Breath-Holding Spells in Children

A breath-holding spell is precisely what it sounds like: a child holds her breath until she turns blue or even passes out. The spell is triggered by a stimulus that causes the child to be angry, frus­trated, surprised, frightened, or uncomfortable. She will begin to cry, but shortly thereafter she will become quiet, exhale, and stop breathing. That’s when she’ll become either pale or bluish, and she may lose consciousness. Usually within seconds, she will wake up and return to her normal activity level. The whole episode can last anywhere from a couple of seconds to half a minute.

Breath-holding spells are involuntary and are not associated with any other behavioral or physical problems. With some chil­dren, the spells occur infrequently (perhaps every few months), but with other children, they occur several times a day. The first spell usually occurs between 6 and 18 months of age. Half of the children who experience breath-holding spells will stop having them by five years of age. The spells will stop for almost all chil­dren by age seven.

No one really understands why certain children have breath-holding spells and others do not. Furthermore, what is going on in the body is not entirely understood. One theory is that hyper­ventilation followed by a deep exhale reduces the flow of blood back to the heart, which, seconds later, means there is decreased blood flow to the brain. This causes a child to become pale or blue and pass out. Another theory is that children with breath-holding spells have more dramatic drops in their blood pressure than children who don’t experience the spells. Again, following a stimulus, a drop in blood pressure results in decreased blood flow back to the heart, which in turn causes reduced blood flow to the brain.

At first it can be difficult to tell the difference between a breath-holding spell and a seizure. However, whereas breath-holding spells tend to be brought on by a precipitating event and almost always involve crying during the spell, seizures are not brought on by any particular stimulus and almost never involve crying. Also, during a breath-holding spell, you may notice that your child’s heart rate slows down considerably. By contrast, during a seizure, the heart rate speeds up rather than slowing down. Finally, most children are extremely sleepy after a seizure. After a breath-holding spell, however, there is only a brief period of fatigue lasting seconds or minutes, and more often there is no fatigue at all.