Pediatrics | Published February 28, 2019

Ask the pediatrician: Breath-holding spells

Hi Dr. Collison,

My four-year-old son can become very upset or frustrated when he does not get his way. It has gotten to the point where he passes out because he is so upset. Is this normal? What can I do to keep this from happening?

It sounds like your son is experiencing a breath-holding spell. A breath-holding spell is an involuntary reflex that occurs when a child stops breathing. This condition is most common in toddlers ages one to three, but can affect children up to six years of age.

The most common type of breath holding is called a cyanotic spell. A situation causes the child to become upset, such as when they are being disciplined, and he or she cannot bring himself or herself to take a breath. In some cases, this will cause the child to pass out. Once the child passes out, their breathing returns to normal. Another type of breath-holding spell is called a pallid spell. This is when a child’s heart rate slows down, which is often caused by pain. Again, the child may pass out.

Breath-holding spells can be especially scary for parents because their child’s skin may turn blue or purple, specifically around the lips. Other signs include muscle twitches or seizures. The best way you can help your son during an episode is to stay calm. If he shows signs of passing out, lay him on the floor so that he doesn’t hit his head if he falls. Also, make sure he doesn’t have anything in his mouth (like food) that could pose a choking hazard. Once he wakes up, reassure him that he is safe.

The good news is that most children outgrow breath-holding spells and they do not cause any lasting side effects. If your son continues to experience breath-holding spells, make an appointment with his pediatrician to make sure the episodes aren’t related to anything more serious like seizure disorders. His pediatrician can also help identify triggers so that you can find ways to deal with situations that won’t cause additional breath-holding spells.

 If he passes out and does not start breathing within one minute, call 911 immediately.