Breath-holding spells are brief periods where a baby or young child holds his or her breath, often as a response to fear, pain or frustration. The condition is usually benign, but it can be frightening for parents or caregivers. 

We asked pediatric emergency medicine physician Meghan Martin, M.D., what causes breath-holding spells and what parents should do about them.

What does a breath-holding spell look like?

There are a couple of ways it could go. One way is that, in response to an event, a child could start “silently crying,” where their face looks like they’re crying, but no sound comes out. Another pattern is when a child may make an initial cry and then hold their breath, where no sound comes out. Either way, the child could turn red or blue or pale and may even briefly pass out.

What are some of the causes of breath-holding spells?

Most often, it’s a child’s individual reaction to something frightening, or to pain or to being upset. It is usually benign, but not always. Sometimes recurrent breath-holding spells can be a sign of low iron or iron deficiency anemia. Breath-holding spells have also been related to low selenium (an antioxidant mineral found in nuts, fish and meat) levels in some kids.

There are other explanations that are fairly rare, including conditions such as long QT syndrome, Rett syndrome or the potential of seizures. When we see these kids in the Emergency Center, we get a medical history and we’re usually able to determine what is going on, but sometimes we may want to start them on an iron supplement or run some tests such as an EKG to look at their heart rhythm or maybe an EEG if we’re concerned that there may be seizures happening.

At what ages do breath-holding spells occur, and do children outgrow them?

Kids tend to have breath-holding spells primarily between the ages of 6 months and 6 years — with the peak in occurrence of around 12 to 18 months. That’s usually the age when kids can’t fully communicate how upset or frustrated they are. 

These breath-holding spells are not what parents have traditionally thought of as “temper-tantrums,” are they?

No, these spells used to be thought of as “attention-seeking,” and the advice was to ignore them. But the latest information suggests that these spells really are involuntary. Providing comfort and attention to your child is recommended. A parent may try to lay the child down flat, and it may help to blow in their face to startle them into taking a breath. The spells usually last between 15 and 60 seconds.

What is your bottom-line advice for parents when it comes to breath-holding spells?

My bottom-line advice is to understand that these are not uncommon. Yes, they can be scary and nerve-racking, but they don’t necessarily mean anything serious is going on with your kiddo. If the spells are consistent or frequent, consult with your child’s pediatrician. If your child ever stops breathing for more than a minute during one of these spells, seek emergency medical attention.