Breath-holding spells are perhaps the most frightening of the common, benign behaviors of childhood. Desperate parents often want to splash cold water on the child's face, start mouth-to-mouth resuscitation, or even begin CPR. Thankfully, breath-holding spells resolve spontaneously soon after the child passes out, and unless the fall hurts the child, she will be fine afterwards. The spell usually resolves within 30 to 60 seconds, with the child catching her breath and starting to cry or scream. Sometimes children will have real seizures as part of breath-holding spells, but these brief seizures are not harmful, and there is no increased risk of the child's developing a seizure disorder. Breath-holding spells occur in about 5% of children.

The first time a spell occurs, parents should have the child examined by a doctor. Because breath-holding spells do share several features in common with seizure disorders, the two are often confused. In epileptic seizures, a child may turn blue, but it will be during or after the seizure, not before.

If your doctor confirms that the event was indeed a breath-holding spell, it is a good idea to check for anemia. Treating the anemia, if present, will often decrease the frequency of passing out. The parents' most important job, however, is to not reinforce the breath-holding behavior -- either by bending to the child's will or by paying more attention to her when she has these spells. Instead, if you are certain she hasn't choked on something, place her in a safe spot (without giving in to whatever she held her breath to achieve), and ignore her behavior.

Alan Greene MD FAAP

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Khanh-Van Le-Bucklin M.D. & Liat Simkhay Snyder M.D.

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