Watching your child have a breath-holding spell can be scary and overwhelming. These spells occur in about 5% of healthy children, and about 20% to 33% of children with breath-holding spells have a family history of them. Our Associate Clinic Medical Director of the Child Health Clinic, Elizabeth Kudron, MD, MPH, shares what happens during these spells, how to keep your child safe, when to call your child’s doctor and more.

What is a breath-holding spell?

A breath-holding spell is when your child or baby holds their breath for long enough that they temporarily stop breathing, which sometimes causes them to pass out. You might notice a child get blue lips or face right before passing out during a breath-holding spell. These incidents are almost always triggered by an upsetting event, such as being angry that parents or caregivers set limits, being scared, falling or being in pain due to a mild injury. Most spells only last 10 to 60 seconds. 

It is important to know that this is something a child can’t control, and you can’t prevent them from occurring. They will only occur when your child is awake and do not occur during sleep. 

Here’s what a spell might look like:  

• The child may cry and then will hold their breath until they stop breathing.
• The child’s face and lips may appear blue.
• Some children will pass out and fall to the floor.
• After passing out, most children appear stiff; you may also notice a few muscle jerks.
• Your child will start breathing again in less than one minute. Most children are back to their normal selves within two minutes.

What is the difference between a breath-holding spell and choking?

It can be hard sometimes to tell the difference between a breath-holding spell and if your child is choking. The biggest difference is the inciting event. Breath-holding spells are almost always triggered by a child being upset compared to a child who is choking might be eating a snack or playing with a small toy in their mouth before the event.

In breath-holding spells, children are holding their breath. If a child is choking, they are almost always trying to breath but having difficulty doing so, which may sound like a high-pitched sound when attempting to breathe in or appears panicked. If you are concerned your child is choking, call 911.

When do breath-holding spells start?

For children who have breath-holding spells, their first one typically occurs between 6 and 18 months, but they can occur anytime from birth to 5 years of age. Breath-holding spells usually stop happening by age 6. It’s important to know that children under the age of 6 months do not have breath-holding spells and should be immediately evaluated by a doctor if a caregiver thinks their baby stopped breathing.

What should you do to prevent your child from getting hurt during a breath-holding spell?

You can help keep your child safe when they have a breath-holding spell by following these steps:

• Help your child lie flat on their side during a spell.
• Stay with them until the spell ends and they start breathing again.
• Make sure there isn’t anything around your child that they could hit their heads, arms or legs on.
• Do not put anything in your child’s mouth because it could make them choke or vomit.
• Try to remain calm. The spell should last less than 1 minute.
• Call 911 if your child is not breathing for more than 1 minute, as this could indicate something else is going on that might require immediate medical attention, such as choking or a seizure.

What should you do after a breath-holding spell?

Even though a breath-holding spell can be overwhelming and might cause worry, you can focus on comforting your child immediately after a spell. Then, you can return to your regular activities. Remember that they didn’t have a breath-holding spell on purpose. It’s OK to feel scared, but it's important to reassure your child that they are safe.

Are breath-holding spells harmful?

Although breath-holding spells are often frightening for caregivers, they do not cause brain damage or any other harm, and your child will outgrow them.

Why do some children have breath-holding spells?

We aren’t exactly sure what causes breathing-holding spells. Research has suggested that breath-holding spells are an abnormal reflex of the nervous system in young children that allows them to hold their breath long enough to stop breathing momentarily. Children do not do this on purpose, and they don’t have control over it. While teaching your child positive ways to cope with emotions is important, breath-holding spells do not occur due to a lack of emotional control.

When should you talk to your child’s doctor about breath-holding spells?

You should talk to your child’s doctor if you think that your child had a breath-holding spell. Some children with breath-holding spells may have low iron or blood levels (anemia). Your child’s doctor may want to run additional tests and can help determine if your child has breath-holding spells or another diagnosis, such as seizures which can sometimes appear similar to a breath-holding spell.