’re frightening, breath-holding spells rarely cause harm.

Two types of breath-holding spells

Breath-holding spells are of two types: cyanotic and pallid.

Cyanotic episodes are the more common type. The child typically holds his or her breath for 10-15 seconds or more during a tantrum or other upsetting event. The child starts to look blue then loses consciousness. Sometimes rhythmic shaking movements that look like seizures happen during the short time the child is unconscious. The child may be sleepy for up to 30 minutes after an episode.

Pallid breath-holding spells usually happen after a child is injured. The child may seem fine right after the injury then lose consciousness about 30 seconds later and may briefly stop breathing. The associated seizure-like movements occur more often in pallid episodes than in cyanotic episodes.

“We don’t know exactly why breath-holding spells occur, though we think that a temporary dysfunction in the autonomic nervous system likely plays a role,” Holz said. “The autonomic nervous system helps control heart rate, blood pressure and drive to breathe.”

These relatively short pauses in breathing can be very frightening. Generally, they do not cause any permanent harm to the child if they are due to simple breath-holding spells. However, other disorders including heart rhythm abnormalities and seizure disorders also can mimic breath-holding spells.

See a doctor after an episode

Your child should see a health care provider the first time a breath-holding spell causes him or her to lose consciousness.

An office visit in the next few days is recommended if a normally healthy child regains consciousness quickly and seems fine. However, there are certain situations where you should bring a child to the emergency department after a breath-holding spell.

  • The child was rhythmically shaking during the episode, like a seizure.
  • It’s hard to wake the child after the episode.
  • The child has a fever, infection or other medical problems.

Be prepared to tell the doctor about any family history of seizures or heart defects. Your child’s doctor may order more tests to figure out if an underlying medical condition caused the episode.

Next steps for parents

There is good news for parents with children who have breath-holding spells. Children outgrow them, and medical care isn’t needed after every event for children who are otherwise healthy.

Let caregivers know about breath-holding spells and what to do if the child has one.

Giving iron supplements to children with low iron levels may decrease how often some kids have breath-holding spells. Your child’s pediatrician can help you make a plan for avoiding trigger events.

“For many children with breath-holding spells, the trigger can be as simple as telling a child ‘no’ or delivering mild discipline,” Holz said. “This can be challenging for parents as they struggle to find a balance between avoiding frequent breath-holding spells and maintaining appropriate boundaries and consistent discipline.”

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