Breath-Holding Spells in Children — Why They Happen and What to Do

Dr. Sandip Gupta

This video explains breath-holding spells — a situation where a crying or angry child, or one who has just been hurt (a fall or a knock on the head), suddenly stops breathing, which panics parents. The doctor clarifies why it happens, what to do, and when to see a doctor. When it happens: Usually between 6 months and 2 years of age. What triggers it: A child getting a noxious stimulus — falling, hitting their head on a wall or the ground — may suddenly start crying and stop breathing while crying. Or a child may be stubborn about something, like a toy or food, and when refused, holds their breath. During the spell the child may turn blue or pale, which frightens parents. How common it is: About 1 in 105 children may have this kind of episode between 6 months and 2 years. Why it happens: The exact cause isn't fully clear, but it is mostly linked to genetic factors — parents who had similar episodes in their own childhood tend to have children with the same tendency. It has also been associated with iron deficiency anaemia, since iron is important for children's growth; lack of iron can contribute to this behaviour. Children who are generally stubborn also have a higher tendency to develop breath-holding spells. What to do during a spell: Don't panic. It usually resolves on its own within 1 to 2 minutes, and the child starts breathing again. Turn the child's head to one side. Check the mouth and remove any chocolate, toffee or food particle; if the child is frothing, wipe away the saliva, keeping the head turned to one side. Sprinkle a little normal-temperature water on the baby's face — this sometimes triggers breathing to restart. Cuddle the baby and talk to them. With this, about 99% of the time the child returns to normal breathing. When to rush to the doctor: If the spell is prolonged — more than 2 to 5 minutes — the child may be at risk of injury or other problems; contact your doctor and go to the clinic immediately. At the clinic, doctors typically try to stimulate the baby and give oxygen, and most children recover. Very rarely, a child may develop seizures because of a breath-holding spell, which is a serious concern needing a doctor. Telling it apart from other conditions: Tet spell / cyanotic spell (seen in babies with congenital heart disease like Tetralogy of Fallot) — unlike a breath-holding spell, where the child turns blue only during the episode, these babies are blue all the time, and it worsens during crying spells. Seizures — jerky or irregular breathing, but the baby usually does not turn blue in early stages, and there are shaking movements of the hands and feet, which is less typical of a breath-holding spell. In any concerning episode: turn the child's head to one side, make sure nothing is in the mouth, don't try to give anything in the mouth at that time, and go to hospital if needed. Questions this video addresses: What is a breath-holding spell; at what age does it happen; why does a child stop breathing while crying or being stubborn; how common is this; what causes it, including the link to iron deficiency and genetics; what should parents do immediately during a spell; when does a breath-holding spell need urgent medical attention; and how is it different from a cyanotic (Tet) spell or a seizure. Relevant for: parents whose child suddenly stops breathing or turns blue/pale while crying, angry, or after a fall or bump; parents panicking during their child's first breath-holding episode; parents wanting to know the correct first-response steps; parents asking whether iron deficiency is linked to breath-holding spells; parents asking when to rush to a doctor versus wait it out; and parents trying to tell a breath-holding spell apart from a heart-related cyanotic spell or a seizure. Disclaimer: This video is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Every child is different — please consult your pediatrician to confirm the diagnosis and to check for iron deficiency, and seek immediate medical attention if the spell lasts more than a couple of minutes, if your child has shaking movements or seizures, or if you suspect a heart-related cause.