Breath-holding Spells in Infants & Young Children
What are Breath-holding Spells?
Breath-holding spells are one of the most terrifying events a parent can witness. Believe me, I have a former breath-holder and I am surprised I came through that phase with my sanity still intact. Just as the name suggests, children who are breath-holders hold their breath , most often until they pass out. This does not mean that there is something more serious going on with with your child, it happens in perfectly healthy children and is equally prevalent in males and females. This phenomenon, which can begin as early as 6 months and last up until age 5 or 6, is most common in 2 year olds. It also quite often has a genetic link in most families. My sister was a breath-holder and her eldest son was as well. Many people have the perception that children who are breath-holders are spoiled or lacking discipline. Although unruly children may have breath-holding spells, it is more than likely something a child has no control over. My son's first episode was ironically the day he turned 6 months old. I'm assuming at that age he was not trying to manipulate me or "get his own way". In any event, I will never forget the experience.
Everything was calm and peaceful, we were having a typical "mommy and new baby" day. My son was not long up from his afternoon nap and I was holding him in my arms because as he was doing his favorite thing, breast-feeding. It wasn't until I brought him up to my shoulder to burp him that I noticed he was "different". He took in a breath of protest I assume, but he didn't let that gasp back out, it was "stuck", nothing was happening, he looked terrified and his color was slowly turning blue and then he went limp in my arms- I was freaking out to say the least. I laid him down on his back on the couch so I wouldn't give in to panic and do something stupid like shake him (never shake an infant). I then immediately called his Dad and started yelling hysterically that he wasn't breathing, I was crying and panicked and not making much sense, I had no idea of what I should do. Out of confusion and desperation, I began gently rocking his body back and forth by placing my hand on his chest and he suddenly responded. This whole episode which seemed to last forever was probably only a minute long tops. It was horrifying! I wasn't long getting him to the emergency room.
At the emergency room I was assured that although disturbing to witness, breath-holding spells were not harmful and did not pose any serious health risks. A spell typically lasts only a few seconds before a child regains consciousness and resumes breathing normally. The doctor assured me that the "passing out" part was actually a good thing because once this happens, the brain get a signal that says "okay, breathe now". This was great news to hear, yet it provided no comfort or ability to lessen the horror of what I had just witnessed. I prayed to God that this was an isolated incident and that I would never have to witness something like this ever again. It wasn't! This continued, pretty much on a weekly basis until he turned 4 years old. What did change was the severity of the breath-holding spells, he went from having color changes to passing out to having both of those types plus being passed out long enough to have a mild seizure, in which his body would stiffen and his eyes roll back. He had the fourth type of breathing-holding spells referred to as Complicated breath-holding spells. (I guess he felt the colic he had in the first three months wasn't enough to rattle Mommy) I never did get used to the breath-holding, nor was I able to be "okay" with it and not worry when it was happening. I was sure every time that it happened that "they" were wrong and there was something seriously wrong with my child. Then just like that, the episodes ended and life went back to normal.
Types of Breath-holding Spells
- The most common type of breath-holding is called Simple breath-holding spell, it is characterized by holding the breath in during the end expiration. The most common triggers for this type of spell is usually frustration or an injury which causes the temporary cessation of breathing during the end expiration. There is no major change in circulation or amount of oxygen and recovery is quick and spontaneous.
- The second type of breath-holding spell is called Cyanotic breath-holding spells. The are usually brought on by anger, frustration or an injury or painful experience. The child cries and has forced expiration. This can sometimes lead to cyanosis(blue in color), loss of muscle tone and even loss of consciousness. The child usually recovers from these episodes fairly quickly, although some children will require rest and some may even fall asleep for awhile afterwards (an hour or so). EEGs are normal in these children and there is no relationship to the development of seizures or cerebral injury as a result of these types of spells.
- The third type is called Pallid breath-holding spells and are less common and more unpredictable because they happen after a child has gotten a sudden fright or startle (like being surprised from behind or suddenly hearing a loud noise). They can also occur as a result of a painful event. The difference with this type is the child turns pale (as opposed to blue) and passes out with little to no crying at all. The child is usually recovered and alert within a minute or so. The child is also likely to have a stronger tendency towards syncope (fainting) in adulthood with this type of breath-holding in childhood.
- The fourth and final type of breath-holding is called Complicated breath-holding spells. It is basically a more severe form of the two most common types. It typically begins as a cyanotic or pallidspell but ends with the child having a seizure like episode. EEGs in these children when not having an episode also are generally normal.
What To Do If Breathing Stops
- remain calm and check your childs mouth for food or any other object that may pose a choking hazard when they regain consciousness
- check the childs immediate surroundings for any danger in the event that a seizure may occur, remove any objects which may cause harm to your child
- roll your child over onto his/her side
- in the event that breathing does not resume in a timely manner, call 911 and begin CPR while you wait for help to arrive
Although breath-holding spells are not harmful, they can sometimes be a sign of an underlying medical condition and should be checked out.
Most spells are a response to strong emotions (like being angry, scared, or frustrated), but some are caused by more serious medical conditions, like a seizure disorder, heart arrhythmia or iron deficiency anemia.
Treating these conditions may help reduce the frequency of breath-holding spells.The diagnosis of a breath holding spell is made clinically. A good history including the sequence of events help to make an accurate diagnosis. Some families are advised to make a video recording of the events to aid diagnosis. Easier said than done unless you have nerves of steel. I didn't manage to get my sons episodes recorded even once over a four year period.
Once underlying conditions are ruled out, a doctor can help parents determine what triggers a spell in their child, how to prevent future spells, and how to deal with them if they do happen. Although very terrifying and upsetting to watch you will begin to notice a pattern of when these are most likely to occur in your child. It is important to carry on as normal after an incident as children will quickly catch on if these spells give them special treatment, this may increase the frequency of breath-holding spells. It is also important to not fear being firm or discipline your child to avoid a breath-holding spell, children learn quickly and can be very manipulative. If you have a breath-holder take comfort that they will grow out of it eventually and most likely your nerves and sanity will still be intact. Good luck.