Breath-holding spells involve episodes in which young children begin to cry (typically because they are angry, frustrated, or hurt), seem to get “stuck” while exhaling, turn bluish, then pass out or even have seizure-like movements. The child usually wakes up within a minute and, in some cases, may be groggy for a while. The frequency of episodes can vary: some children experience multiple spells throughout the day while others may have one a year.

Episodes tend to start sometime between 6 and 12 months of age, are at their worst between 12 and 18 months of age, and then gradually stop happening. Most children stop having episodes by age 3 to 4 years, although some continue for longer. These types of episodes can “run in the family”: in about one-third of kids with these spells, a parent had them when he or she was little, too.

We are not sure why these episodes occur. Doctors who study this area suspect the spells have something to do with a slightly faulty autonomic nervous system. If they are “typical” spells (involving crying, then blueness) the outlook is very good and children get over them without any long-term effects. Some spells involve hardly any crying and are followed by intense paleness; these may need further evaluation.

Watching your child have a breath-holding spell can be scary. To keep your child safe, make sure there are no sharp or hard objects near the child during an episode. If you begin to see a pattern of when the episodes occur, such as when a child becomes frustrated, try to keep his or her emotions more balanced by offering a distraction.

If your child’s breath-holding spells are typical, aside from perhaps a blood test for anemia (see below), no other tests are needed. The major alternate diagnosis that might explain this type of spell is a seizure. A seizure, however, wouldn’t always be preceded by crying or only occur when awake.& Usually seizures occur unexpectedly, and they tend to occur more often during sleep. Investigation for seizures really only makes sense if the description of the episodes is unusual or unclear.

There are several reports that if a child with cyanotic (blue) breath-holding spells has iron deficiency anemia, correcting it (by giving iron) can make the spells get better. This may be worth checking into if your child is having frequent spells.

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Go to the Children’s Health health topic.