Clinical Reference Systems: Pediatric Advisor 10.0
- A child is suddenly injured, frustrated, angry, or
frightened, makes one or two cries and then holds his
breath in expiration until he becomes blue around the
lips and passes out.
- Most children stiffen and some may have a few twitches or
- The child breathes normally again and becomes fully alert
in less than 1 minute.
Breath-holding spells begin between the ages of 6 months and
2 years. They occur only while the child is awake.
An abnormal reflex allows 5% of normal children to hold
their breath long enough to pass out. Most children do not
do this deliberately.
Holding the breath (when frustrated) and becoming bluish
without passing out is such a common reaction in young
infants that it is not considered abnormal.
Breath-holding spells usually occur from one or two times a
day to one or two times a month. Children usually stop
having breath-holding spells by the time they are 4 or
5 years old.
Breath-holding spells are not dangerous, and they don't lead
to epilepsy or brain damage.
- Treatment during attacks of breath-holding
These attacks are harmless and always stop by
themselves. Time the length of a few attacks, using a
watch with a second hand.
During an attack, do not hold your child upright.
Instead, he should lie flat. This position will
increase blood flow to the brain and may prevent some of
the muscle jerking. Put a cold wet washcloth on your
child's forehead until he starts breathing again. Don't
start resuscitation or call a rescue squad--it's not
necessary. Also, don't put anything in your child's
mouth because it could make him choke or vomit.
- Treatment after attacks of breath-holding
Give your child a brief hug and go about your business.
A relaxed attitude is best. If you are frightened,
don't let your child know it. If your child had a
temper tantrum because he wanted his way, don't give in
to him after the attack.
- Prevention of breath-holding spells
Most attacks from falling down or a sudden fright can't
be prevented. Neither can most attacks that are
triggered by anger. However, some children can be
distracted from their breath-holding if you intervene
before they become blue. Tell your child to come to you
for a hug or to look at something interesting. Ask him
if he wants a drink of juice.
If your child is having attacks every day, he probably
has learned to trigger some of the attacks himself.
This can happen when parents run to the child and pick
him up every time he starts to cry, or when they give
him his way as soon as the attack is over. Avoid these
responses and your child won't have an undue number of
- Prevention of injuries
The main injury risk of a breath-holding spell is
a head injury. If your child starts to have an attack
while standing near a hard surface, go to him quickly and
help lower him to the floor.
Call Your Child's Physician During Office Hours If:
- More than one spell occurs each week.
- The attacks change.
- You have other concerns or questions.
Caution: Call a rescue squad (911) if your child has a
different kind of attack during which he stops breathing for
more than 1 minute or turns white (not blue).