Breath Holding Spells

Dear Lisa,

I have a 2-yr old that frequently holds her breath when she cries. My son used to do the same, but he grew out of it before turning 1. I'm worried that she is still doing this. She doesn't do it every time she cries, but she does it enough to have me worried. She's even passed out due to holding her breath. What can I do?

“Worried Mom in New Jersey”,

Dear “Worried Mom in New Jersey”,

Breath Holding spells are very frightening to watch. As you already know, a child who holds her breath first starts to cry or becomes angry and then appears to hold her breath. In a few seconds the child may turn pale or blue in color and then go limp.(1)

When witnessing a Breath Holding spell, some parents fear that their child may be having a seizure because in some cases the child develops tonic clonic movements similar to a seizure. The difference between a seizure and a Breathing Holding spell is that a child with a Breath Holding spell cries first, holds her breath, turns pale or blue in color and then develops jerking movements. When a child has a seizure, she has seizure activity or jerking of the extremities first and then develops a change in color to pale or blue during or right after the seizure.(1) When a child has a seizure there usually is no obvious precipitating event. A child who holds her breath commonly does this during a tantrum.

Breath Holding spells occur in 5% of children between 6 months and 6 years old.(1) The treatment for Breath Holding is to ignore the behavior. Sometimes the most difficult advice a parent can receive is the instruction to “do nothing”. It would be much easier to just give a child a medication to make her stop this behavior, but unfortunately there is no medicine that stops a child from holding her breath. It should reassure you to know that there are no serious long term effects or damage done due to Breath Holding spells.(1)

Actually, passing out is the best thing that can physiologically happen to a child’s body during a Breath Holding spell. When a child passes out, the body’s natural reflexes keep the child breathing. This ensures that the required amount of oxygen reaches the brain.(2) If a child sees that a parent becomes upset and does whatever that the child wants to prevent the Breath Holding spell, she will continue to carry out this behavior in order to get attention.

The best way to avoid a Breath Holding spell is to avoid situations that lead to a tantrum. If your child tends to have tantrums at the store, leave her at a relative’s or friend’s home when shopping. If this is not an option try other alternatives to keep her occupied at the store. For example, hide a toy or a book in the closet for a few weeks. Then bring it out at the store for her to play with. The introduction of the new toy will entertain her long enough for you to get your job done.

If your daughter tends to have a tantrum or hold her breath when she’s over tired, try to prevent situations where she misses a nap. Just remember that you are older and wiser than she is and you can manipulate the environment to avoid situations that you know will precipitate a tantrum. You also have the ability to keep her environment safe in case she has a Breath Holding Spell and goes limp. Measures such as keeping her away from stairs, covering the sharp corners of furniture and removing hard objects from the area will assure that she will not become injured when she passes out.

There is no reason to be worried that your daughter is still having Breath Holding Spells at the age of two. This is a common age for them to occur. Breath Holding spells tend to be prevalent during the toddler years. You are fortunate that your son outgrew the episodes by the time he was one year old because for many parents this is not the case. All children do outgrow Breath Holding spells by grade school.(1) It should be reassuring to know that this phase in your daughter’s life will come to an end.

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References:
(1)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990: 66-67.
(2)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:213.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Childhood Behavior