Crucial Points About Breath-Holding Spells in Infants

    Updated 14 April 2020 |
    Published 10 June 2019
    Fact Checked
    Reviewed by Tanya Tantry, MD, Obstetrician & Gynecologist, Medical Consultant at Flo
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    If you’re the kind of parent who checks your baby’s breathing while he or she is asleep, then breath-holding can be a particularly frightening experience. Join Flo to learn what this common condition is, how to recognize it, and how to treat it, and the steps you can take to help prevent it.

    What are breath-holding spells?

    Breath-holding spells (benign paroxysmal nonepileptic disorder) are episodes in which a child cries because he is hurt, frightened, or upset, then turns pale or blue and loses consciousness. The episodes typically last no longer than a minute, and estimates suggest that almost 5% of the pediatric population may demonstrate such episodes, which occur in healthy children between 6 months and 4 years of age.

    It’s not uncommon for parents to worry about their baby’s breathing, and many will regularly check an infant during the night to make sure that all is well. Even if you’re not that type of parent, breath-holding can cause a lot of anxiety. Despite this, breath-holding is a common condition and usually isn’t a cause for concern. If you’re facing this issue with your child, the best way to deal with it is to be educated.

    Breath-holding spells: causes

    In infants and children who are affected by this condition, breath-holding spells occur after frustration, anger, or pain lead to inconsolable crying. Some children experience only occasional episodes of breath-holding, while for others it may occur daily or more often. There also appears to be a familial element to this condition. If you or your relatives had similar experiences in early life, your baby may be more prone to it as well.

    In some cases, breath-holding is linked to iron deficiency anemia. This condition causes a reduction in the number of red blood cells in circulation, which can result in tiredness, shortness of breath, and heart palpitations. If your baby’s breath-holding spells don’t follow intense crying or emotional upset, they are likely the result of iron deficiency.

    Breath-holding spells usually begin between 6 to 18 months and resolve by 4 to 5 years old; however, in some people, they begin earlier or last into adulthood. These spells are involuntary, so your child cannot do anything to control them. Although they are upsetting to watch, they are harmless and are followed by a complete recovery. They affect up to 1 in 20 children and both boys and girls experience the condition equally.

    Breath-holding spells: symptoms 

    There are 2 types of breath-holding spells:

    • Pallid: child becomes extremely pale
    • Cyanotic: child turns a blue color, especially around the lips (the most common, representing around 85% of cases)

    You may notice your baby becoming increasingly hysterical and be unable to calm him or her. Later, your infant will start to hyperventilate — this is when the rate of breathing becomes abnormally high. At this stage, the skin of the lips or other parts of the body may become cyanosed as a result of inadequate oxygen supply to these tissues. When this happens, you’ll see the skin turn blue or blue-gray.

    In some cases, an infant will lose consciousness at this point, and their body may stiffen or twitch while in this state. This can understandably be very alarming for parents or other bystanders, but fortunately, the episodes pass quickly without negative after-effects. Typically, the unconsciousness that results from a breath-holding incident lasts less than a minute and is followed shortly afterwards by a complete recovery.

    Breath-holding spells: diagnosis 

    While a breath-holding episode may look like a seizure, there are no seizure discharges seen on the electroencephalogram (EEG) recording of the brain. Therefore, a child experiencing an episode does not need to be treated with seizure medication.

    Episodes lasting only a minute do not require you to perform CPR on the baby or child. In the rare event that the child does not breathe after 3 minutes, then CPR should be started.

    It's important that you seek expert medical advice after the first occasion of a breath-holding spell. Your baby's pediatrician will conduct a thorough examination to look for any evidence of a more serious underlying condition.  Your doctor may want to perform an ECG to check for an irregular heartbeat. And if there is any suspicion that iron deficiency is to blame for these episodes, a blood test can easily determine if this is the case.

    Breath-holding spells: treatment

    The natural tendency is to pick the child up when they start to experience a breath-holding spell, but holding the child upright may actually prolong the event. Just as with fainting, keeping the head down restores blood flow to the brain.

    If iron deficiency is determined to be the cause of the condition, your doctor will recommend iron supplements for your child. Otherwise, treatment of breath-holding usually consists of nothing more than educating parents and/or caregivers, and reassuring the baby or child.

    Breath-holding spells: prevention

    Breath-holding can be a stressful experience for parents, but try to remember that in addition to being ultimately harmless, there are a number of helpful measures you can take until your baby grows out of this phase in their life.

    You will quickly realize that it’s far better to avoid getting to the point of a breath-holding spell than to deal with one after it has fully developed. With this in mind, be aware of your baby’s triggers. Remember that breath-holding results from becoming uncontrollably upset, so do what you can to avoid your child experiencing unusual frustration, anger, or pain.

    Being well rested is critical for your baby. Infants and children are far better able to cope with negative emotions when they have had adequate sleep — and this means that they are substantially less likely to descend into the kind of emotional meltdown that may trigger breath-holding. Establish a consistent sleep schedule and make sure you factor naps into your baby’s routine.

    Hunger and dropping blood sugar levels can also precipitate temper tantrums and emotional upset. Plan a consistent schedule of meals and snacks that keep your baby well fuelled throughout the day and less vulnerable to crankiness. And if you’re away from home, make sure that it doesn’t disrupt your infant’s sleep and diet.

    Child psychology plays a big part in how well you deal with breath-holding spells. It's important to develop effective methods for calming your baby when he or she becomes upset so it does not escalate into breath-holding. For instance, keep favorite toys or activities on hand for use during such a situation. If nothing else is available, remember that a reassuring hug and some gentle rocking may be all that is needed.

    As a final note, be alert to your bundle of joy using breath-holding to manipulate you or your partner! Once a child realizes the impact breath-holding has on their parents, it’s very common for them to start using it as a bargaining chip when they can’t get what they want. If you’re very clear with your baby that this won’t result in any special treatment, they’ll quickly abandon the tactic.

    History of updates

    Current version (14 April 2020)

    Reviewed by Tanya Tantry, MD, Obstetrician & Gynecologist, Medical Consultant at Flo

    Published (10 June 2019)

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