What parents should know about breath-holding spells in children

Breath-holding spells are episodes where a child involuntarily stops breathing, usually after a strong emotion such as anger, frustration, pain, or fear. They can cause the child to turn pale or blue, lose consciousness, or even have a seizure. They are not harmful, but they can be very scary for parents and caregivers.

Breath-holding spells typically occur in children between 6 months and 6 years of age, with the peak incidence around 2 years. They affect about 5% of healthy children, and are more common in boys than girls. They can happen multiple times a day or very rarely, depending on the child and the trigger.

What parents should know about breath-holding spells in children
What parents should know about breath-holding spells in children

There are two types of breath-holding spells: cyanotic and pallid. Cyanotic spells are more common and are usually triggered by anger or frustration. The child may cry or scream, exhale deeply, and then hold their breath until they turn blue, especially around the lips. They may also become rigid or limp, and briefly lose consciousness. They usually recover quickly, but may feel drowsy or upset for a while.

Pallid spells are less common and are usually triggered by pain or fear. The child may lose consciousness and turn pale, without crying or screaming. They may also have a slow heart rate, low blood pressure, and dilated pupils. They may have stiff limbs, lose bladder or bowel control, or have body jerks that resemble a seizure. They usually recover within a minute, but may be pale and sweaty for some time.

What causes breath-holding spells?

Breath-holding spells are not intentional or manipulative. They are an involuntary reflex that happens when the child’s nervous system reacts to a strong emotion or stimulus. The exact mechanism is not fully understood, but it may involve a temporary imbalance in the oxygen and carbon dioxide levels in the blood, or a disruption in the signals between the brain and the heart.

Some children may have a genetic predisposition to breath-holding spells, as they tend to run in families. They may also be more likely to occur in children who have iron deficiency anemia, a condition where the blood does not have enough red blood cells to carry oxygen. However, breath-holding spells are not a sign of a serious medical problem, and do not cause brain damage or developmental delay.

How to respond to breath-holding spells?

The most important thing to do when a child has a breath-holding spell is to stay calm and reassure them. Do not panic or shake the child, as this may worsen the situation. Instead, follow these steps:

  • Lay the child on their back or side, with their head slightly lower than their body. This will help blood flow to the brain and prevent choking.
  • Check the child’s airway, breathing, and pulse. If they are not breathing or have no pulse, start CPR and call for emergency help.
  • If the child is breathing and has a pulse, wait for them to regain consciousness. Do not give them anything to eat or drink until they are fully alert.
  • After the spell, comfort the child and check for any injuries. If the child had a seizure, they may be confused or sleepy for a while.
  • Keep a record of the spell, including the date, time, duration, trigger, and symptoms. This will help the doctor diagnose and manage the condition.

How to prevent breath-holding spells?

Breath-holding spells cannot be completely prevented, but there are some strategies that may reduce their frequency and severity. These include:

  • Treating any underlying medical conditions, such as iron deficiency anemia, that may contribute to breath-holding spells. The doctor may prescribe iron supplements or other medications to correct the problem.
  • Avoiding or minimizing the triggers that cause breath-holding spells, such as pain, fear, or frustration. This may involve using positive reinforcement, distraction, or relaxation techniques to help the child cope with stressful situations.
  • Teaching the child to express their emotions in healthy ways, such as talking, drawing, or playing. This may help them vent their feelings and prevent them from holding their breath.
  • Seeking professional help if the child has frequent or severe breath-holding spells, or if they interfere with their daily activities. The doctor may refer the child to a specialist, such as a neurologist, a psychologist, or a speech therapist, for further evaluation and treatment.

What are the long-term effects of breath-holding spells?

Breath-holding spells are not harmful in the long term, and most children outgrow them by the time they are 6 years old. They do not affect the child’s intelligence, behavior, or personality. However, they can be very distressing for the child and the parents, and may affect their quality of life. Therefore, it is important to seek medical advice and support if the child has breath-holding spells, and to follow the recommended management plan.

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