Breath holding Spells: what to do when your toddler has one

Breath-holding Spells:

What to do when your child has one.

A friend called me with a typical story that sounds like this, “my toddler gets angry and turns blue then passes out.” She said, “why does she keep doing that?”

I replied, “I think it sounds like a breath-holding spell.”

What it is?

This is a spell where a child has a brief period of crying, typically followed by holding their breath (in forced expiration), turning blue and then passing out (goes limp and loses consciousness)

They are common between ages 6 months and 6 years. Most children have their first spell before 18 months of age and outgrow it between ages 5 to 8 years.

These events are usually occur after being upset or scared or suddenly injured

They happen only when awake.

A typical cycle is- child gets upset, lets out a loud cry, holds their breath, turns blue, & then passes out. The duration of passing out lasts less than 1 minute and your child typically breathes and acts normally within 2minutes of the event.

Most children can have 1-6 spells a week.

Is it a seizure?

No, it may mimic a seizure but it is not.

Children with breath-holding seizures also don’t have the post-ictal phase associated with seizures (phase of sleepiness or tiredness that occurs after a seizure).

They do not lead to epilepsy or brain damage.

Unless there are other underlying problems, these children develop normally.

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What causes it?

An abnormal pain and emotion reflex causes this. About 5% of normal children to involuntarily hold their breath and make their heart rate slow down.

Blood flow to their brain decreases long enough to trigger a brain activity that causes them to pass out. It does not damage their brain.

It is important to know that they have no control over them.

Chances of a child having these spells is also increased if a family member had it

How is it diagnosed

Breath-holding spells are diagnosed based on the history and description of the event.

In some cases evaluation such as ECG (EKG) to rule out any heart rhythym abnormalities and/or EEG maybe done to rule out seizures (if history isn’t clear enough).

How to prevent them?

Behavior coaching: Since most are due to anger, and tantrums, behavior coaching may help

Iron deficiency anemia is more prevalent in children with breath-holding spells. So Iron supplements may help prevent them if your child is anemic.

Ask your Pediatrician to consider checking Iron levels.

What to do if your child has one?

During the episode:

– Stay calm even if you are scared

– Safety: Make sure your child is in a safe environment

– Position: Place them on the side, helps normal blood flow. Don’t lift them by force. Allow them to recover.

– Never put anything in their mouth (no food, water or medications too)

After the episode,

-Calm and console your child with a hug

– If it was due to a tantrum, don’t change your decision due to the spell. Being firm and consistent helps them learn rules too.

– Be sure to follow up with yout doctor to be sure it’s a breath holding spell and nothing else