What is breath-holding?

Breath-holding spells are brief periods when young children stop breathing for up to 1 minute. These spells often cause a child to faint (lose consciousness). They are usually not a behaviour the child does on purpose.

The most common type of breath-holding spell usually occurs in response to emotions, such as anger or frustration. These spells are caused by a change in your child's usual breathing pattern.

Another type of spell occurs in response to fear, pain, or injury, especially after an unexpected blow to the head. These spells are caused by a slowing of your child's heart rate.

Breath-holding spells can occur in children between 6 months and 6 years of age and are most common from 1 to 3 years of age. How often they happen varies a lot in different children. The spells are usually not serious, do not cause permanent damage or affect a child's future health, and gradually go away on their own over time.

What are the symptoms?

In general, breath-holding spells cause a child to faint. A spell may sometimes cause the muscles to twitch or the body to stiffen. Your child will wake up on their own and start to breathe again normally.

Call 911 or emergency care right away if your child does not start breathing within 1 minute.

Symptoms of spells brought on by emotions like anger or frustration include:

• Red or blue-purple skin colour, especially around the lips.
• A short burst of strong crying that lasts less than 30 seconds.
• Hyperventilating (overbreathing).
• A pause in breathing after exhaling.

Symptoms of spells brought on by fear, pain, or injury include:

• Pale skin colour.
• A single cry or no cry at all.
• Slowing of the heart.
• Sweating.
• Sleepiness or fatigue after the episode.

Some children also have seizures during breath-holding spells. This does not mean they have a seizure disorder. Seizures are different from mild twitching, and they may cause a child to vomit or pass urine. They are more likely to occur in children who have long periods of breath-holding.

What can you do at home?

Home treatment usually is all that is needed for breath-holding spells. You can make breath-holding spells less likely by helping your child get plenty of rest, feel secure, and manage their frustration.

• Have regular rest times and daily routines for your child. And make sure your child gets enough sleep at night.
• Keep your home atmosphere calm, and set an example for your child when it comes to controlling anger.
• Allow your child to make some simple choices, such as which shirt to wear.
• Praise your child when your child learns new tasks, behaves well, or meets your expectations.
• Avoid overprotecting or sheltering your child from the normal frustrations of childhood. Limit unnecessary frustrations, but do not try to remove them all.

Keeping your child safe during a spell

• Lay your child on the floor on their back, facing either upward or to one side.
• Protect your child's head, arms, and legs from hitting something hard or sharp.
• If your child was eating before a spell, open your child's mouth carefully and look for pieces of food, but do not try to remove food with your fingers. Instead, tilt your child's head to the side so the food can come out on its own.
• Touch and talk to your child to help yourself stay calm.
• Time the spell with a watch. Spells usually last only a minute but seem longer.
• Do not give your child any medicines during a spell.
• Allow your child to wake up on their own after a spell.

Call 911 or emergency care right away if your child does not start breathing within 1 minute.

After a breath-holding spell

After a spell happens, reassure and comfort your child. Keep in mind that your child is not doing this on purpose. Make sure all your child's caregivers understand the cause of breath-holding spells and how to manage them.

Talk to your doctor if:

• Spells become more frequent or more severe or change their pattern.
• You have questions or concerns about the spells.