What is a breath-holding spell?
A breath-holding spell is an event in which a
child stops breathing for a short time. These
spells can cause a child to pass out (lose
consciousness). Breath-holding spells often
happen when a young child is angry or
afraid. These spells can happen right after a
minor accident, a painful event or when
Breath-holding spells are often part of a
toddler temper tantrum. The spells are not
intentional behavior on the child’s part. The
spell is a reflex reaction to something
unpleasant to the child.
Why do these spells occur?
Breath-holding spells occur in 5% of
otherwise healthy children. They can occur
in children between 6 months and 6 years of
age. They are most common from 1 to 3
years of age. Breath-holding spells vary in
how often they happen and how severe they
are. Some children have them once a year
while others may have several spells within
one day. Often parents who have seen one
breath-holding spell can predict when
another is going to happen.
Breath-holding spells are most often not
serious, do not cause permanent damage, or
affect a child’s future health. They slowly
go away on their own.
Are there different types of breath-
holding spells and symptoms?
There are two types of breath-holding spells.
Cyanotic or “blue” spells are the most
common type. These start with a short burst
of vigorous crying after anger, frustration,
pain, or fear. Sometimes there is
hyperventilating. This is followed by a
pause in breathing after breathing out
(exhaling). The face begins to turn red
followed by turning blue, especially around
the lips. This lasts only a short time and the
child often goes limp and passes out. The
spell may sometimes cause the muscles to
twitch or the body to stiffen. After a few
seconds, breathing starts up again and the
skin color returns to normal. The child
regains consciousness soon after.
Pallid or “pale” spells are the less common
type. These spells follow a painful event,
such as falling and bumping the head or
being suddenly startled. The child opens the
mouth as if to cry but nothing comes out.
The child stops breathing, becomes very
pale, passes out, and becomes limp. The
heart rate slows down during these spells.
In longer spells, the child can arch the back
and become stiff. After the spell, the heart
rate speeds up again, breathing restarts, and
consciousness returns. The child may
recover quickly or may be drowsy and sleep
for awhile after the spell.
Some children have both cyanotic and pallid
spells at one time or another in their lives.
What causes breath-holding spells?
Breath-holding spells are caused by a
change in the usual breathing pattern or a
slowing of the heart rate. These are brought
on by pain or strong emotions.
In some children, breath-holding spells may
be related to iron deficiency anemia. This is
a condition in which the body does not make
a normal number of red blood cells.
Sometimes there is a history of these spells
in the family.
How are breath-holding spells diagnosed?
Breath-holding spells are usually diagnosed
after the doctor hears a report of the
symptoms. Recording the symptoms and
describing them accurately will help with
the diagnosis. If your doctor thinks the child
might have a seizure disorder, anemia, or
heart irregularity, tests may be done. Some
children will have a brain wave test (EEG)
done to evaluate for seizures. Not all
children with breath-holding spells need a
brain wave test done. A blood test to check
for anemia might be done.
How are breath-holding spells treated?
Unless a doctor decides there is a health
problem causing the spells, there is no
medical treatment for them.
During a breath-holding spell, protect the
child from injury. Lay the child on the side
and watch. Do not hold the child upright
and do not shake the child or put anything in
the mouth. Do not splash water on the child.
Breath-holding spells will stop on their own,
often within a minute or less. The child will
catch their breath and start to cry or scream.
Seizures rarely happen with breath-holding
spells. There is no increased risk of the
child later developing seizures from these
After the spell is over treat the child
normally. Do not punish the child’s
These spells can be frightening, but parents
should treat the child as normally as
possible. Do not treat the child differently
from other children. Help your child to feel
safe. Make sure your child gets plenty of
rest. Try to reduce his or her frustration, but
allow normal childhood activities. When
possible, use distraction to avoid temper
Where can I get more information about
American Academy of Pediatrics
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright 8/2017. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Clinical Nutrition Services Department and the
Department of Nursing. HF#7290