These are frightening but common events that occur in about 5 percent of children between six months and six years of age. There is a history of breath holding among parents or siblings in about one out of four families in which it occurs.
There are two types of breath-holding episodes. In the more common cyanotic type, crying occurs after a physical or emotional incident that provokes fear, anger, or frustration. Normally, most young children who suddenly become upset will release a long, continuous cry that finally ends just in time to take a big gasp of air and then cry out again. The breath holder extends her cry so long that she doesn’t quite make it to the breath she needs. She suddenly becomes stiff, arches her back, and turns blue in the face. She may lose consciousness for about 15 seconds (which can seem much longer to the first-time observer) and make brief jerking movements of the arms and legs that resemble (but are not) a brief seizure. Finally she will take a breath. When the episode is over she will be fully awake and aware, not confused or unresponsive as would be the case after a seizure. The second type is the pallid breath-holding spell, in which the child becomes pale in response to a sudden painful stimulus (for example, getting her finger caught in a door or having blood drawn at the doctor’s office). Aside from the child being pale rather than blue, this episode looks similar to the cyanotic breath-holding spell. These spells ultimately arise from a brief lack of oxygen available to the brain. Although they are very dramatic and may appear life-threatening, breath-holding spells end spontaneously. They do not cause brain damage, nor are they a form of epilepsy. However, they can be very stressful to a parent or caregiver, especially if he or she has never seen one.
Once you have observed one or more breath-holding spells and know how they end, you can be calmer when one occurs in the future. While the term breath-holding spell implies that this event might be purposeful, be aware that it is not a performance or a deliberate, premeditated act. Nevertheless, don’t let the potential of one of these spells become an indirect form of manipulation by your child. Some parents may give in to a child’s demands to avoid seeing another spell (“We can’t let Johnny get too upset, or he might turn blue again”). This is both unwise and unnecessary. If your child becomes upset over reasonable limits or appropriate disciplinary measures and has a breath-holding spell as a result, you should not feel guilty or alarmed. Stick to your principles. Children normally stop having these episodes on their own, no specific intervention is needed.