It is not considered abnormal when frustrated infants hold their breath and actually become bluish without passing out. However, some young children can trigger this response long enough to eventually pass out.

Those parents who have experienced these episodes with their children say it can be scary—especially when seen for the first time—but you can look for specific characteristics to give you the reassurance that all is well. Consider the following to help you evaluate a true “breath-holding episode.”

Characteristics of a Breath-Holding Spell

  • The child gives out one or two long cries.
  • The spell is preceded by a frustrating event.
  • At the end of exhaling, breath is held until lips become bluish.
  • The child passes out or may stiffen, and some may even twitch or have muscle jerking.
  • Normal breathing resumes in less than one minute followed by being fully alert.
  • Spells occur only when child is awake.
  • Onset of spells occurs between 6 months and 2 years of age.
  • Attacks occur from one to two times per day to one to two times a month.
  • Episodes usually end by 4 or 5 years of age.

Actions a Parent Can Take during These Spells

  • Remain calm; safety is the main issue for the child.
  • During the attack, protect the child and have her lie flat.
  • Apply a cold, wet washcloth to the child’s forehead until he starts breathing again.
  • Be sure to time the length of a few attacks, in seconds, since it is difficult to estimate.
  • Give your child a brief hug afterward and go about your business, especially if the spell was preceded by a temper tantrum. Do not give in to demands.
  • Make a list of all the behavior or events that seem to trigger these spells.

When a Parent Should Seek Medical Advice

  • Call 911 immediately if the breath-holding spell lasts longer than one minute or if the child is struggling for each breath and unable to speak or cry. Begin mouth-to-mouth breathing until EMS arrives or child begins to breathe again.
  • Talk with the pediatrician or have child seen within one hour:
    • if this is the first witnessed spell
    • after a spell has ended and the child is still not fully alert after two minutes
    • if the child was unconscious for longer than two minutes, but is now alert and breathing normally
  • Call the pediatrician’s office the next day:
    • if there were muscle jerks during the spell and jerking has not occurred before
    • if the child has had spells before but has never been seen by a physician for the issue, especially if the child is a picky eater
    • if the child has greater than one spell per week

This article was written by Marilyn Perry, RN, BSN, MS, a nurse on the Children’s Direct Physician Access Line at St. Louis Children’s Hospital.


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