Breath-holding

Breath-holding usually happens when babies or children:

• are crying
• are frightened or upset
• have had a minor accident and have gone into shock.

These children will cry, then catch their breath and ‘hold’ it without breathing. This is not done on purpose – even if it seems that children are holding their breath as part of an extreme tantrum.

Scary as they are, breath-holding spells usually end within 30-60 seconds, when children catch their breath and start to cry or scream. In some cases, children will hold their breath until they lose conciousness. When this happens, the body automatically kick-starts breathing again.

Some cases of breath-holding are associated with iron deficiency anaemia. Your GP can do a simple blood test to determine whether this is a likely cause.

Children as young as six months can have breath-holding spells. Around 90% of children stop doing it by the time they’re six. The spells can happen as often as several times a day, or as rarely as once a year.

What to do when children hold their breath

Follow these tips to help children through breath-holding spells.

• Stay calm. The spell is likely to pass within a minute.
• Lay child on the side and watch over until the spell ends.
• Do not put anything in the child’s mouth, not even your fingers to clear the airway. If the child starts having jerky movements, you can hold the child’s head, arms or legs to prevent injury.
• Don’t shake the baby or child. This won’t stop the breath-holding and can cause injuries.
• Reassure other children or adults present that it is a harmless spell and will pass soon.
• Sometimes children might fall and hurt themselves during the spell. If you think this has happened, it’s best to check with a doctor.

When to see a doctor

Also consult a doctor if your child:

• is younger than six months
• has frequent attacks (more than once a week). Ask whether anaemia might be a cause. If it is, ask about the possibility of using iron supplements
• looks confused or drowsy after the breath-holding
• has shaking and stiffness lasting for much longer than a minute, and takes a while to recover. This might not be simple breath-holding.

Preventing breath-holding

You can’t prevent breath-holding, but you might be able to prevent the events leading up to it.

• When children start to get upset, try to distract them.
• Reassure children after they’ve had a fright or a shock.
• Give children plenty of warning if you need to make a change to a different or new activity or situation. This means they won’t get too much of a fright when things change.
• Learn more about managing tantrums. You might be tempted to give in to your child during a tantrum, because you are worried the tantrum will cause breath-holding. But giving in to tantrums often causes more tantrums.

The two types of breath-holding

Cyanotic breath-holding (or ‘blue spells’) is the most common type of breath-holding. Children who are affected:

• cry or get upset
• catch and hold their breath and then turn a bluey-purple colour, particularly around the mouth.

Pallid or pale breath-holding (or ‘pale spells’) is less common than cyanotic. Children:

• might not be crying
• catch and hold their breath – their heart rate slows down and their skin can look pale
• sweat and are tired when the spell is over
• who have these spells might also faint as adolescents or adults. 

During both types of breath-holding, some children pass out. Once they do their breathing kick-starts again. Some children have jerky movements or a seizure, but this is very rare.

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