Breath Holding Spells (BHS)

What are Breath Holding Spells (BHS)

Breath Holding Spells are when your child holds his or her breath and stops breathing. Your child is not doing this on purpose. BHSs may happen in response to fear, anger, pain, or being startled. There are two kinds of BHSs:

• Cyanotic. This is when your child turns blue in the face. This usually happens when your child is upset. This form of BHS is more common and easier to predict.
• Pallid. This is when your child turns pale in the face. This can happen when your child is surprised, so it is less common and harder to predict.

Although a BHS can be scary for you to watch, it is not dangerous for your child. Most children with this condition outgrow it.

What are the causes?

This condition seems to be due to an abnormal nervous system reflex. This causes otherwise healthy children to hold their breath long enough to change color and sometimes pass out when they are startled or upset.

What increases the risk?

Your child is more likely to develop this condition if he or she:

• Has a family history of BHSs.
• Has iron-deficiency anemia.
• Has certain genetic conditions, such as Rett syndrome.

What are the signs or symptoms?

A BHS often occurs in this pattern:

• Something triggers the spell, such as being scolded or startled.
• Your child may begin to cry. After a few cries or prolonged crying, your child becomes silent and stops breathing.
• Your child’s skin becomes blue or pale.
• Your child passes out and falls down.
• Sometimes, there is brief twitching, jerking, or stiffening of the muscles.
• Your child wakes up shortly and may be a bit drowsy for a moment.

A mild spell may end before your child passes out.

How is this diagnosed?

This condition may be diagnosed by medical history and physical exam. Your child may also have other tests, such as:

• Electrocardiogram (ECG). This checks to see if your child has a heart condition.
• Blood tests.
• Electroencephalogram (EEG). This checks to see if your child has a seizure disorder.

How is this treated?

Your child may need treatment for this condition only if it has an underlying cause. If your child has an iron deficiency, treatment may include iron supplements. Your child’s health care provider will also help you know the steps to take when your child has a BHS.

Follow these instructions at home:

• Follow the instructions from your child’s health care provider about what to do when your child has a breath-holding spell. This may include:
  • Acting calm during the spell. Your child can notice your anxiety and may become more frightened if he or she senses that you are afraid.
  • Helping your child lie down during the spell. This helps to prevent to head injuries and shortens the spell. Do nothold your child upright during a spell.
  • Placing your child on his or her side if he or she loses consciousness. This helps your child avoid breathing in food or secretions. If a spell occurs while eating and an airway is blocked, the airway must be cleared.
  • Putting a damp, cool washcloth on your child’s forehead until he or she starts breathing again.
  • Reassuring your child after the spell is over.
• Learn what triggers your child’s spells and try to avoid those triggers. However, do notallow BHSs to prevent you from using normal discipline and limit-setting.
• Give medicines, including supplements, only as directed by your child’s health care provider.

Contact a health care provider if:

• Your child’s BHSs are getting worse or happening more often.
• Your child’s BHSs change.

Get help right away if:

• Your child has muscle twitching, stiffening, or jerking that last more than a few seconds.
• Your child has one seizure after another.
• Your child has trouble breathing.
• Your child has trouble recovering from a seizure.
• Your child has signs of head injury, such as:
  • Severe headache.
  • Repeated vomiting.
  • Being difficult to awaken.
  • Acting confused.
  • Difficulty walking.