What is a Breath Holding Spell?

A breath holding spell is an episode where a healthy child briefly stops breathing and loses consciousness. This usually happens in response to a painful, upsetting, or startling situation. For parents, breath holding spells can be frightening, but they are usually not dangerous, and treatment generally focuses on trying to prevent them from happening. It is advisable to have a doctor examine the child to confirm that the issue is not an underlying medical problem like asthma or allergies. In most cases, children should stop experiencing such spells by around age eight.

In so-called “pallid” breath holding spells, the issue is neurological in origin and happens because of stimulation of the vagus nerve, a key nerve responsible for regulating heart rate and certain other bodily functions. This usually happens because a child experiences a sudden, sharp pain, like a fall or a broken limb. The child will turn pale, stop breathing, faint, and then recover. This may only happen once in response to an extreme situation, and never again.

Cyanotic breath holding spells happen because of a subconscious reaction to trauma or upset. The child may scream or cry and then stop breathing, turning blue and rigid. Some children experience what look like seizures before recovering. After the child starts breathing again, the skin should return to its more natural color. People around the child may be concerned, but children usually experience no ill effects from the breath holding spell.

A doctor can evaluate the patient to look for any medical issues and may request an electroencephalogram study if the child experiences seizures. Once the doctor determines that the breath holding spell is not a sign of a more serious problem, she can recommend some steps for parents to take. The link between breath holding spells and trauma may lead a doctor to suggest that parents avoid exposing the child to frightening television shows and stories, and have heated, intense conversations in another room. Avoiding obvious traumatic triggers known to cause a breath holding spell in the past can also be helpful, as can sending the child to psychotherapy for assistance with managing trauma.

One risk with management of breath holding spells is accidental reinforcement of the behavior, where children may learn to avoid punishment and consequences for their actions by holding their breath until they faint. Parents naturally turn from angry to concerned when a children experiences a breath holding spell, and it is important to make sure the child still receives punishment if he was doing something wrong, even if the nature of the punishment needs to be adjusted to make it less traumatic.