As a follow on to last Monday’s blog on toddler tantrums, I thought that this week we might have a chat about “breath holding spells” that can be associated with tantrums.

This is a fairly common condition that we see in little children and is where a child will hold their breath until they change colour and quite literally pass out (becoming unconscious). Unlike toddler tantrums that we have discussed before (see the recent blog post at:  https://kids-health.guru/toddler-tantrums/ ) this behaviour is actually NOT deliberate, and the child cannot control them.

The episodes typically occur in children between the ages of 6 to 18 months although they can and do start earlier in some babies.  There is a wide range in the reported frequency (or incidence) of this condition – some sources stating about 5% of children, and some as high as 27%!^1,2 Most children who do this, will have 1-6 spells per week, but up to a quarter of children will have multiple spells each day.³

It is uncommon for breath holding spells to occur for the first time in children over the age of 2 years. They can occur in both girls and boys, and in around a third of children who do it, there is a family history of breath holding.  They are stressful for a parent to watch but are ultimately not harmful to the child.

Here is what they look like:

• The episodes usually last less than a minute
• The are often triggered by something specific – fear, pain/injury, a sudden fright or the child getting frustrated or angry about something.
• The child will start to cry (sometimes the child might not even give a cry out loud), but then will make no noise even though it looks like they are still crying
• The child will then either hold their breath and turn blue (especially around the lips; this is called “cyanosis” and is caused by a low level of oxygen in the blood – this is called “Cyanotic breath holding”) and then become limp and pass out, or they will look very pale and then faint (“pallid breath holding”)
• There might be a brief period where the child appears to go stiff and arch their back, sometimes their limbs might jerk for a few seconds. The breath holding spell itself is not a seizure but may lead to a seizure in some children.  In the vast majority of cases, no treatment is necessary.
• There may be loss of bladder or bowel control
• The child will usually regain consciousness within a minute, and can either return to normal very quickly, or seem tired or even sleep for a little while.

 

What do you do?

Place your child in the recovery position (roll them onto their side) and move away anything around them that they could potentially hurt them.  Keeping them upright can sometimes prolong the episode.  Do NOT put anything in their mouth.

If your child has a seizure/fit with muscle twitching that lasts longer than a few minutes, you should take your child to see the GP, or if the seizure is ongoing, call an ambulance.

Wait.  Your child will start to breathe again quickly (even though it might seem like ages) on their own.

Once they wake up, do not punish them or make a fuss.  Even if you feel stressed about it (and you will!), try to act normally – like as if nothing has happened.

Prevention

Iron deficiency anaemia (when your child doesn’t have enough iron in their diet and their level of red blood cells becomes low as a result) is associated with breath holding spells.  This is diagnosed on some clinical signs that your doctor will look for when examining your child (usually looking pale – conjunctiva, gums, palms of hands) and a blood test.  An iron supplement might be suggested to try to reduce how often the episodes occur.

Otherwise, it can be difficult to prevent breath holding attacks because all children will experience pain, frustration or fright at some stage or other.  Simply giving in to the demand or frustration however, will teach the child that if they cry, scream and get upset they will get what they want – potentially making the problem worse or more frequent.  What you CAN do however, is teach your child ways to calm down and deal with their frustration or anger.   Strategies like deep breathing, or “ignore/distract” (see my last blog post on Toddler Tantrums – link above) could potentially reduce the frequency of breath holding spells.  Also making sure they have had enough sleep, that they are not hungry (and in doing so, making sure they don’t have a shorter fuse than normal) or prompting them to “use their words” (and if they can’t, getting them to show you what they want/need) can also help.

When to seek medical advice:

• If your child’s breath holding spells are associated with a fit (stiffening or shaking) lasting longer than a few minutes
• If your child is having lots of spells (more than one a day) – this can still be normal, but warrants a check up
• If your child is having these spells without a trigger or provoking factor
• If your child’s spells persist past the age of around 6 years.
• If it takes your child a long time to recover from the episone
• If there is anything else that is making you worried

 

Your child should grow out of this condition by the time they reach the age of 6 years.  It is thought that kids who suffer from breath holding attacks have a greater tendency to faint as teenagers or adults.

Hope you found this post helpful!  Until next time, stay well!

xxDr Megs

 

REFERENCES

1. Bridge EM, Livingston S, Tietze C. Breath-holding spells: their relationship to syncope, convulsions, and other phenomena. J Pediatr. 1943;23:539–561.
2. Victorian Government ED fact sheet.  Breath holding (in children). http://www.health.vic.gov.au/edfactsheets/downloads/breath-holding-in-children.pdf . Accessed May 1, 2018.
3. RCH Melbourne fact sheet.  Breath Holding.  https://www.rch.org.au/kidsinfo/fact_sheets/Breath_holding/ . Accessed May 1, 2018.