Breath-Holding Spells In Children

Breath-Holding Spells, Pediatric

Breath-holding spells (BHS) are when your child holds his or her breath and stops breathing. Your child is not doing this on purpose. BHS may happen in response to fear, anger, pain, or being startled. There are two kinds of BHS:
• Cyanotic. This is when your child turns blue in the face. This usually happens when your child is upset. This form of BHS is more common and easier to predict.
• Pallid. This is when your child turns pale in the face. This can happen when your child is surprised, so it is harder to predict and less common.
Although BHS can be scary for you to watch, it is not dangerous for your child. Most children outgrow it.

RISK FACTORS
Risk factors for BHS include:
• Family history

This causes otherwise healthy children to hold their breath long enough to change color and sometimes pass out when they are startled or upset.

SIGNS AND SYMPTOMS
BHS often occur in this pattern:
• Something triggers the spell, such as being scolded or startled.
• Your child may begin to cry. After a few cries or prolonged crying, your child can become silent and stops breathing.
• Your child’s skin becomes blue or pale.
• Your child passes out and falls down.
• Sometimes there is brief twitching, jerking or stiffening of the muscles.
• Your child shortly wakes up and may be a bit drowsy for a moment.
Mild spells may end before your child passes out.

DIAGNOSIS
BHS may be diagnosed by medical history and physical exam. Your child may also have other tests, such as:
• EKG. This checks to see if your child has a heart condition.
• Blood tests.
• EEG. This checks to see if your child has a seizure disorder.

TREATMENT
Your child may need treatment for BHS only if it is caused by an underlying cause. This may include iron supplements, if your child has an iron deficiency. Your child's health care provider will also help you know the steps to take when your child has

This may include:
○ Acting calm during the spell. Your child can pick up on your anxiety and may become more frightened if he or she senses tha you are afraid.
○ Helping your child lie down during the spell. This helps prevent head injuries and shortness the spell. Do not hold your child upright during a spell.
○ Placing your child on his or her side if he or she loses consciousness. This helps your child avoid breathing in food or secretions. If a spell occurs while eating and an airway is blocked, the airway must be cleared.
○ Putting a damp, cool washcloth on your child’s forehead until he or she starts breathing again.
○ Reassuring your child once the spell is over.
• Learn what triggers your child’s spells and try to avoid those triggers. However, do not allow BHS to prevent you from normal discipline and limit setting.
• Give medicines, including supplements, only as directed by your child's health care provider.

SEEK MEDICAL CARE IF:
• Your child’s BHS are getting worse or more frequent.
• Your child’s BHS change.

SEEK IMMEDIATE MEDICAL CARE