What should parents know about breath-holding spells?

What does the evidence show for breath-holding spells in children?

• A spell can begin after crying, pain or a startle, with a brief pause in breathing and sometimes blue or pale coloring. It is not a deliberate act of defiance. The history and recovery pattern help clinicians distinguish it from other causes of loss of awareness. 1
• Several conditions can cause a child to faint or appear unresponsive. A description of the trigger, color, movements and return to normal helps the pediatrician decide what assessment is appropriate. A previous reassuring event should not automatically explain a substantially different one. 2
• Iron deficiency is associated with some breath-holding spells, and the clinician may order blood tests. Iron dosing should follow the child’s findings and prescription. Do not start concentrated drops or use an adult supplement simply because another child’s spells improved with iron. 1
• If an episode includes collapse or jerking, protect the child from falls and nearby hard objects, stay close and keep objects out of the mouth. Do not restrain the child or shake them. An uncertain or prolonged event needs medical help rather than attempts to force a response. 3
• An infant who is unresponsive and not breathing normally needs emergency services and infant CPR according to training or dispatcher instructions. The possibility of a breath-holding spell should never delay that response. Use age-appropriate emergency guidance for an older child. 4

When should I call my provider about breath-holding spells in children?

Call emergency services if the child remains unresponsive, has ongoing breathing difficulty, does not resume normal breathing or has prolonged jerking. A first or substantially different event needs clinical assessment. Do not assume a newborn’s breathing pause is a benign spell.