Breath holding spell
Key points
- A breath holding spell is an involuntary holding of the breath with loss of consciousness in response to a confrontational situation.
- Breath holding is seen in some normal children approximately 8 months to 2 years of age.
- A history and routine physical examination may be done to rule out a physical cause of the breath holding.
- However, the breath holding behavior should not be "rewarded" by undue attention following the episodes, as this may encourage repeat behavior.
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.
Written and revised by
David Cohen, M.D.
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