Breath-Holding Spells

What are Breath-Holding Spells?

Breath-Holding Spells may occur when a young child involuntarily “holds” his/her
breath, resulting in a blue, gray or pale color of the face and body. It may occasionally
be followed by fainting and a brief period of unconsciousness.

What Causes a Breath-Holding Spell?

Typically, a child between the ages of 6 months to 6 years will become emotionally
upset, resulting in a prolonged inspiration and a subsequent “holding” of his/her
breath (cyanotic spell). In some circumstances, a child may be surprised, excited,
angered or frightened and may lose consciousness rapidly (pallid spell). It is hypothesized
that the child loses consciousness due to a lack of cerebral blood flow from stimulation
of the vagus nerve.

What are the symptoms of Breath-Holding Spells?

In addition to the color changes and occasional loss of consciousness, children
may rarely have a brief seizure after they faint. These seizures will resolve on
their own very quickly. Fortunately, the children begin breathing again spontaneously
after they lose consciousness.

How are Breath-Holding Spells Diagnosed?

These spells are usually diagnosed by history alone. Your health care provider may
choose to evaluate your child’s heart with an electrocardiogram (ECG) or look for
an underlying seizure disorder with an electroencephalogram (EEG). There is no relationship
between these spells and epilepsy.

How are Breath-Holding Spells Treated?

The spells self-resolve as your child gets older. Parents, family members, child
care providers and teachers should be aware of the possibility of a breath-holding
spell. In the event that your child begins to “hold” his/her breath, caretakers
should recognize the possibility of fainting and work to keep the child safe. It
is not recommended that caretakers “give in” to the child’s requests or wants just
to avoid a spell. Parents may wish to consult with their health care provider or
a trained therapist to explore effective behavior modification techniques.

Anticonvulsant medications are not effective in this condition. Atropine has been
studied as a potential medication, but the side effects make this medication an
unlikely choice. If your child has gastroesophageal reflux, your health care provider
may choose to treat this condition more aggressively in order to minimize stimulation
of the vagus nerve.

Parents should be taught how to respond and treat a seizure in the event that it
should happen in association with a Breath-Holding Spell. They should activate their
local emergency medical system (e.g. Call 911) if their child loses consciousness
for greater than 1 minute.

What are the Complications of a Breath-Holding Spell?

These spells will not harm your child as long as proper safety precautions are met
to avoid trauma during a fall to the ground. There are no known long-term effects.
You may want to talk to a therapist if you find yourself avoiding discipline for
fear of inducing a spell.


Schmitt BD. Instructions for Pediatric Patients. Philadelphia: WB Saunders 1992

Avery ME, Pediatric Medicine, Williams and Wilkins, 1989

Reviewed by: Dan Feiten MD

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