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 tales might sound like amusing anecdotes of little ones in their "terrible two's" phase, but to the parents of these toddlers they're not so funny.

Breath-holding spells can be terrifying for parents. As the name implies, kids hold their breath until they pass out. This phenomenon, which can happen in healthy children between 6 months and 6 years old, is most common around age 2.

Although disturbing to those who witness them, breath-holding spells aren't harmful and pose no serious health risks. A spell typically lasts only a few seconds before a child regains consciousness and resumes breathing normally.

In most cases, breath-holding spells can be predicted and even prevented once triggers are identified, and 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. Parents who have witnessed prior cyanotic spells know exactly when another one is about to occur because the 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 lose consciousness for up to a minute. In the most extreme cases, kids have seizures. Having a seizure does not cause any long-term harm or put a child at risk of developing a seizure disorder.

If Breathing Stops During a Spell

If your child has a breath-holding spell (stops breathing; turns blue, purple, or white in the face; and passes out for 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
• roll your child over onto his or her side
• remove all objects or furniture within reach in case your child has a seizure
• begin administering CPR if your child does not resume breathing

When to See the Doctor

If this is your child's first breath-holding spell, seek medical care. Although breath-holding spells are not harmful, they can sometimes be a sign of an underlying medical condition and should be checked out.

Most spells are a response to strong emotions (like being angry, scared, or frustrated), but some are caused by more serious medical conditions, like a seizure disorder, heart arrhythmia, or iron deficiency anemia. Treating these conditions may help reduce the frequency of breath-holding spells.

Once underlying conditions are ruled out, a doctor can help parents determine what triggers a spell in their child, how to prevent future spells, and how to deal with them if they do happen.

Preventing Future Spells

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

Your doctor can work with you to achieve this delicate balance by helping you find better coping strategies for you and your child. Try not to give in to tantrums and obstinate 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.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: May 2013
Originally reviewed by: Rosemary Casey, MD