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They usually have a trigger, such as anger or frustration. Breath holding spells occur in 5% of healthy children and are most common between 6 months and 6 years. Most children have their first breath holding spell before 18 months. Breath holding may occur as part of a pattern or as a one-off. There are several causes, but they usually involve children experiencing a strong emotion before holding their breath. This article outlines the different types of breath holding spells, their causes, and what caregivers can do when they happen. What is a breath holding spell Share on PinterestImage Source/Getty ImagesA breath holding spell is where a young child holds their breath — usually until they briefly lose consciousness. The child may go rigid or limp, and their usual complexion may turn pale or bluish due to a lack of oxygen. The child usually regains consciousness in less than 1 minute. Breath holding spells often follow strong emotions, such as anger, frustration, pain, or fear. They are common following temper tantrums. A painful or frightening experience may also be the trigger. Breath holding spells do not indicate a health issue and do not harm the child. However, they can be distressing to witness. Breath holding spells are similar to sleep apnea, where a person stops breathing for a few seconds before starting again. Types There are two types of breath holding spells: cyanotic and pallid. Both types can be frightening to witness, but they are not harmful. Below is an outline of both types. Cyanotic breath holding spells Doctors also call cyanotic breath holding spells “blue spells.” They often result from anger or frustration. The child may: cry or screamexhale deeplyhold their breath and turn blue, especially around the lipsbecome rigid or floppy briefly lose consciousness recover quickly or feel drowsy for a while Learn more about the cause of blue lips in a baby. Pallid breath holding spells Pallid breath holding spells are also called “pale spells” and are less common than blue spells. A slow heart rate causes them, and people may mistake them for a seizure. Children may experience a pale spell after a minor injury or shock. The child may: lose consciousness and turn paleopen their mouth to cry but be unable to make a soundhave stiff limbs or lose bladder or bowel controlbecome sweatyhave body jerks Why do breath holding spells happen Children who experience breath holding spells do not choose to hold their breath to seek attention, even though it might appear that way. Breath holding spells are involuntary. When a child chooses to hold their breath to get what they want, they do not lose consciousness and begin breathing as usual when they perceive they have won. Triggers for breath holding spells may include:a temper tantrumthe child feeling upset, angry, or frustrateda caregiver reprimanding a child the child feeling frightenedthe child being in pain Experts do not know the exact cause of breath holding spells. There may be a genetic component as 25–30% of children who experience them have a near relative who has also experienced them. Breath holding children may be more likely to faint as adolescents and possibly as adults. Studies have also suggested links with:iron deficiency anemiaautonomic nervous system dysfunction, where the bodily systems that control automatic functions, including the heartbeat and breathing, may not work correctly Breath holding spells are a symptom of certain genetic syndromes, such as 16p11.2 microdeletion syndrome and Riley-Day syndrome. What can caregivers do when it happens Parents and caregivers should respond to a child having a breath holding spell by: staying calmexpecting the spell to pass in less than 1 minutelying the child on their side and remove anything hard or sharp away from their reachstaying with themgiving them reassurance and rest after the episodeacting as usual when the child regains consciousness, avoiding making a fuss Actions that are not helpful to a child having a breath holding spell include:reprimanding them shaking them or splashing them with waterperforming CPR A child that regularly has breath holding spells should have a checkup with a healthcare professional to rule out medical conditions. Treatment Doctors do not recommend treatments for breath holding spells as most children outgrow the condition. However, according to a 2019 study, some children may benefit from taking iron supplements — even if they are not diagnosed with iron deficiency anemia. Caregivers should talk with a doctor before giving a child supplements. Caregivers may benefit from counseling to give reassurance and help them manage a child’s breath holding episodes. Learn about 11 iron-rich foods for toddlers. Prevention There are several strategies caregivers can try that may prevent breath holding spells. They include:distracting the child in situations that may trigger breath holdinggiving the child plenty of warning when things are about to changecomforting the child when they are frightened or having a difficult experiencehelping older children learn to recognize emotions such as anger and frustration by naming them and exploring how they feel in the bodytrying to prevent the child from becoming overtired or hungry if those situations trigger episodes When to contact a doctor Most children will grow out of breath holding by the time they are 6 years old. The episodes are usually harmless and do not need medical investigation. However, caregivers should consult a doctor in the following circumstances:the child is younger than 6 monthsspells happen more than once per weekbreath holding begins suddenlythe child looks confused and excessively drowsy after holding their breaththe child shakes and goes rigid for longer than 1 minute, and they take a while to recoverthe child falls and hits their head during a spell Caregivers should talk with a doctor if a child has a breath holding spell for the first time. The doctor can check for signs of more serious conditions, such as epilepsy. Outlook Breath holding spells should become less frequent as a child matures. In most cases, the spells do not cause long-term damage, although some people experience fainting episodes in adolescence. Summary Breath holding spells are most common in children between 6 months and 6 years. Most children have their first episode before 18 months. Strong emotions, such as anger, fear, pain, or frustration, usually precede breath holding spells. Temper tantrums are common triggers. There are two types of breath holding spells. The cyanotic type is the most common, and children usually turn blue in the face, particularly around the lips. The pallid type results from a drop in heart rate. The child may experience a minor injury or shock before turning pale. Children may lose consciousness for a few seconds, but they will recover without needing medical help. Although they can be distressing to watch, caregivers should stay calm if their child has a breath holding spell. They should reassure their child but avoid making a fuss or reprimanding them. If a child holds their breath frequently or an episode happens before they are 6 months old, caregivers should consult a doctor. Last medically reviewed on September 27, 2022Pediatrics / Children's HealthParenthoodChildToddler 6 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Breath holding. (2018).https://www.rch.org.au/kidsinfo/fact_sheets/Breath_holding/Breath holding. (2022).https://raisingchildren.net.au/babies/behaviour/common-concerns/breath-holdingFlodine, T. E., et al. (2022). Breath holding spells.https://www.ncbi.nlm.nih.gov/books/NBK539782/Gurbuz, G., et al. (2019). Iron supplementation should be given in breath-holding spells regardless of anemia.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350795/Leung, A. K. C., et al. (2019). Breath-holding spells in pediatrics: A narrative review of the current evidence.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6696822/Punitha, K. (2021). Riley-Day syndrome.https://www.ijcrt.org/papers/IJCRT2104020.pdfFEEDBACK:Medically reviewed by Mia Armstrong, MD — By Sarah Charmley on September 27, 2022 Latest newsWhat sets 'SuperAgers' apart? Their unusually large neuronsOmega-3 may provide a brain boost for people in midlifeSeasonal affective disorder (SAD): How to beat it this fall and winterCDC: Monkeypox in the US 'unlikely to be eliminated in the near future'Why are more women prone to Alzheimer's? New clues arise Related CoverageWhen do babies start talking?Medically reviewed by Karen Richardson Gill, MD, FAAP Babies typically say their first words between 7–12 months of age. 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