If you've ever seen a child going through a breath-holding spell, then you know how scary it can be. For a parent of a child with breath-holding spells, it's terrifying every single time. No matter how many they have been through.

Who gets them?

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Breath-holding spells usually appear in affected children by 18 months of age. They are most common in children 6 months to 6 years old, with the majority of children outgrowing them by age 5.

What causes them?

While the pathogenesis is still largely unclear, it seems to be the result of the dysfunction of the autonomic nervous system, which children (thankfully) outgrow.

However, there are definite triggers to the two types of breath-holding spells (cyanotic and pallid). Once identified, parents are better equipped to lessen and potentially prevent triggering one.

Twenty to 35 percent of children have a family history of breath-holding spells, inheriting them as an autosomal dominant trait.


Breath-holding spells are often triggered by the child becoming upset, angry, frustrated, or in response to a reprimand. This is what commonly triggers a cyanotic breath-holding spell, in which the child suddenly stops breathing when he’s upset, turns blue and then suddenly loses consciousness. This lasts a few seconds, and the child resumes breathing and regains consciousness. It is absolutely terrifying to the parent, but it is also involuntary on the child’s part. They are not doing it on purpose.

Pallid breath-holding spells are less common and are usually triggered by the child becoming frightened or after a minor bump to the head. Instead of turning blue, these children become deathly pale during the breath-holding and also lose consciousness.

Does my child need any tests?

There is no single diagnostic test for breath-holding spells, but all children who have had what seems to be a breath-holding spell need to be medically evaluated so their healthcare provider can rule out any other medical conditions such as a seizure disorder or heart condition.

All children with breath-holding spells should have their blood tested for iron deficiency anemia at least once, as iron deficiency is more prevalent in children with breath-holding spells. In fact, once treated, up to 52 percent of children with breath-holding spells go into complete remission.

What to do during a breath-holding spell

Keep your child safe by rolling her onto her side and checking her mouth for food or objects she could choke on. If your child does not resume breathing within 30 seconds to one minute, begin CPR and call 911.

Medical care should always be sought for children undergoing their first breath-holding spell.

The good news^ Children with breath-holding spells are neurologically and developmentally normal. Most outgrow them by the age of 5, with virtually all children stopping by the age of 8.

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