Are there different types of breath-holding spells?

There are two types of breath-holding spells:

1. Blue spells (cyanotic breath-holding) are the most common type. The child starts to cry after anger, frustration, physical pain or fright. They lose their breath and turn red in the face followed by turning blue (especially around the mouth). This lasts only a short time and the child often goes limp, passes out or may even fall to the ground. A child may have a seizure after a blue spell, but this is rare.
2. Pale spells (pallid breath holding) are less common. They can occur very early in life and can be frequent, causing considerable anxiety in the family. They do not have any serious consequences but they are frightening to witness. They also happen after a child has an upset such as a minor bump on the head. The child opens their mouth as if to cry but nothing comes out. They then faint and can look deathly pale. The child usually goes limp and falls to the ground. In longer spells they can arch their back and become stiff. As with blue spells, the child may, on rare occasions, have a seizure. The child may recover quickly or may be drowsy and sleep for a while.

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What causes breath-holding spells?

The cause of breath-holding spells is not known. Most children who go through a stage of breath-holding do not have a serious problem and do not have epilepsy. Sometimes there is a history in the family of similar episodes.

 

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When do they start and will they stop?

Breath-holding spells usually start before 18 months of age and usually stop by six years. It is a condition that causes no short or long-term consequences. Some children with pale spells may have faints as they grow older.

 

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How often do they occur?

Breath-holding spells vary in severity and frequency. They may happen fairly often but every child is different. Watch your child to understand when they are most likely to have a spell. This will help you know when they are going to have a spell.

 

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What to do during a spell?

Lie your child on their side and observe. Don’t shake your child or put anything in their mouth. Keep their arms, legs and head from hitting anything hard or sharp. Treat your child normally after the event. Do not punish or reward the behaviour.

 

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What needs to be done for my child?

Discuss the problem with your family doctor. Your child will need a thorough examination to see that they do not have any other problems. Breath-holders are usually healthy.

 

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What should concern my family doctor and me?

• loss of consciousness and becoming very pale without any provoking factors
• very frequent spells (such as several per week or more than once a day) should be assessed. This may be within the spectrum of what can happen but it should be further investigated
• breath-holding spells followed by prolonged stiffening or shaking which goes on more than a minute, associated with slow recovery needing several hours of sleep, or confusion for a long period of time

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What can be done in the meantime?

No special treatment is required. Anti-epileptic treatment is not effective and is rarely recommended. Iron deficiency should be looked for if there are frequent events. Make sure your child gets plenty of rest; help them feel secure and help minimise and manage their frustration. It is important that your child is not treated in a special way or different from their siblings. Behavioural problems can outlast the period of time that the spell can occur. A behaviour modification program may help. Ask your family doctor for help with this.

 

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Acknowledgements

Starship Foundation and the Paediatric Society of New Zealand acknowledge the co-operation of The Children's Hospital at Westmead, Sydney Children's Hospital at Randwick, and Kaleidoscope - Hunter Children's Health Network in making this fact sheet available to patients and families.

 

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Endorsement

This fact sheet was endorsed by PSNZ - 23/03/2006

Copyright

Fact sheets are subject to copyright. In the interests of information sharing they may be copied but acknowledgement must be given to PSNZ and Starship Foundation.
© The Paediatric Society of New Zealand and Starship Foundation 2005 - 2012

The Paediatric Society of New Zealand http://www.paediatrics.org.nz

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