About breath-holding spells

Breath-holding usually happens when babies or children:

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

Children cry, then catch their breath and ‘hold’ it without breathing. They don’t do it on purpose – even if it looks like they’re holding their breath as part of an extreme tantrum.

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

Breath-holding spells can happen as often as several times a day, or as rarely as once a year.

Children as young as six months can have breath-holding spells, but breath-holding is most common in children aged 1-2 years. Around 90% of children stop doing it by the time they’re six years old.

Some cases of breath-holding are associated with iron deficiency anaemia. Your GP can do a simple blood test to work out whether this is the cause in your child’s case.

It’s natural to feel scared and even panic the first time your child has a breath-holding spell – especially if you’ve never heard of breath-holding before. It might help to know that breath-holding doesn’t cause long-term damage or have any harmful effects on the brain.

What to do during breath-holding spells

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

  • Stay calm. The spell is likely to pass within a minute.
  • Lay your child on his side and watch over him until the spell ends.
  • Don’t put anything in your child’s mouth, not even your fingers to clear the airway. If your child starts having jerky movements, you can hold her head, arms or legs to prevent injury or move away items that could hurt her.
  • Don’t shake your baby or child. This won’t stop the breath-holding and can cause injuries.
  • Reassure other children or adults present that it’s 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.
  • Once your child has recovered, don’t punish or reward him or make a big fuss.

Seek medical attention the first time your child has a breath-holding incident. Your health professional will check to make sure that your child does not have a more serious condition.

When to see a doctor about breath-holding

You should consult a doctor about breath-holding if your child:

  • is younger than six months
  • has spells more than once a week – these might be caused by anaemia
  • suddenly starts breath-holding
  • looks confused or drowsy after breath-holding
  • becomes very pale or loses consciousness
  • has shaking and stiffness lasting for 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 breath-holding:

  • Try distracting your child in situations where she might have a breath-holding spell.
  • Give your child plenty of warning if you need to make a change to a different activity or situation. This means he won’t get too much of a fright when things change.
  • Learn more about managing tantrums, if this is what seems to trigger your child’s breath-holding spells.
  • Reassure your child after she’s had a fright or a shock.
  • Try to avoid your child becoming too hungry or overtired.
  • Help older children learn to recognise emotions like frustration. If your child can recognise and manage these emotions, it might stop them turning into the anger or fear that triggers breath-holding.

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.

Some children have jerky movements or a seizure, but this is very rare.

My daughter was a breath-holder. Our paediatrician talked to us about what to do if she didn’t start breathing again – things like knowing how to do first aid.
– Mandy, mother of a two-year-old