Definition

• A spell that includes holding the breath, then turning blue and passing out

Health Information

Symptoms

• Triggered by an upsetting event such as being angry about limit-setting. Also triggered by being frightened or being injured. Examples are falling down or bumping the head.
• The child gives out 1 or 2 long cries
• Then holds his breath until the lips and face become bluish
• Then passes out
• Then often becomes stiff or rigid. Sometimes, children progress to having a few twitches or muscle jerks. This happens in about 30% of children.
• Then resumes normal breathing in less than 1 minute.
• Becomes fully alert in less than 2 minutes
• Onset between 6 months and 2 years of age. Stop by age 6.
• Only occurs 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.
• They occur in 5% of healthy children. Breath-holding spells can run in families.
• Start 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.

Care Advice

1. Overview:
   • 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 muscle jerking.
3. Cold Pack:
   • Use a cold, wet washcloth to your child’s forehead. Do this until they start to breathe again.
   • That’s the only treatment your child should need.
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. Don’t Overreact:
   • Don’t start mouth-to-mouth breathing or call 911. It’s not needed.
   • 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 attacks, give your child a brief hug. Then, go about your business.
   • If your child has a temper tantrum, don’t give in after the attack.
7. Prevention of Injuries:
   • The main injury risk of a breath-holding spell is a head injury. Try to prevent this if possible.
   • If your child is standing near a hard surface, go to him quickly. In case of an attack, help lower him to the floor.
8. Prevention of Future Attacks:
   • Once started, most attacks can’t be stopped. They have to run their course.
   • However, some children can be distracted if you intervene before they become blue.
   • Tell your child to come to you for a hug. Another option is to look at something interesting with them. Ask him if he wants a drink of juice or his favorite fluid. It’s worth a try.
9. What to Expect:
   • The attacks occur from 1 or 2 times a day to 1 or 2 times a month.
   • Kids outgrow them by age 6.

Call Your Doctor If

• Attacks become more frequent
• Attacks change
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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