A breath-holding spell is nothing but a short spell in which a child stops breathing. The child does this immediately after a painful, frightening or emotionally upsetting experience. The experience can be a fright, a minor bump or a sudden startle or when the child is upset.  In a typical breath-holding spell, the child holds the breath, and then turn blue or pale (pale grey) for a short time and may lose consciousness (temporarily). The child stops exhalation or outward breath.

When a child becomes upset or experienced sudden pain, they may react to it by holding breath and losing consciousness for a short period. Breath-holding spells look like seizures, but they are not. An episode of such a spell can make any parent scary, but they should not worry. The breath-holding spell can occur in healthy children as well as they are common in other children.

Causes of Breath-holding spells

There are two distinct conditions of breath-holding spells: When a child becomes upset, frightened or angry, or frustrated about something; or, when a child experiences pain or sudden shock. In these two cases, they hold their breath. In general, an episode of breath-holding spell begins with a crying reaction to anger, fear, and pain.

Breath-holding spells are not purposeful or deliberate. It is an automatic reaction by a child to something unpleasant (an episode of a breath-holding spell is an involuntary reaction to a sudden event). Which means a child doesn’t have any control over them. A typical breath-holding spell episode may last for less than a minute. During this period the child’s heart rate, breathing pattern and blood pressure levels may change.

Types of Breath-holding spells

breath-holding spells are of two types – blue spells (cyanotic breath-holding spells) and pale spells (pallid breath-holding spells).

Blue Spells or Cyanotic Breath Holding Spells

Blue spells are common. In this type of breath-holding spells, a child becomes very frustrated and upset, cry or scream, breath out forcefully or exhale very hard, but do not breath in. Their lips turn blue and face also becomes bluish (due to lack of oxygen around their lips and facial area). This episode may last for a few seconds. A child sometimes becomes floppy and lose consciousness (faint).

Pale Spells or Pallid Breath Holding Spells

These spells occur when a child becomes upset or when a child feels hurt – just after a minor injury. It can also happen when a child feels a sudden scare or pain. They are less common but are often mistaken for a seizure.

Typical symptoms of these spells include the following: the child looks pale; try to cry or shout by opening the mouth but with no sound; heartbeat becomes slow; arms and legs become stiff; holds breathing and faints.

When you see or witness the first breath-holding spell in your child, it is better to approach a paediatric neurologist to have a better clinical examination and complete assessment of the condition. Though breath-holding spells are not life-threatening, it is good to have them evaluated by a specialist doctor to rule out any underlying medical condition. Your child neurologist is a better person to determine whether the episodes of breath-holding were in fact there or is it any other medical condition.