Breath-holding spells: Why some toddlers turn blue and pass out

Jessica Farber was picking up her son from daycare the first time he held his breath to the point of losing consciousness. When she went to put on Theo’s jacket, the 15-month-old opened his mouth to protest. “He did one of those big, silent cries that usually ends when they catch their breath, but it never resolved,” recalls Farber, now a mom of three. “He ended up contorting his body and going limp in my arms. He basically turned blue and passed out.”

The daycare director (who also happened to be Farber’s mother) called 911. Meanwhile, Farber laid Theo down and was about to attempt mouth-to-mouth resuscitation when he suddenly started breathing again. The entire ordeal lasted only 60 seconds, but it had a lasting impact on the Toronto mom. “It was a shocking experience,” she says. “I felt like he was going to die.”

Ten days later, it happened again. But this time, Theo’s body jerked and his head tilted to the side repeatedly after he lost consciousness. It looked like he was having a seizure.

In reality, in both cases, her son was having what’s known as a breath-holding spell, a relatively common phenomenon that affects up to five percent of kids, usually infants and toddlers between the ages of six months and four years. “In my practice, there’s probably not a single week that goes by without meeting parents who are concerned because this has happened, often in the bath or when the child was crying because a toy was taken from them,” says Ran Goldman, a paediatrician and emergency physician at BC Children’s Hospital.

Even though breath-holding spells occur in one child in 20, doctors still don’t know what causes them. They used to think it was attention-seeking behaviour, but it’s now understood that the episodes are involuntary. A 2014 study from Turkey suggested that a delay in the development of the brain stem could be the culprit. “We think it might be a sign of immaturity of the brain to deal with stressors,” says Julia Jacobs, director of the Pediatric Epilepsy Program at Alberta Children’s Hospital. “It’s kids who are more excitable than other kids, and they are less mature when it comes to regulation.”

Most children experience cyanotic breath-holding episodes, which are triggered by excessive crying out of anger or frustration. Kids seem to run out of breath on the exhale, turn blue around the lips and then lose consciousness, usually for no longer than 30 seconds.

Fewer children have a pallid breath-holding spell, brought on by a sudden scare or injury that causes their heart rate to slow and breathing to stop. These episodes look more like a fainting spell, with kids turning white before they pass out.

When a child loses consciousness because of breath holding and their body convulses like Theo’s did, parents often wonder about epilepsy. But the jerking that comes from breath holding is caused by a temporary lack of oxygen to the brain, not abnormal brain activity.

If your child experiences involuntary breath holding, your healthcare provider will ask you to make note of the episodes’ frequency and duration. If the spells are daily or if your child is losing consciousness for longer than 30 seconds, further testing may be needed. Jacobs recommends that all children who are experiencing episodes get an EKG, a non-invasive test that measures the heart’s electrical activity.

Breath holding has also been linked with iron-deficiency anemia. Some doctors recommend treatment using iron supplements, which has been shown to reduce the frequency of spells.

Once parents understand what’s happening—and that their child will always start breathing again—it’s easier to stay calm during an episode. Focus on protecting your kid’s head and limbs from hitting anything if they lose consciousness. In most cases, kids carry on with their day afterwards, but might continue crying or need a nap.

If you catch a spell early, there’s also a trick you can try to get them breathing right away. “What the parent needs to do is to blow on the child’s face abruptly and immediately, and to do that with all the force that they can get from their lungs,” says Goldman. This normally stops the spell, he says. Farber used this technique, among others, on Theo, and says it was always effective.

Now six years old, Theo has gone two years since his last breath-holding spell. He’s a happy, healthy kid who has no memory of his breath holding. And his mom is feeling calm about it, too, because she’s learned there shouldn’t be any long-term effects. “We know for sure the [spells] are relatively innocent,” confirms Goldman. “They do not cause any brain damage or long-term consequences.”

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