Breath-holding spells are an involuntary reaction in which an infant or toddler stops breathing, passes out, and recovers quickly. They are not necessarily a medical emergency, but the first time one occurs you need to have the child checked out by your pediatrician; they may well advise you not to worry if it happens again.

These spells are rare, occurring in only about 5% of children, and are usually not related to a serious medical condition. However, they can be a sign of anemia, and may be associated in some cases with spasms or seizures, although they generally do not indicate a long-term seizure disorder. Spells usually occur in children between 6 months and 6 years old, and are most common around 2 years of age.

The general form of a spell is a) something upsetting happens b) the child stops breathing, c) the child may change color and/or pass out. These may occur almost simultaneously, or may take a couple minutes to play out. The upsetting event can be a minor wound, an emotional response (e.g., they can't have the toy they want), or being suddenly frightened. There are two types:

Cyanotic breath-holding spells occur when the child is upset and crying, and becomes so worked up that they forget to inhale; they turn blue and may pass out.

Pallid breath-holding spells occur when a sudden shock or pain causes the child's heart rate to slow suddenly, reducing blood flow to the brain; they turn pale and may pass out. These attacks happen much faster, and with less warning.

In either case, if the child does not breathe for longer than one minute this becomes a medical emergency. It is also important to determine that this is a spell, and that they are not choking.


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