Breath-Holding Spells in Babies

When to get help

Call emergency services — 999 in the UK, 112 or 999 in Ireland and across the EU, 911 in the US and Canada, 000 in Australia, 111 in New Zealand — if your baby stops breathing and does not start again within about a minute, does not come round quickly, has a fit, or is floppy and unresponsive afterwards. Also call if the episode happened with no crying beforehand, or during sleep, because that is not the breath-holding pattern.

See a doctor after the first episode, even if your baby recovered completely within a minute. The NHS advises getting breath-holding episodes checked, partly to confirm the diagnosis and partly because iron deficiency anaemia and, occasionally, a heart rhythm problem can be found in children who have them.

Seek advice again if the episodes become more frequent or longer, if they start happening without an obvious trigger, if your baby is under six months, or if there is jerking of the limbs during them.

What actually happens

A breath-holding spell almost always starts with a trigger: a fright, a bump, frustration, anger, pain or sudden shock. Your baby cries, and then, at the end of a breath out, stops breathing.

Within about ten to twenty seconds the colour changes. The face and lips go blue, or in the other type go very pale. Some babies then go limp, and some stiffen and briefly jerk. Breathing restarts on its own, colour comes back, and most babies are alert again within a minute, though they are often sleepy and clingy afterwards.

The NHS is clear that these episodes are not usually harmful, that a baby is not doing it on purpose, and that they are not a form of naughtiness or manipulation. A baby cannot voluntarily hold their breath to the point of losing consciousness. Once consciousness goes, normal breathing resumes automatically.

The two types

The blue type is the common one. It follows crying — anger, frustration or pain — and the child goes blue around the lips and face before going limp. It is triggered by the mechanics of a hard cry and a prolonged out-breath.

The pale type usually follows a sudden fright, a knock to the head, or a shock, sometimes with very little crying first. The child goes white and floppy, and this version is driven by the heart rate slowing sharply for a few seconds. It looks even more alarming, and is just as benign in the usual case.

Both types typically start between about six months and two years, and most children have grown out of them by around four or five. They may happen once, or several times a week.

How to tell it apart from a seizure

The order of events is the giveaway. In a breath-holding spell the sequence is trigger, cry, silence, colour change, then limpness or a brief stiffening. In a seizure the movements usually come first, or there is no trigger and no cry at all, and afterwards a child is often confused or heavily sleepy for a much longer period.

Some breath-holding spells do end in a few seconds of stiffening or jerking because the brain has been briefly short of oxygen. That does not make it epilepsy, and it does not mean your child will develop epilepsy. But a first episode is always assessed rather than assumed, which is why the advice above is to be seen.

The iron question

Iron deficiency anaemia is found more often in children who have breath-holding spells than in those who do not, and treating it can reduce how often the spells happen. That is why a blood count is a reasonable thing to ask about at the appointment after a first episode, particularly in a baby who was premature, who is a fussy eater, or who has had a lot of cows' milk once past one year.

If iron is low, treatment is prescribed and monitored. Do not buy iron supplements over the counter for a baby; iron is one of the commonest causes of accidental poisoning in small children and the amount depends on weight and blood results.

What to do during an episode

Stay calm, and stay with your baby. Lay them on their side on a flat surface where they cannot fall or knock into anything. Note the time it starts — episodes feel far longer than they are, and a timed thirty seconds is a much more useful thing to report than a panicked guess.

Do not shake your baby, do not slap or splash them with cold water, do not blow in their face, and do not put anything in their mouth. None of it shortens the episode and shaking can cause serious injury. Once your baby comes round, comfort them and let them rest.

Film it if someone else is present and the baby is safe. As with any episodic event, a short video answers questions that description cannot.

Living with them

Try to notice the triggers, because many are predictable: hunger, tiredness, being rushed, sudden frustration over something out of reach. Heading those off — a snack before the shops, an earlier nap, giving warning before a change of activity — genuinely reduces frequency in many children.

Do not start giving in to whatever preceded the episode in order to prevent the next one. The spells are not chosen, but the situations that trigger them can become more frequent if a child learns that a particular reaction changes an outcome. Handle the behaviour before it exactly as you would if the spells did not happen.

Tell nursery, grandparents and anyone else who looks after your baby what to expect and what to do, and give them the sequence in writing. The first time somebody else sees it, they will call an ambulance unless they have been told, and that is a reasonable thing for them to do.