Children's Hospital Colorado

Breath-holding Spell

  • A spell that involves holding the breath, then turning blue and passing out
  • Breath-holding spells were diagnosed by your child's doctor

Symptoms of a Breath-Holding Spell

  • An upsetting event happens right before the spell. A common trigger is being angry about parents setting limits (temper tantrums). Another is getting scared. Some spells are triggered by a sudden injury, such as falling down.
  • The child gives out 1 or 2 long cries
  • Then holds his breath until the lips and face become bluish
  • Then passes out and falls to the floor
  • Then often becomes stiff. May also have a few muscle jerks.
  • Normal breathing starts again in less than 1 minute. Becomes fully alert in less than 2 minutes.
  • Only happens when child is awake, never when asleep

Cause

  • A reflex response to strong feelings. This reflex allows some children to hold their breath long enough to pass out. Spells do not happen on purpose.
  • This happens in 5% of healthy children. Breath-holding spells can run in families.
  • Starts between 6 months and 2 years of age. Goes away by age 6.
  • Many young children hold their breath when upset, turn blue, but don't pass out. This is common and normal.
  • Frequent spells can happen in children who have anemia (low red blood count). This can happen if your child doesn't eat enough foods with iron. If your child is a picky eater, your doctor may order a blood test.

Call 911 Now

  • Breathing stopped for more than 1 minute and hasn't returned
  • You think your child has a life-threatening emergency

Go to ER Now

  • Trouble breathing after spell ends

Call Doctor or Seek Care Now

  • Passed out more than 2 minutes by the clock and normal breathing now
  • First breath-holding spell
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor During Office Hours

  • Never been checked by a doctor for the spells
  • Spells happen without a reason (no triggers)
  • Muscle jerks during spell
  • Picky eater (especially for meats)
  • Lots of tantrums trigger the spells
  • Spells happen more than once a week
  • You think your child needs to be seen, but the problem is not urgent
  • You have other questions or concerns

Self Care at Home

  • Normal breath-holding spell

Care Advice for Breath-holding Spells

  1. What You Should Know About Breath-Holding Spells:
    • While breath-holding spells are scary for parents, they are harmless.
    • Normal breathing always returns on its own.
    • The spells don't lead to seizures (epilepsy).
    • Here is some care advice that should help.
  2. Lie Down:
    • During the spell, have your child lie down.
    • This will increase blood flow to the brain.
    • Remove any food from his mouth.
    • Do not hold your child upright. It decreases blood flow to the brain. This could cause some jerking of body muscles.
  3. Cold Washcloth to Forehead:
    • Put a cold, wet washcloth on your child's forehead. Keep it on until he or she starts breathing again.
    • That's the only care your child needs.
  4. Time the Length of Not Breathing:
    • These spells always seem to last longer than they really do.
    • Time the length of a few spells. Use a watch with a second hand.
    • Breathing almost always returns by 60 seconds.
    • It's hard to guess at the length of a spell and get it right.
  5. Stay Calm:
    • Don't start mouth-to-mouth breathing. Don't call 911.
    • Don't put anything in your child's mouth. It could cause choking or vomiting.
    • Never shake your baby. It can cause bleeding in the brain.
  6. Don't Give In After the Spell:
    • Some breath-holding spells start with a temper tantrum (Such as your child wanted something and you said "No"). Don't give in to her before or after the attack.
    • After spells, give your child a brief hug and go about your normal routine.
  7. What to Expect:
    • Spells happen from 1 or 2 times a day to 1 or 2 times a month.
    • Kids outgrow them by age 6.
  8. Call Your Doctor If:
    • Spells become more frequent
    • Spells change
    • You think your child needs to be seen
    • Your child becomes worse

Disclaimer

The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.

  • Not a Substitute - The information and materials in Pediatric HouseCalls Symptom Checker should not be used as a substitute for the care and knowledge that your physician can provide to you.
  • Supplement - The information and materials presented here in Pediatric HouseCalls Symptom Checker are meant to supplement the information that you obtain from your physician. If there is a disagreement between the information presented herein and what your physician has told you -- it is more likely that your physician is correct. He or she has the benefit of knowing your child's medical problems.
  • Limitations - You should recognize that the information and materials presented here in Pediatric HouseCalls Symptom Checker have the following limitations, in comparison to being examined by your own physician:
    • You can have a conversation with your child's doctor.
    • Your child's doctor can perform a physical examination and any necessary tests.
    • Your child could have an underlying medical problem that requires a physician to detect.
    • If your child is taking medications, they could influence how he experiences various symptoms.

If you think that your child is having a medical emergency, call 911 or the number for the local emergency ambulance service NOW!

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