Breath-holding Spell

Is this your child's symptom?

• A spell that involves holding the breath, then turning blue and passing out
• Breath-holding spells were diagnosed by your child's doctor

Symptoms of a Breath-Holding Spell

• An upsetting event happens right before the spell. A common trigger is being angry about parents setting limits (temper tantrums). Another is getting scared. Some spells are triggered by a sudden injury, such as falling down.
• The child gives out 1 or 2 long cries
• Then holds his breath until the lips and face become bluish
• Then passes out and falls to the floor
• Then often becomes stiff. May also have a few muscle jerks.
• Normal breathing starts again in less than 1 minute. Becomes fully alert in less than 2 minutes.
• Only happens when child is awake, never when asleep

Cause

• A reflex response to strong feelings. This reflex allows some children to hold their breath long enough to pass out. Spells do not happen on purpose.
• This happens in 5% of healthy children. Breath-holding spells can run in families.
• Starts between 6 months and 2 years of age. Goes away by age 6.
• Many young children hold their breath when upset, turn blue, but don't pass out. This is common and normal.
• Frequent spells can happen in children who have anemia (low red blood count). This can happen if your child doesn't eat enough foods with iron. If your child is a picky eater, your doctor may order a blood test.

When to Call for Breath-holding Spell

Call 911 Now

• Breathing stopped for more than 1 minute and hasn't returned
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Age less than 6 months old
• Passed out more than 2 minutes by the clock and normal breathing now
• First breath-holding spell
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor During Office Hours

• Never been checked by a doctor for the spells
• Spells happen without a reason (no triggers)
• Muscle jerks during spell
• Picky eater (especially for meats)
• Lots of tantrums trigger the spells
• Spells happen more than once a week
• You think your child needs to be seen, but the problem is not urgent
• You have other questions or concerns

Self Care at Home

• Normal breath-holding spell

Care Advice for Breath-holding Spells

What You Should Know About Breath-Holding Spells:

• While breath-holding spells are scary for parents, they are harmless.
• Normal breathing always returns on its own.
• The spells don't lead to seizures (epilepsy).
• Here is some care advice that should help.

Lie Down:

• During the spell, have your child lie down.
• This will increase blood flow to the brain.
• Remove any food from his mouth.
• Do not hold your child upright. It decreases blood flow to the brain. This could cause some jerking of body muscles.

Cold Washcloth to Forehead:

• Put a cold, wet washcloth on your child's forehead. Keep it on until he or she starts breathing again.
• That's the only care your child needs.

Time the Length of Not Breathing:

• These spells always seem to last longer than they really do.
• Time the length of a few spells. Use a watch with a second hand.
• Breathing almost always returns by 60 seconds.
• It's hard to guess at the length of a spell and get it right.

Stay Calm:

• Don't start mouth-to-mouth breathing. Don't call 911.
• Don't put anything in your child's mouth. It could cause choking or vomiting.
• Never shake your baby. It can cause bleeding in the brain.

Don't Give In After the Spell:

• Some breath-holding spells start with a temper tantrum. Example: your child wanted something and you said "No." Don't give in to your child before or after the attack.
• After spells, give your child a brief hug and go about your normal routine.

What to Expect:

• Spells happen from 1 or 2 times a day to 1 or 2 times a month.
• Kids outgrow them by age 6.

Call Your Doctor If:

• Spells become more frequent
• Spells change
• You think your child needs to be seen
• Your child becomes worse

Remember! Contact your doctor if you or your child develop any "Contact Your Doctor" symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 05/06/2025

Last Revised: 01/25/2025

Copyright 2000-2025 Schmitt Pediatric Guidelines LLC.