Breath holding spell Health Article

Definition

A breath holding spell is an involuntary pause in breathing, sometimes accompanied by loss of consciousness. It usually occurs in response to an upsetting or surprising situation.

Causes, incidence, and risk factors

Breath holding is seen in some normal children from as early as age 2 months, but can start as late as 2 years old. Severe spells can be seen in 4 - 5% of children. Most cases have stopped by the time a child reaches ages 6 - 8.

Breath holding spells appear to be a reflexive response to fear, a confrontational situation, a traumatic event (for example: pain), or to being startled. The sudden reaction can cause the nervous system to slow the heart rate or breathing temporarily, causing breath holding and color changes.

Breath holding spells can run in families, so if a child's parents had similar spells in childhood, the child may be more likely to have spells. They also can occur with genetic conditions, such as Riley-Day syndrome or Rett syndrome. Children with iron deficiency anemia may also have increased episodes of breath holding.

Symptoms

• Bluish discoloration of the skin caused by lack of oxygen (cyanosis) or loss of skin color (pallor)
• Crying and then stopping breathing (apnea)
• Momentary unconsciousness or fainting
• Short seizure-like movement (one to two jerks)

After being startled or becoming upset, the child may make a short gasp and then exhale and stop breathing. Then the child quickly becomes blue (cyanotic) and may have many jerky movements that look like a small seizure.

The event ends with a brief period of unconsciousness, at which time normal breathing restarts. The child's color improves with the first breath and the event ends. The child may repeat this behavior several times per day, or do it only on rare occasions.

Breath holding can be a frightening experience for parents, who may think it is a seizure or even cardiac arrest. After a doctor has diagnosed the child with breath holding spells, the parent can simply wait for the event's natural end.