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By Sarah Hunstead
Sarah Hunstead
03 Jul, 2020

I guess that’s why they call it the blues – breath holding episodes in toddlers.

Breath-holding spells can happen after your child has had a fright, minor injury, a tantrum or they are upset.

Breath holding episodes are common in children aged 6 months to 6 years. Although they are frightening to watch, your child is not harmed in any way. Breath-holding spells can happen after your child has had a fright, minor injury, a tantrum or they are upset.

“Most children who have breath-holding spells will have their first spell before they are 18 months old, and most children grow out of breath holding by the time they are six years old. Children who breath hold will usually have one to six spells per week, but up to 25 percent of children who breath hold will have multiple spells each day.”

Royal Children’s Hospital Melbourne

Erin, a paediatric nurse and CPR Kids Educator, shares her experience:

“As an emergency nurse, I’d heard of breath holding spells. I’d looked after toddlers brought into hospital after holding their breath until they passed out. These children were seen by a doctor, their parents reassured that everything was okay and that although it was distressing to watch they would eventually grow out of it. However, this didn’t make it any less scary the first time it happened in my own home.

On her 2nd birthday, my over excited (and over tired) daughter, Emma, tripped and fell over. She opened her mouth to cry. I rushed over to her expecting to hear the screams of shock and pain. But then nothing. I picked her up. She didn’t cry. She didn’t breathe. A look of panic flashed across her face. Quickly- so very quickly- she turned blue. Her eyes rolled back. She went limp in my arms. That’s when my nursing instincts took over. I laid her down on her side on the floor. She came to and cried. And I never knew how relieved I would be at the sound of my child crying.”

There are two types of breath holding – cyanotic (blue) and pallid (pale). The Royal Children’s Hospital Melbourne fact sheet on breath holding describes the following signs and symptoms:

Blue spells (cyanotic breath holding)
Blue spells are the most common. Your child may have hurt themselves or become very upset or frustrated, and they will:

  • cry or scream

  • breathe out forcefully

  • breath hold and turn blue, especially around the lips – this blueness is caused by a lack of oxygen, and lasts a few seconds

  • become floppy and lose consciousness (faint)

NO TREATMENT IS NEEDED.*

No long-term damage is done due to the brief period with reduced blood oxygen levels.

Don’t splash your child with water or blow air in their face.

Pale spells (pallid breath holding)
Less common than blue spells. They can happen in young children after a minor injury or if the child is upset. Pale spells are caused by a slow heart rate and are often mistaken for a seizure. Your child will:

  • open their mouth as if to cry but no sound comes out

  • faint and look very pale

  • have a brief period where their arms and legs become stiff or lose control of their bladder/bowel.

No treatment is needed and your child will start breathing and recover by themselves.*

Royal Children’s Hospital Melbourne fact sheet on breath holding

Sydney Children’s Hospital fact sheet on breath holding

While your child is having an episode, roll them on their side and keep them safe from injury. There is no need to do anything – they will start breathing again on their own.

There is evidence to show that in some children breath holding episodes can be linked to iron deficiency anaemia. Speak with your doctor about whether your child needs testing/supplementation.

Although incredibly scary to watch, it is important that after an episode you treat your child normally, and as if nothing has happened.

It is a good idea to speak with your GP or Paediatrician for more information if your child is having frequent breath holding episodes.

*This advice is for families whose child has been diagnosed with common breath holding episodes. If your child has complex spells/underlying condition follow the advice of your paediatrician, or if the episode is different to normal (ie they are not recovering like they normally do) call 000 ambulance. Trust your instinct.

REFERENCES:

Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence Current Paediatric Reviews 2019

Alexander K C Leung Amy A M Leung Alex H C Wong Kam Lun Hon 

https://pubmed.ncbi.nlm.nih.gov/30421679/

Iron Deficiency and Cyanotic Breath-Holding Spells: The Effectiveness of Iron Therapy Paediatric Haematology and Oncology 2018

Sherifa A Hamed 1Eman Fathalla Gad 2Tahra Kamel Sherif 3

https://www.tandfonline.com/doi/abs/10.1080/08880018.2018.1491659?journalCode=ipho20

Royal Children’s Hospital Melbourne fact sheet on breath holding

Sydney Children’s Hospital fact sheet on breath holding

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