Breath Holding In Babies And Children

Overview

A breath-holding spell is when a child briefly stops breathing after crying or being upset. It can make them look blue or pale and pass out for a few seconds. It's not dangerous and children usually outgrow it.

Yes. Breath-holding spells affect about 5 percent of otherwise healthy children under age 6.

They usually start between 6 months and 2 years of age and can continue until around age 5. Boys and girls are affected equally.

Symptoms

Common symptoms

• The spell almost always follows a strong emotion like anger, frustration, shock, or pain.
• After crying for a short time, the child may go quiet, stop breathing, and turn blue around the lips.
• The child may become limp and pass out for a few seconds.
• Within 30 seconds, breathing restarts and the child quickly looks normal again.

Causes

Main causes

• A reflex that causes the nervous system to briefly 'pause' breathing in reaction to strong emotion or pain.
• The automatic nervous system is still immature in young children, leading to an exaggerated response to stress.
• A low iron level (iron deficiency) may trigger breath-holding spells in some children.

Risk factors

• A family history of breath-holding spells.
• Iron deficiency anemia (low iron stores in the blood).
• A child with a quick-tempered or strong-willed temperament.

When to see a doctor

See a doctor urgently if:

• If the episode lasts longer than 30 seconds without breathing.
• If the child turns blue and does not recover (does not start breathing and does not respond).
• If the child has a seizure that lasts more than a minute.
• If it happens after a head injury or after taking any medication.

Book a routine appointment if:

• If the spells are new and you have not spoken to a healthcare provider yet.
• If the episodes happen several times per week.
• If you have any concerns about your child's development or behavior.

Diagnosis

A doctor will usually diagnose breath-holding spells by asking about exactly what happened before and during the episode, and by examining your child. The doctor will want to know if the child turned blue or pale, how long the episode lasted, and how the child recovered.

Tests that may be done

• Usually no tests are needed.
• Sometimes a blood test to check for iron deficiency (anemia).
• If the doctor has any doubt, an ECG (electrocardiogram) to check the heart.
• Rarely, an EEG (electroencephalogram) to check brain waves if seizures are suspected.

What to expect at your appointment

Seeing a doctor can confirm that the frightening episodes are healthy breath-holding spells and not something more serious. The doctor will give you reassurance and practical advice.

Treatment

There is no cure needed for breath-holding spells. Treatment focuses on keeping your child safe during an episode and reducing the triggers that start one. If iron deficiency is found, your doctor may suggest iron supplements.

Self-care at home

• During a spell, lay the child on their side and make sure the area is safe. Do not put anything in their mouth.
• Do not shake, slap, or pour water on the child – it doesn't help and could be harmful.
• Stay calm. After the spell, give a brief cuddle and then return to your normal routine so the child doesn't learn that the spell brings a special reward.
• Try to avoid situations that commonly trigger spells, such as overtiredness, hunger, or battles over bedtimes and treats.

Medical treatments

If blood tests show low iron (iron deficiency), your doctor may recommend iron therapy, usually in the form of a liquid or tablet prescribed just for your child. In very rare, severe cases, a specialist might consider medication to stop the reflex, but this is not needed for the great majority of children. Medicines are always used only under the guidance of your healthcare provider.

Living with this condition

Breath-holding spells do not require any restriction on your child's normal activities. They can play, go to school, and socialise like any other child. Most parents find the hardest part is watching their child's colour change, but it's helpful to know that these spells end on their own.

Lifestyle tips

• Keep a consistent sleep schedule to avoid tiredness.
• Teach simple ways to handle strong feelings, like using words for frustration.
• Have a calm, predictable home routine to reduce stress.

Diet and exercise

Give your child a healthy, balanced diet with iron-rich foods such as lean meat, beans, dark leafy greens, and iron-fortified cereals. Regular active play is also good for overall health and emotional wellbeing.

Mental health and emotional wellbeing

Parents and caregivers may feel anxious, frightened, or even embarrassed when a spell happens in public. This is very normal. Remember that the spell is not harmful and will pass. If anxiety about the spells or about your child is taking over, talk to your GP or a health professional.

Prevention

There is no guaranteed way to stop breath-holding spells, but you may be able to reduce how often they happen by noticing your child’s early signs of upset and distracting or calming them before frustration peaks.

Complications

If left untreated

• Children who have breath-holding spells are otherwise healthy, and not treating them does not cause health problems.
• If a child is misdiagnosed and actually has a heart or neurological condition, then delayed diagnosis could be more serious – which is why it's always worth asking a doctor.

Long-term outlook

The outlook is excellent. The vast majority of children outgrow breath-holding spells by the time they start school. The spells do not affect intelligence, behaviour, or later health. With simple reassurance and management, you and your child can ride out this short phase.

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