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
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