What do I do if my child has a breath-holding spell?

Breath-Holding is common in young children, and scary to witness as a parent - learn how to best respond to these frightening spells.

It can be extremely distressing to witness your child holding their breath – but these spells are actually common in young children and are generally not harmful.

The cause of breath-holding is not known. It is usually involuntary and is caused by a slowing of the heart rate or changes in your child’s usual breathing patterns for a few seconds, often brought on by strong emotions such as anger, fear, pain, or frustration.

Most children who have breath-holding spells will have their first spell before they are 18 months old and usually grow out of breath-holding by the age of six. Children who breath-hold can have multiple spells every week, and in some cases, every day.

There are 2 types of breath-holding spells – blue spells and pale spells.

Blue spells (also referred to as cyanotic breath-holding) are the most common. They occur when a child hurts themselves or becomes very frustrated. The child will cry or scream, followed by a forceful exhale of breath, and then breath-holding. They will turn blue – especially around the lips – which lasts a few seconds. They may even become floppy and lose consciousness.

Although this is scary to watch, no treatment is needed. There is no need to splash your child with cold water or blow air in their face. No long-term damage is done due to the brief period with reduced blood oxygen levels.

Pale spells (also referred to as pallid breath-holding) are less common. They occur after a minor injury or when a child is upset, and are the result of a slow heart rate. The child will open their mouth as if to cry, but with no sound. They will faint and appear very pale, followed by a brief period where their arms and legs may become stiff, or they lose control of their bladder/bowel. Because of these symptoms, these breath-holding spells are sometimes mistaken for a seizure.

Again, no treatment is needed and your child will start breathing and recover by themselves.

When your child is having a spell, lay them on their side and monitor them. Remove objects from around your child to prevent injury. Do not put anything in their mouth, including your fingers.

Once the spell has subsided, your child may be drowsy and sleep for a short time.

Seek medical attention if you a worried for any reason, or if your child;

Knocked their head or injured themselves during the breath-holding spell
Seems confused or drowsy for a prolonged period of time after the spell
Has muscle twitching or a fit
Has breath-holding spells more than once a day or several times a week
Your child has a complicated breath-holding spell (follow your action plan from your child’s doctor)

Once your child has recovered, it is important to act normally. Don’t punish them or make a fuss, just treat your child as normal like nothing happened. If your child holds their breath as a part of a tantrum, distraction may be a good form of prevention.

In some children, breath-holding spells may be related to iron-deficiency anaemia, so your doctor may want to check your child’s iron levels.

For further reading and learning, check out our LIVE on breath-holding spells, or visit The Royal Children’s Hospital Melbourne Fact Sheet on Breath-Holding Spells.