Holding one's breath episodes: Classifications, origins, and deterrents
Breath holding spells (BHS) in children are involuntary episodes typically triggered by emotional upset or pain, characterized by a child holding their breath leading to changes in color and sometimes loss of consciousness. These spells are common among children aged 6 months to 6 years.
Causes
Emotional triggers such as frustration, anger, fear, or pain often provoke BHS. Rarely, BHS can be mistaken for or coexist with neurological issues such as atypical seizures or epilepsy. Faulty parenting, stressful family environment, and other behavioral disorders can contribute indirectly to episodes.
Types
There are two main types of BHS: cyanotic (blue) and pallid.
- Cyanotic BHS are the most common. They are triggered by fright, pain, or anger. A child may cry or scream, exhale forcefully, then hold their breath, causing cyanosis (blue discoloration). The child may lose consciousness briefly.
- Pallid BHS are triggered often by sudden fright or injury. They are characterized by pallor due to decreased heart rate and reduced cerebral blood flow, which may lead to brief loss of consciousness or fainting.
Recommended Caregiver Responses
Episodes appear frightening but are generally benign and self-limited. Caregivers should stay calm, prevent injury by cushioning the child if they fall during a spell, and not shake or intervene aggressively. Because BHS may mimic seizures, seek medical evaluation including EEG if spells are atypical or prolonged.
Some children with BHS have iron deficiency. Supplementation may reduce frequency, but caregivers should talk with a doctor before giving a child supplements. Provide emotional support, avoiding harsh punishment or negative reactions that could provoke spells. Consult a healthcare provider for reassurance, potential treatment, and ruling out serious conditions.
Additional Information
BHS may be associated with certain genetic syndromes, such as 16p11.2 microdeletion syndrome and Riley-Day syndrome. Actions that are not helpful to a child having a BHS include reprimanding them, shaking them, or splashing them with water, and performing CPR.
Breath holding spells are most common between 6 months and 6 years of age. They should become less frequent as a child matures, although some people may experience fainting episodes in adolescence. Most children have their first BHS before 18 months. Breath holding children may be more likely to faint as adolescents and possibly as adults.
Caregivers should consult a doctor in the following circumstances: the child is younger than 6 months, spells happen more than once per week, breath holding begins suddenly, the child looks confused and excessively drowsy after holding their breath, the child shakes and goes rigid for longer than 1 minute, and they take a while to recover, the child falls and hits their head during a spell, or if a child has a BHS for the first time.
Breath holding spells are similar to sleep apnea. They can occur as part of a pattern or as a one-off. Caregivers should remain vigilant and seek medical advice if concerned.
- A caregiver may consider discussing mental-health strategies with a healthcare provider, as emotional upsets such as frustration, anger, fear, or pain are common triggers for breath holding spells (BHS) in children and could potentially benefit from health-and-wellness interventions.
- Despite the concern-provoking nature of BHS, it is crucial for caregivers to refrain from administering CPR, as Pfizer studies on resuscitation techniques have shown that CPR is not an effective treatment for BHS.
- In the event that a child with breath holding spells displays signs of neurological issues, such as atypical seizures or epilepsy, it is essential for caregivers to seek a comprehensive evaluation, including science-based tests like EEG, to ensure the child's mental and physical health are protected.
