Watching a baby stop breathing, turn pale or blue, and start twitching can be one of the most frightening moments a parent can experience. Yet, for many families, this exact situation has a name: a breath-holding spell. While dramatic and distressing, these episodes are generally benign and resolve on their own within seconds or minutes.
What is a breath-holding spell?
A breath-holding spell is an involuntary episode where a child, typically between six months and four years old, momentarily stops breathing, usually in response to intense emotion such as anger, frustration, pain, or fear. During the spell, the child may cry out, hold their breath, turn blue or pale, and even lose consciousness. Some children twitch or stiffen briefly before spontaneously recovering.
There are two main types of breath-holding spells: cyanotic and pallid. Cyanotic spells, the most common form, follow crying or temper tantrums. Pallid spells are more likely after a sudden shock or minor injury and often involve a temporary slowing of the heart.
How common are these episodes?
Breath-holding spells affect approximately 5% of healthy children, with the highest frequency between six months and two years. They tend to diminish in severity and frequency as the child grows older and are usually outgrown entirely by the age of 5 or 6.
These episodes are not seizures, and they are not under the child’s conscious control. Despite how alarming they may appear, breath-holding spells do not cause brain damage and do not increase the risk of sudden infant death syndrome (SIDS).
What causes breath-holding spells?
The exact cause remains unclear, but researchers believe a temporary disruption in the autonomic nervous system, which controls involuntary body functions like heart rate and breathing, plays a role. In pallid breath-holding spells, a brief drop in heart rate can trigger loss of consciousness. Cyanotic spells are thought to stem from a reflexive breath-holding during crying.
Some studies have explored a potential link with iron deficiency. A 2017 study found that iron supplementation significantly reduced the frequency of breath-holding spells in children with low serum ferritin levels. This suggests iron plays a role in modulating the autonomic nervous system response.
How are they diagnosed?
Diagnosis is primarily clinical, based on a detailed description of the event. Paediatricians usually ask about the child’s age, what happened just before the spell, and whether there was any loss of consciousness, twitching, or unusual movements. A key detail is that these episodes often follow a predictable trigger such as a tantrum or a sudden scare.
If the child experiences twitching or stiffening, doctors may conduct further tests to rule out epilepsy or cardiac conditions. Electroencephalograms (EEGs) and electrocardiograms (ECGs) are sometimes used to differentiate breath-holding spells from more serious neurological or heart-related problems.
What should parents do during a spell?
- Stay calm and ensure the child is in a safe position. The best thing to do is to place the child on their side on a soft surface and remove anything nearby that could cause injury. Avoid shaking or slapping them, which can do more harm than good.
- Observe the duration and symptoms. Most spells last less than one minute. Note whether the child loses consciousness, changes colour, or twitches, and how long it takes for them to recover. This information is vital for your paediatrician.
- Seek medical advice if it’s the first time or if spells change in pattern. Doctors will want to rule out other conditions, especially if the episode involves prolonged unconsciousness, confusion after recovery, or no obvious trigger.
Can anything be done to prevent them?
In many cases, no treatment is needed. However, if spells are frequent or severe, iron levels may be tested, and supplements may be prescribed. In the study mentioned earlier, children who received iron therapy had a marked reduction in the frequency of breath-holding spells within two months.
Parents can also try to reduce triggers by avoiding situations that lead to tantrums or frustration. Establishing routines, giving the child choices to reduce resistance, and maintaining a calm environment may help. However, it’s also important not to overreact to spells or give in to demands just to avoid an episode, as this can reinforce difficult behaviour.
When is it something more serious?
While most breath-holding spells are harmless, a few red flags require further investigation. These include spells that occur without any clear trigger, last more than a minute, or result in prolonged confusion or disorientation afterwards. If there is a family history of seizures, fainting, or cardiac problems, this should also be discussed with your GP.
One 2019 study emphasised the importance of distinguishing breath-holding spells from epileptic seizures and syncope (fainting) due to heart conditions. Children with abnormal ECGs or unexplained spells may be referred to a paediatric cardiologist or neurologist for further assessment.
What is the long-term outlook?
The vast majority of children outgrow breath-holding spells by the time they enter primary school. There is no evidence that these spells lead to developmental delays, behavioural issues, or chronic health problems. Most children develop normally and do not require ongoing treatment or intervention.
While the episodes are distressing, understanding what they are — and more importantly, what they are not — can give parents reassurance. A child who appears lifeless for a few seconds can understandably cause panic, but with the right information and medical support, families can manage these spells confidently and safely.
Layla Townsend is a freelance child health writer based in Leeds.
This article was written by Layla Townsend from www.psychreg.org
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