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About Breath-Holding Spells

Many of us have heard stories about stubborn or willful toddlers who hold their breath until they turn blue in the face. These might sound like amusing "terrible twos" tales, but they're not funny to the parents of these toddlers. Breath-holding spells can be terrifying for parents because kids often hold their breath until they pass out.

But these spells aren't intentional — they're an involuntary reflex, which means kids have no control over them. Although they're upsetting to watch, breath-holding spells aren't harmful and pose no serious health risks. A spell typically lasts less than a minute before a child starts breathing normally again.

Breath-holding spells can happen in healthy children between 6 months and 6 years old, but are most common during the second year of life. They can be more common in kids with a family history of them.

In most cases, breath-holding spells can be predicted and even prevented once triggers are identified. Kids usually outgrow them by age 5 or 6.

Types of Breath-Holding Spells

Breath-holding spells differ by cause and characteristics:

• Cyanotic breath-holding spells happen when a child stops breathing and turns blue in the face. These spells are often triggered by something that upsets the child, like being disciplined. While crying, the child exhales (breathes out) and then doesn't take another breath in for a while. Parents who have witnessed prior cyanotic spells know exactly when another one is about to happen because their child's face slowly turns a shade of blue, ranging from light blue to almost purple.
• Pallid breath-holding spells are less common and more unpredictable because they happen after a child has gotten a sudden fright or startle (like being surprised from behind). Unlike with cyanotic spells, kids turn very pale, almost white, during the spell.

Both types of spells cause kids to stop breathing and sometimes lose consciousness for up to a minute. In the most extreme cases, kids might have seizures. Having a seizure does not cause any long-term harm or put a child at risk of developing a seizure disorder.

If a Child Passes Out During a Spell

Most of the time, you don't need to do anything during a breath-holding spell. Your child should stay lying down until the spell is over.

If your child passes out for a brief time, stay calm and:

• check your child's mouth for food or any object that could pose a choking hazard once your child regains consciousness
• remove all objects or furniture within reach in case your child has a seizure

Kids with breath-holding spells usually start breathing within a minute.

Call 911 if your child remains blue or is not breathing for longer than a minute.

When to See the Doctor

If this is your child's first breath-holding spell, get medical care. Although breath-holding spells aren't harmful, it's good to get your child checked out. A doctor can determine whether it was in fact a breath-holding spell or another medical condition that looks like one.

These spells are an involuntary response to strong emotions (like being angry, scared, or frustrated) and tend to happen in healthy children. Because they're involuntary (not done on purpose), they're not a behavioral problem. A doctor can help parents understand what triggers a spell in their child, how to prevent future spells, and how to deal with them if they do happen.

Sometimes, iron deficiency anemia might cause kids to have breath-holding spells. So a doctor might do a blood test to check for anemia. Treating the anemia may help reduce the number of the spells.

Preventing Future Spells

Once kids mature and develop better coping skills, they usually outgrow breath-holding spells. But in the meantime, parents can face a challenge greater than witnessing the spells themselves: finding ways to discipline their child that won't trigger another spell.

Your doctor can work with you to help you find coping strategies for you and your child. Try not to give in to tantrums and stubborn behavior — young kids need limits and guidelines to help them stay safe and become well-adjusted emotionally.

With experience, courage, and your doctor's help, you can learn to cope with breath-holding spells while providing a safe and structured environment until your child outgrows them.