Dr Andy Raffles
Breath Holding in Children
About 20% of babies and young children have a habit of breath-holding at some time between the ages of 6 months to 4 years, although the episodes can start earlier and go on later. When breath-holding episodes do occur in younger infants, then a frequent cause is pain, as may occur from reflux or ear pain. There is often a strong family history. Breath-holding is one of the commoner symptoms that worry parents but usually has no underlying serious cause.
Usually, each episode of breath-holding occurs during a crying session but can occur just in response to a painful or frightening episode, without a preceding bout of crying. In a breath-holding episode, your baby seems to take a big breath during the cry, breathes out, but fails to breathe in. Their face will go red or blue, and they will faint or resume breathing, usually without intervention.
The episode of breath-holding is usually triggered by an episode of anger, frustration, or pain. Your baby will cry, and they seem to breathe out after a long yell, but not breath in. Their lips turn blue, and either breathing restarts, or they may go on to turn blue all over, and then lose consciousness. This is a feint, which is the baby’s safety mechanism. As they lose consciousness then automatically and inevitably, will start to breathe again. Whilst unconscious, even for a few seconds, they may go stiff, and then twitch. This is a small fit, but the episode is so short there is no likelihood of brain damage.
In general breath-holding episodes are self-limiting, each episode lasting just a few seconds, but this of course can feel like a lifetime when you are watching your child turn blue. Invariably your nerves will be frayed by these events.
Breath-holding is not related to epilepsy, and unless the child was going to develop epilepsy anyway, will not cause epilepsy to start. The episodes are very different in many ways. They will almost invariably have been crying or upset by some event just before turning blue. In epilepsy, there is not usually such a close relationship between a trigger and the event. After the breath-holding episode, they will rapidly be bright and alert, after an epileptic fit they will usually be sleepy.
If they are frequent then advice can be sought, but there are no effective treatments. However, some simple measures can help reduce the frequency of episodes:
Identify if painful reflux is the cause
Avoid reinforcing the behaviour, i.e ignore the triggers
Distract her during crying episodes.
Remain calm and remind other caregivers that these are harmless episodes.
If breath-holding is identified as attention-seeking, then don’t provide the attention but do reassure them after the event.
If the breath-holding spells are very frequent ie 5-10 times per day every day, and lasting more than about a minute, and do not seem to be related to the triggers mentioned above, or if you have any other worries then seek further advice from your doctor or other health care advisor.
White or pallid/pale may be more serious: a previously happy child goes very pale and falls to the ground. This must be investigated by a Paediatrician to exclude fits or heart rhythm disturbances.