Key points about breath-holding spells
- breath-holding spells are quite common in young tamariki (children)
- they are scary to watch, but your child does not need any medical treatment
- tamariki may hold their breath if they get a fright or are upset
- there are 2 main types of breath-holding - blue spells and pale spells
- blue spells and pale spells only last a few seconds and do not cause any long-term harm
Breath-holding spells are scary to watch, but your child does not need any medical treatment.
What is a breath-holding spell?
Toddlers, and sometimes pēpi (babies), can have breath-holding spells (or ‘attacks’). Breath holding is common, especially in tamariki aged 6 months to 6 years old. They happen in about 5% of tamariki.
A breath-holding spell may happen after a child gets a fright or is upset.
They are scary to watch, but your child does not need any medical treatment. Your child may recover quickly or be unresponsive for a short period (a few seconds).
Breath-holding spells often happen as part of toddler tantrums. The spell is an automatic reaction to something unpleasant - it is not a deliberate behaviour on your child's part.
When breath-holding spells usually start and stop
Most tamariki who have breath-holding spells will have their first spell before they are 18 months old. Most tamariki grow out of breath-holding spells by the age of 6 years.
How often breath-holding spells can happen
Breath-holding spells are different for different tamariki. They may happen fairly often, sometimes several times a day or only every few weeks or months. They usually happen more often when your child is overtired, upset or irritable (grizzly). Often parents who have seen breath-holding spells can predict when another is likely to happen.
Different types of breath-holding spells
There are 2 types of breath-holding spells. Both types may happen in the same child at different times in their life.
Neither type has any serious consequences (unless your child hurts themselves if they fall) but they are frightening to see.
Blue spells (cyanotic breath-holding)
Blue spells are the most common. Your child may have hurt themselves or become very upset or frustrated, and they will:
- cry or scream
- breathe out forcefully
- breath-hold and turn blue, especially around the lips - this blueness is caused by a lack of oxygen, and lasts a few seconds
- may become floppy and lose consciousness (faint)
- slowly return to normal breathing and colour within a minute
Pale spells (pallid breath-holding)
These are less common. They can happen in young tamariki after a minor injury or if a child is upset. Pale spells are caused by a slow heart rate. It can look like your child is having a seizure. Your child will:
- open their mouth as if to cry but no sound comes out
- faint and look very pale
- have a brief period where their arms and legs become stiff or they lose control of their bladder or bowel
- slowly return to normal breathing and colour
Causes of breath-holding spells
Breath holding is not deliberate. It is caused by either a change in a child's usual breathing pattern or a slowing of their heart rate. Strong emotions such as anger, pain, fear or frustration can trigger breath-holding spells.
Breath-holding spells can run in families.
Most tamariki with breath-holding spells do not have a serious underlying problem.
Do breath-holding spells mean my child has epilepsy?
Breath-holding spells can look like epileptic seizures and the 2 are often confused. Breath-holding spells are not related to epilepsy, even though they can look similar.
Do breath-holding spells cause any long-term problems?
Your child will not have any long-term damage due to brief breath-holding spells. Some tamariki with pale spells may be more likely to faint as they grow up.
What to do when your child has a breath-holding spell
If your child is having a breath-holding spell follow these steps.
Try not to panic.
Lie your child on their side and stay with them.
Don't shake your child, put anything in their mouth, or splash them with water.
Remove objects from around your child that could injure them.
Allow the spell to stop by itself.
Treat your child normally after the event - do not punish or reward the behaviour or make a big fuss.
When to get medical help for your child
Take your child to a health professional if:
- your child is having very frequent spells (several times a week)
- the spells happen without your child being frustrated, startled or hurt beforehand
- your child with breath-holding spells has stiffening or shaking
- your child takes a long time to recover and needs several hours of sleep, or seems confused for a long period of time
- your child is less than 6 months of age
- you are worried
Diagnosing breath-holding spells
Tamariki who have breath-holding spells are usually healthy. Your health professional will examine your child to check they do not have any health issues such as an irregular heartbeat.
Your health professional may suggest a blood test to check your child’s iron levels. Your health professional may suggest iron medicine. This can reduce the frequency and severity of breath-holding spells.
Iron Deficiency In Children & Young People
Managing breath-holding spells
Medical treatment is usually not needed.
Make sure your child gets plenty of rest, help your child feel secure and help minimise and manage their frustration.
Don't treat your child differently from their brothers or sisters, or other tamariki. Tamariki do not have breath-holding spells on purpose. Making a big fuss after a spell can make them happen more.
