How to Deal With Breath Holding Spells In Children

If there is any doubt as to whether your child is having a breath-holding spell and you do not know why your child has turned blue and stopped breathing, you should begin CPR. Usually, by the time you make this snap decision, the breath-holding spell will be over, and your child will be coming to.

No matter how dramatic a breath-holding spell appears, you do not need to do anything. Your child will begin to breathe and wake up on her own. You may wish to place your child some­where safe (for example, lay her on her back on the floor) and remove any objects from her hands.

Again, the best way to treat a breath-holding spell is to help prevent it. If you know that a certain reaction or behavior by you will trigger a spell, avoid that reaction or behavior. Continue to set limits for your child. Don’t let breath-holding spells scare you away from good parenting, but do it in a way that causes the least amount of reaction and frustration.

When does my doctor need to be involved?
Let your doctor know if your child has breath-holding spells. If you are not sure that what your child is experiencing is in fact a breath-holding spell, call your doctor.

What tests need to be done, and what do the results mean?
If your doctor cannot be sure that your child had a breath-holding spell and not a seizure, your child will likely have an evaluation to rule out a seizure. The tests might include an elec­troencephalogram (EEG) and sometimes an imaging study such as a CT scan or MRI.

Sometimes there may be concern that breath-holding spells are related to heart function. This is especially common when the spells involve a blue color change. If cardiac problems are sus­pected, tests may include an electrocardiogram (EKG) and an echocardiogram (ECHO), and a simple chest X ray.

In some cases, blood work is done to evaluate a child with breath-holding spells. Although this is largely considered unnecessary, checking hemoglobin and serum ferritin may be worthwhile. These tests look for anemia (low iron level), which may play a part in breath-holding spells.

What are the treatments?
There are no specific treatments for breath-holding spells. Many children outgrow them by the end of the toddler years, and all children outgrow them by age seven. However, minimizing the triggers that lead to the spells can help reduce their frequency, especially if your child is having many per day.

There is a theory that iron supplementation reduces the fre­quency of breath-holding spells. Initially, toddlers with these spells were thought to be anemic, and when they were treated appropriately, their breath-holding spells decreased. However, even children who are not anemic may have fewer breath-holding spells when treated with iron. Therefore, some doctors recommend a daily iron supplement for all children with breath-holding spells.

What are the possible complications?
Children do not die from breath-holding spells. Although the spells look dramatic and many children will turn blue and lose consciousness, breath-holding spells are benign.

Probably the most common complication of a breath-holding spell is injury from passing out. Falling can result in head trauma or a broken limb. A child who is holding something sharp, such as scissors, while having a breath-holding spell can cut herself.

Rarely, a child’s EKG will show long QT syndrome. This heart rhythm abnormality can be associated with a risk of sudden death in both children and adults. Among children with breath-holding spells, long QT syndrome is generally seen when the spells are provoked by excitement, not anger or fright. The best way to rule out long QT syndrome is with an EKG. If it is determined that your child has long QT syndrome, you will likely be referred to a pediatric cardiologist for evaluation. It is important to realize that children with breath-holding spells often have normal EKGs and children without breath-holding spells can have long QT syn­drome.