Child Neurology New York

When Your Child Has Breath-Holding Spells

The Problem:
Breath holding spells are quite common in small children. About 5-10% of all young children have them at least once.
Typically these events are precipitated by a frustrating event: being hurt or frightened, or getting angry or upset.
They usually start between 6 months and 2 years of age and disappear by the age of 4-5 years.
They may be infrequent, occurring occasionally 1-2 times per month, to multiple times per day from even minor provoking frustration.
Breath holding spell are not dangerous and have nothing to do with epilepsy.

How it Looks:
The spell is typically triggered by crying after an upsetting event. Then the child suddenly exhales deeply, then stops crying and at the same time holds his breath until his lips and then the whole face becomes bluish. Usually that breath holding lasts for several seconds (never longer than a minute), on top of which he may (or may not) pass out, fall down, or return to the baseline. One third of those kids who do pass out do also get a few symmetrical muscle twitches or jerks, mostly in the arms. After the spell, the child becomes fully alert, however can be quieter than prior to the spell.

What to Do During the Spell:

  • Stay calm and observant: time the event with a second hand, since your subjective perception of time can double or triple while watching your child looking so distressed.
  • If the spell lasts past 10 seconds, position the child flat to increase blood flow to the head. You may apply a cold wet washcloth on the forehead.
  • Do not resuscitate! Do not put anything in the child's mouth: it could cause choking or vomiting.
What to do After the Spell:
  • A relaxed and as a matter of fact attitude is the best. Give the child a brief hug and go about your business.
  • Don't show the child that you are frightened or overly concerned.
Prevention of Spells:
  • Breath holding spells are harmless and stop by themselves.
  • If your child had a temper tantrum before the spell because he wanted his way, don't give in to him. That will encourage the spells to change from sporadic to learned behavior.
  • If your child has multiple daily spells, he probably learned to trigger them. In this case, discourage him from doing so by as firm and calm an attitude as possible.
RED FLAGS:

  • Duration longer than one minute (>50-60 seconds) timed by the clock.
  • The child becomes pale rather than bluish.
  • The spell is not triggered by frustration or pain.
  • Jerking is noted in one limb only, or one side is involved more than the other.
  • Jerking precedes holding of the breath or follows immediately after.