Breath-Holding Spells in Children

Causes, Symptoms, Safety, and When Parents Should Worry

Breath-holding spells in children are brief episodes where a child stops breathing, changes color, and may faint after crying, pain, or emotional distress.

Although extremely frightening for parents, these episodes are usually harmless and self-limiting.

Most children outgrow breath-holding spells by 4–5 years of age, and they do not cause brain damage or epilepsy.

This guide explains:

• Why breath-holding happens

• What occurs during an episode

• How to respond safely

• When to seek medical help

• Prevention strategies

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What Are Breath-Holding Spells?

Breath-holding spells are involuntary reflex events, not deliberate behavior.

They commonly occur in children aged:

👉 6 months to 5 years

Episodes are often triggered by:

• Crying

• Frustration

• Anger

• Fear

• Sudden pain

• Minor injury

• Startle or shock

The child briefly stops breathing and may lose consciousness.

Importantly, the child is not doing this intentionally and cannot control it.

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What Happens During a Breath-Holding Spell?

During an episode, you may notice:

• Loud crying followed by silence

• Breath held after exhaling

• Mouth open but no sound

• Skin turning blue, pale, or grey

• Body becoming stiff or limp

• Brief fainting

• Occasional jerky movements

Episodes usually last:

⏳ Less than 60 seconds

Afterwards, the child may appear:

• Sleepy

• Confused

• Tired

Recovery is typically rapid.

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Types of Breath-Holding Spells

Understanding the type helps reassure parents.

1. Cyanotic (Blue) Breath-Holding Spells — Most Common

These occur after:

• Crying

• Tantrums

• Anger or frustration

Features:

• Child cries hard

• Stops breathing

• Turns blue

• May faint briefly

This type is emotion-triggered.

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2. Pallid Breath-Holding Spells (Reflex Anoxic Seizures)

Less common but more dramatic.

Triggered by:

• Sudden fright

• Pain

• Startle

Features:

• Child becomes pale

• Heart rate briefly slows

• Sudden collapse

• Brief unconsciousness

Despite the name, these are not epileptic seizures.

They occur due to a temporary vagal reflex slowing the heart.

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Are Breath-Holding Spells Dangerous?

In most cases:

✔ Harmless
✔ Self-resolving
✔ No brain damage
✔ Not epilepsy
✔ No long-term complications

Although frightening to witness, they rarely cause serious harm.

Children typically grow out of them naturally.

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What Should Parents Do During an Episode?

Stay calm and ensure safety

DO:

✔ Lay child flat on the floor or bed
✔ Turn child to the side
✔ Remove nearby objects
✔ Observe duration
✔ Allow spontaneous recovery

DO NOT:

✘ Shake the child
✘ Put anything in the mouth
✘ Splash water
✘ Panic

The spell will usually stop on its own within seconds.

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When Should You See a Doctor?

Medical evaluation is recommended if:

🚨 First episode
🚨 Spells occur frequently
🚨 Episodes last longer than 1 minute
🚨 Injury occurs during fainting
🚨 Child has delayed development
🚨 Family history of seizures or heart disease
🚨 Occurs without crying or trigger

Always seek advice if you feel unsure.

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Causes and Risk Factors

Breath-holding spells are linked to:

• Immature nervous system reflexes

• Emotional sensitivity

• Temperament

• Fatigue

• Hunger

Important medical association:

👉 Iron deficiency anemia

Low iron levels increase frequency and severity.

Many children improve significantly after iron supplementation.

Your pediatrician may recommend:

• Blood tests

• Iron therapy if deficient

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Is There Any Treatment?

There is no specific medication for breath-holding spells.

Management focuses on:

Medical

✔ Check iron levels
✔ Treat anemia

Behavioral

✔ Consistent parenting
✔ Calm discipline
✔ Structured routine
✔ Avoid reinforcing tantrums

Most children outgrow spells without intervention.

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Preventing Future Spells

You cannot completely prevent episodes, but you can reduce triggers.

Helpful strategies

✔ Regular meals and sleep
✔ Avoid overtiredness
✔ Stay calm during tantrums
✔ Set consistent boundaries
✔ Teach emotional expression
✔ Provide reassurance

As children mature emotionally, spells usually disappear.

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Quick Parent Action Plan

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Key Takeaways

✔ Breath-holding spells are common in toddlers
✔ Not intentional behavior
✔ Not epilepsy
✔ Usually harmless
✔ Most children outgrow by age 5
✔ Iron deficiency should be checked

With reassurance and proper care, these episodes become less frequent over time.

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FAQ 

Are breath-holding spells dangerous?

No. They are usually harmless and self-limiting.

Can my child stop breathing permanently?

No. Breathing resumes automatically.

Are these seizures?

No. They are reflex events, not epilepsy.

Should iron be checked?

Yes. Iron deficiency is commonly associated.

When do children outgrow them?

Typically by 4–5 years.

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Dr. Hala Mashhood
Consultant Pediatrician
Article reviewed 2026