Breath-Holding Spells in Babies and Toddlers: What Every Parent Should Know
Having a doula by your side during the time you give delivery could be the very thing that makes the difference in how your birth experience will go
Few things are more terrifying for a parent than seeing their child suddenly stop breathing, turn blue or pale, and possibly lose consciousness — all within a matter of seconds. But if this happens during or immediately after a tantrum, bump, or burst of crying, your child may be experiencing a breath-holding spell — a surprisingly common and usually harmless event in young children. I know the first time it happened with my newborn it took less than three minutes to throw our other two kids in the car and head to the hospital, we relieved to find out she was okay. Here is some extremely important things you may want to know incase your child experiences the same thing.
In this article, we’ll take a deep dive into what breath-holding spells are, what causes them, how to tell them apart from more serious conditions, and how you can respond effectively and confidently.
1. What Are Breath-Holding Spells?
Breath-holding spells (BHS) are brief episodes where a child stops breathing, often in response to emotional stress, frustration, pain, or fear. These are involuntary events, meaning the child does not have control over them and is not “holding their breath on purpose” to get attention.
They typically begin between the ages of 6 months and 2 years, with most cases resolving by age 5 or 6. While they can be distressing to witness, breath-holding spells are usually harmless and don’t pose long-term risks.
2. Types of Breath-Holding Spells
There are three main types of breath-holding spells, each with distinct features:
1. Cyanotic Breath-Holding Spells (Most Common)
Trigger: Emotional upset (crying, frustration, anger)
Symptoms:
The child cries vigorously, then stops breathing while exhaling
Turns blue or purple, especially around the lips and face
May go limp or briefly lose consciousness
Cause: Thought to be related to a sudden disruption of breathing and oxygen flow during intense crying
2. Pallid Breath-Holding Spells
Trigger: Sudden pain, fear, or minor injury (like a bump on the head)
Symptoms:
The child may gasp or cry briefly, then suddenly turns pale or white
Quickly loses consciousness, may have a brief limp or stiff posture
Cause: Often linked to an overreaction of the vagus nerve, which slows the heart rate temporarily
3. Mixed Spells
These involve features of both cyanotic and pallid spells and are less common.
3. What Happens During a Spell?
A typical breath-holding spell follows a predictable pattern:
Trigger (emotional stress or pain)
Crying or startling
Breath-holding, often at the end of exhalation
Change in skin color (blue or pale)
Loss of consciousness (in some cases)
Quick recovery, usually within 30 to 60 seconds
Some children may have brief muscle stiffening or twitching, which can resemble a seizure — but these are not epileptic seizures and are caused by temporary lack of oxygen, not brain malfunction.
4. Are Breath-Holding Spells Dangerous?
The good news is that breath-holding spells are almost always harmless. Although alarming, they do not cause brain damage, and the vast majority of children outgrow them completely.
In rare cases, if a child has a particularly long or severe spell, or if they have underlying conditions like iron deficiency anemia, intervention may be necessary to reduce their frequency or intensity.
5. Causes and Risk Factors
Breath-holding spells are not fully understood, but certain factors can increase a child’s risk:
Genetic predisposition: They often run in families
Strong emotional reactivity: Children who are very sensitive or expressive may be more prone
Iron deficiency: Studies show that low iron levels can make spells more frequent and severe
Fatigue or hunger: Spells may be more common when a child is overtired or hasn’t eaten
6. What to do During a Spell?
While it's incredibly hard to stay calm, your reaction is key. Here's what you can do:
Lay your child on their back in a safe space to prevent injury
Stay calm and speak reassuringly
Do not shake or try to "snap them out of it"
Don’t panic — most spells resolve on their own within a minute
Avoid giving in to tantrums to prevent reinforcing behavior
After the spell, your child might be tired or a bit confused, but they typically recover quickly without medical attention.
7. When to see your doctor?
Although breath-holding spells are usually benign, you should consult your pediatrician if:
This is the first spell
Spells are frequent, severe, or prolonged
There are seizure-like movements or twitching during the episode
Your child is not recovering quickly
There’s a family history of seizures or cardiac issues
You’re simply unsure whether what you saw was a breath-holding spell
A doctor may perform a physical exam, check iron levels, and in rare cases, order tests like an EEG or ECG to rule out seizures or heart problems.
Can they be Treated?
Yes — especially if they are frequent or distressing. Management includes:
Iron Supplementation
If iron deficiency is diagnosed, supplementation can significantly reduce the frequency and severity of spells.
Parental Guidance
Helping parents understand the condition and avoid reinforcing tantrums is a major part of treatment. Knowing what to expect can ease the fear and stress around these episodes.
Behavioral Techniques
Positive behavior reinforcement and managing tantrum triggers (hunger, overstimulation, etc.) can help reduce emotional outbursts.
Breath-holding spells are more common than you might think, and while they can be incredibly distressing, they are not a sign of serious illness in most cases. With the right understanding, a calm approach, and medical guidance when necessary, most children grow out of them without any lasting effects.
If you’re dealing with this in your household, know that you are not alone — and that support is available. Keep calm, stay informed, and trust that your little one will grow through this phase with time..
American Academy of Pediatrics. (2017). Breath-holding spells. HealthyChildren.org. Retrieved from https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Breath-Holding-Spells.aspx
Brunson, K. L., & Khanna, R. (2022). Breath-holding spells in children. In S. R. Drell & M. W. Kline (Eds.), UpToDate. Wolters Kluwer. Retrieved from https://www.uptodate.com
DiMario, F. J. (2001). Breath-holding spells in childhood. American Journal of Diseases of Children, 155(3), 283–289. https://doi.org/10.1001/archpedi.155.3.283
Maytal, J., & Libman, R. (1990). Breath-holding spells and their relationship to iron deficiency anemia. Clinical Pediatrics, 29(5), 278–281. https://doi.org/10.1177/000992289002900504
National Library of Medicine. (2022). Breath-holding spells. MedlinePlus. Retrieved from https://medlineplus.gov/ency/article/003200.htm
Hi, I’m Faye, a doula based in the Central Arkansas area. I’m here to support you through your birthing journey and help you feel empowered every step of the way.
I know a lot of people would say there isn’t a such thing as a perfect delivery but I would have to disagree but that’s bologna. The perfect delivery is the one God intended just for you. And I know he shares those desires and places them on your heart. Trusting in God and his ability to bring forth delivery is the best way. Isaiah 66 9-11
With love,
Faye G
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