Breath holding spell

Definition 

A breath holding spell is an involuntary holding of the breath with loss of consciousness in response to a confrontational situation.

Causes, incidence, and risk factors 

Breath holding is seen in some normal children approximately 8 months to 2 years of age. It appears to be a reflexive response to fear, a confrontational situation, a traumatic event (for example: pain), or to being startled.

The child may make a short gasp and then exhale and cease breathing. Then the child rapidly becomes bluish (cyanotic) and may have several jerky movements resembling a small seizure.

The event is terminated by a momentary period of unconsciousness, at which time normal breathing resumes. The color improves with the first breath and the event is over. This behavior may be repeated several times per day or seen only on rare occasions.

Breath holding can be a frightening event for parents who may perceive it as a seizure or even cardiac arrest. Breath holding can be mistaken as a seizure, and seizures can be mistaken as breath holding.

A physician evaluation to determine that the behavior is actually breath holding is appropriate. Breath holding may also be a symptom of a rare genetic disorder, Riley-Day syndrome.

After recognizing the event as breath holding, the parent can simply await the event’s natural conclusion. Afterward, no undue attention should be given the child, which might encourage a repetition of the behavior with future events.

Symptoms 

     
  • Previous episode of breath holding  
  • Exhalation followed by cessation of breathing (apnea)  
  • Cyanosis (bluish discoloration of skin caused by lack of oxygen)  
  • Short (1 to 2 jerks) of seizure-like movement  
  • Momentary unconsciousness

Signs and tests 

A history and routine physical examination may be done to rule out a physical cause of the breath holding. On occasion an EEG may be done, especially if it is difficult to differentiate the seizure-like movements of breath hold from an actual seizure.

Treatment 

No treatment is indicated for this condition. However, the breath holding behavior should not be “rewarded” by undue attention following the episodes, as this may encourage repeat behavior.

Expectations (prognosis) 

This condition normally goes away without treatment before the child is 2 years old.

Complications 

Breath holding may be mistaken for seizures, and seizures may be mistaken for breath holding, so be sure to have your physician make an evaluation.

Calling your health care provider 

Call your health care provider if your child exhibits breath holding behaviors, especially if this is a new behavior for the child or if the child does this frequently.

Prevention 

No preventive measures are available. Counseling for the parents or behavior therapy for the child may be helpful for children that routinely exhibit breath holding spells.

Johns Hopkins patient information

Last revised: December 4, 2012
by Amalia K. Gagarina, M.S., R.D.

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