Breath Holding Spells

INTRODUCTION: Breath holding spells are very common in infants and young children from 6 months to 6 years of age (most common between 1-3 years). These events can be a frightening experience for the parents. These episodes are characterized by brief periods, when the child stops breathing for up to 1 minute and eventually lose their consciousness. These episodes are usually precipitated by anger, frustration, pain etc. These are usually not serious and would not cause permanent damage, and usually will go away on their own as the child grows.

Breathing holding spells are of two major types as mentioned below.


  1. CYANOTIC BREATH-HOLDING SPELLS: This is the most common type and usually occurs in response to anger and frustration. There is usually a brief period of crying, followed by breath-holding, which in turn is followed by loss of muscle tone and loss of consciousness. The child typically turns blue during this episode. If the whole event is prolonged then the child can have seizures.
  2. PALLID BREATH-HOLDING SPELLS: These spells usually follows minor stimulus like frustration at play, scolding by parents or a painful stimuli such as falling, trapping a finger in the door, a minor blow to the head etc. The child typically becomes silent with breath- holding, followed by pallor, brief loss of consciousness and muscle tone. The whole episode would last less than one minute, but the child would be tired and confused for sometime after this event.


The exact reason for these episodes is not clear. These are caused by either a change in the usual breathing pattern (Cyanotic breath-holding spell) or slowing of heart rate (Pallid breath- holding spells). Studies has shown these kids are more common to have Iron deficiency anemia (a condition due to decreased production of red blood cells)


  1. Breath-holding spells are usually diagnosed based on the history of the sequence of events that happened during the spell. Explaining the event in detail (step by step) if witnessed, to the doctor would be of immense help.
  2. Because iron deficiency anemia is common in this type of problem, your doctor might check your child’s blood for complete blood count and iron stores.
  3. If the episodes are prolonged or happening more frequently or if there was seizure associated with these spells then your doctor might do more tests like ECG, EEG etc.

TREATMENT: There is no specific medical treatment for these spells. Breath-holding spells are usually not serious and will go away on their own as the child grows. Treatment with Iron (FERROUS SULPHATE 5-6mg/kg every day by mouth) has shown to decrease the incidence of cyanotic breath-holding spells, even when the child has no anemia. Seizure medications are found NOT HELPFUL in reducing these episodes.

What to do during these spells?

  1. Make sure your child get enough rest and less frustrated.
  2. Try to avoid the triggering events.
  3. Protect your child from injury during these episodes.
  4. More important – STAY CALM
  5. After the episode, reassure the child and make him/her to feel secure.
  6. Remember- these episodes won’t cause any permanent damage to your child.

Author: Dr S Boopathi, MBBS, MD Paediatrics (AIIMS).

Watch the following video to get an idea, how a breath holding episode occurs: