Breath-Holding Spells in Children: What Parents Need to Know. Dr. Narmin Azizova

If your child suddenly stops breathing while crying, turns pale or blue, and even loses consciousness in some cases, they may be experiencing a breath-holding spell. Although alarming for parents, these episodes are generally harmless and do not indicate serious health problems. Breath-holding spells affect approximately 1 in 20 children and typically occur between 6 months and 6 years of age, with the highest prevalence between 1 and 3 years.

What Is Breath-Holding Spells?

Breath-holding spells are involuntary episodes triggered by strong emotions such as pain, fear, anger, or frustration. They can also occur after minor injuries, such as falling backward or hitting the head. During an episode, the child starts crying, takes a deep breath, and then stops breathing momentarily. As a result, they may turn blue (cyanotic spell) or pale (pallid spell). The lips are often the first to change color. In some cases, children momentarily lose consciousness or experience muscle stiffening and brief twitching, which can resemble a seizure.

Fortunately, these episodes usually last less than a minute, after which the child resumes normal breathing and recovers completely. Although distressing to witness, breath-holding spells do not cause brain damage or long-term harm.

Causes of Breath-Holding Spells

Breath-holding spells are primarily linked to genetic predisposition. Studies indicate that around 20-25% of affected children have a family history of similar episodes. Additionally, research suggests that iron deficiency anemia is a contributing factor. Children who are breastfed for extended periods without sufficient iron supplementation, consume excessive tea, or have diets low in iron-rich foods are more prone to experiencing these episodes. According to the World Health Organization (WHO), iron deficiency affects 30-40% of children worldwide and can contribute to various developmental and behavioral concerns.

Diagnosis

There is no specific test to diagnose breath-holding spells. However, doctors can confirm the condition based on a detailed description of the episodes or video recordings provided by parents. Blood tests, particularly iron level assessments, are recommended to check for iron deficiency. Studies have shown that iron supplementation significantly reduces the frequency and severity of breath-holding spells.

Treatment and Management

The management of breath-holding spells largely depends on their frequency and severity. In many cases, no medical treatment is required, as children naturally outgrow the condition by the age of 3 to 6 years. However, addressing iron deficiency with iron supplements can be highly effective. Research published in the Journal of Pediatric Neurology (2019) confirms that treating iron-deficiency anemia can reduce the occurrence of breath-holding spells by up to 50%.

What Parents Should and Should Not Do During an Episode: ✅ Stay calm – Although distressing, panicking can make the situation worse. ✅ Ensure a safe environment – If your child loses consciousness, lay them on their side to prevent injury. ✅ Observe the episode – Most spells resolve on their own within a minute. ❌ Do not shake, slap, or try to force your child to breathe – This can cause more harm. ❌ Do not put water on their face or place objects in their mouth – These actions are unnecessary and can be dangerous.

If a breath-holding spell lasts more than one minute or occurs very frequently, seek medical advice. In rare cases, prolonged episodes may require neurological evaluation to rule out conditions such as epilepsy.

Breath-Holding Spells vs. Epileptic Seizures

Although breath-holding spells can resemble seizures, they have distinct differences. Unlike epilepsy, breath-holding spells always occur after a triggering event (such as crying, frustration, or pain). Additionally, children with breath-holding spells recover quickly and do not experience post-seizure confusion or drowsiness.

Conclusion

Breath-holding spells are a common and benign condition affecting about 4-5% of children worldwide (American Academy of Pediatrics, 2020). While these episodes can be frightening, they do not cause long-term harm or neurological damage. Studies indicate that iron supplementation significantly reduces the frequency of spells, making it a key aspect of management. If your child experiences recurrent episodes, a pediatric evaluation is recommended to rule out underlying medical conditions.

Understanding breath-holding spells can help parents manage them effectively and reduce unnecessary worry. Remember, children do not hold their breath on purpose, and they should never be punished for these involuntary episodes. With time, most children naturally outgrow breath-holding spells without any lasting effects.

Narmin Azizova, the founder of Pediatriya.az