Breath-holding Spell

Is Your Child Sick?

Advanced Pediatric Associates provides on-line health care advice to our patients via nationally recognized pediatric protocols provided by Pediatric Web and written by Barton Schmitt, M.D. ( Medical Director of the After-Hours Call Center at The Children's Hospital of Denver). If you are not a patient of Advanced Pediatric Associates, we recommend that you consult with your own physician regarding health concerns. This information is provided as a guide to our patients, but in no way replaces the advice given by our staff.

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Breath-holding Spell

Is this your child's symptom?

  • 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.

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When to Call for Breath-holding Spell

Call 911 Now

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

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

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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

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

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Copyright 2000-2018. Schmitt Pediatric Guidelines LLC.

Disclaimer:  If you are not a patient of Advanced Pediatric Associates, we recommend that you consult with your own physician regarding health concerns. This information is provided as a guide to our patients, but in no way replaces the advice given by our staff. Occasionally, advice given by our providers or nurse line may vary slightly from that offered by Pediatric Web and its contributors. If you are unsure of any issue regarding your child's health, please call our Patient Care Line at (303) 699-6200. 

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