Breath Holding Spells

Breath holding spells are episodes of brief, involuntary cessations of breathing that occur in children in response to stimuli such as anger, frustration, fear or injury. A breath holding spell is a reflexive response that occurs in some healthy young children, usually between the ages of about eight months and two years. A typical breath holding spell lasts between 2-20 seconds. The child cries or gasps, forcibly exhales, stops breathing and turns either blue (cyanotic form) or pale (pallid form).

 

The frequency of breath holding spells varies from several times a day to perhaps only once a year. About one-third of affected children have two to five spells daily whereas another one-third of affected children average one spell per month.

 

Cyanotic form:

 

About 60 percent of affected children have the cyanotic form of BHS, in which the skin And lips turn bluish. This type of breath holding spell also is called type 1, red-blue form, or cyanotic infantile syncope. It usually occurs when the child is angry or frustrated and may be a component of a temper tantrum.

 

Pallid form:

 

About 20 percent of affected children have the pallid form of BHS in which the child turns pale. It also is called type 2, white breath-holding, reflex anoxic seizure, or pallid infantile syncope. The pallid form of BHS typically follows a frightening or painful experience. An additional 20 percent of affected children have both types of breath holding spells at different times.

 

It sometimes may be possible to prevent or interrupt a cyanotic spell:

 

  • Avoiding situations or events that may lead to tantrums or have caused previous breath holding spells
  • Intervening in temper tantrums with soothing words and gestures
  • Distracting the child
  • Encouraging the child to express emotions
  • Placing a cold cloth on the child's face, particularly within the first 15 seconds

 

Parenting strategies that may help avoid cyanotic spell:

 

  • Ensuring that the child gets plenty of rest, including daytime rest periods and adequate sleep at night
  • Not allowing the child to become too hungry, because hunger can contribute to frustration
  • Minimizing unnecessary frustration
  • Avoiding unnecessary discipline
  • Helping the child to learn other means of expressing anger and frustration
  • Maintaining a regular daily routine
  • Maintaining a calm home atmosphere
  • Allowing the child to make simple choices
  • Appraising accomplishments and good behavior
  • Helping the child to feel secure
  • Helping the child to become more independent and self-confident

 

Parental concerns:

 

Breath holding spells can be extremely frightening for parents, siblings and caregivers. Families need to be reassured that BHS is not a harmful or dangerous event and that no treatment is needed. It is important that caregivers understand the cause of breath holding spells and the proper response.

 

During a breath holding spell parents should:

 

  • Protect children from injury and prevent their arms, legs and head from hitting something hard or sharp.
  • Lay children down on their back or side, preferably on a padded surface such as a carpeted floor; this increases blood flow to the brain and helps prevent muscle jerking.
  • Check for food in the mouth if the child ate just before a spell. Parents should not try to remove the food; rather the child's head should be turned to one side so that the food can come out on its own.
  • Put a cold wet washcloth on your child's forehead until he starts breathing again.
  • Allow children to wake from the spell on their own.
  • Touch and talk to the child.
  • Time the spell with a watch.

 

Treatment after attacks of breath-holding:

 

  • Give your child a brief hug and go about your business.
  • A relaxed attitude is best.
  • If you are frightened, don’t let your child know it. If your child had a temper tantrum because he wanted his way, don't give in to him after the attack.
  • After a spell, briefly reassure your child.
  • Keep in mind that your child is not doing this on purpose. Don't punish your child for having a breath-holding spell.

 

Prevention of injuries:

 

The main injury risk of a breath-holding spell is a head injury. If your child starts to have an attack while standing near a hard surface, go to him quickly and help lower him to the floor.

 

Following a breath holding spell, parents should do the following:

 

  • Acknowledge the child's behavior and emotions.
  • Reassure any other children present that everything is okay and it is not their fault.
  • Hug the child and walk away.

 

Parents should NOT do the following:

 

  • Overreact
  • Call 911 or use mouth-to-mouth resuscitation or cardiopulmonary resuscitation
  • Place anything in the child's mouth which could cause choking or vomiting
  • Give the child any medications during the episode
  • Do anything that could reinforce the behavior, including paying undue attention to the child, making a fuss about the episode or giving in to the child's demands
  • Try to keep children from all frustration by overprotecting or sheltering them

 

A note for the parents:

 

A parent who cannot watch a child having a breath holding spell without intervening should leave the room. Parents who have difficulty dealing with a child's frequent breath holding spells may choose to seek counseling.

 

Call for Help:

 

If a child does not begin breathing on his or her own within one minute, it is not a normal breath holding spell. The parent should call 911 or other emergency services and begin rescue breathing to maintain the child's air passage until help arrives.

 

Keep in mind that breath-holding spells do not:

 

  • Interfere with your child's growth and development.
  • Cause permanent brain damage.
  • Lead to mental illness or emotional problems.
  • Lead to seizure disorders.

 

Talk with your doctor if:

 

  • Spells become more frequent or more severe or change their pattern.
  • You have trouble dealing with your child's breath-holding spells. Counseling may help you handle your concerns and feelings. Do not spank your child or use other types of corporal punishment.

 

Note for parents:

 

Helping your child gain independence and self-confidence in the early years is important and may help reduce breath-holding spells. Ask your doctor for information on how to help your child gain a sense of independence, boost his or her self-confidence and learn to handle frustration

 

 


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