Understanding and dealing with baby breath-holding spells

A breath-holding spell is a phenomenon that often goes unrecognized but deserves special attention from parents. These episodes can be frightening to experience and observe, both for infants—and those around them. This article aims to educate parents about breath-holding spells, describing their causes and symptoms, as well as the appropriate reactions in the event of a crisis.

What is a breath-holding spell?

A breath-holding spell is an episode in which a child stops breathing and may lose consciousness following an emotionally upsetting event. This involuntary reflex usually occurs after intense crying, anger, fear or pain. It's important to note that these spasms are not voluntary. They affect around 5% of children aged 6 months to 5 years, with a higher prevalence between the ages of 1 and 3. Genetic factors may also play a role, since 20% to 30% of children with breath-holding spells have a family member who has experienced similar episodes.

Types of breath-holding spells

There are two main types of breath-holding spells: cyanotic and pallid spells.

Cyanotic breath-holding spell

This is the most common form. The child, often overcome by anger or an upsetting event, cries out, exhales, and then stops breathing. This causes a bluish discoloration of the skin, particularly around the mouth. Episodes usually occur in children aged 1-3 and are rare after the age of 5. These cyanotic spells can sometimes be stopped by applying a cold towel to the child's forehead at the start of the attack. 

Pallid breath-holding spell

This form often occurs after a painful event, such as a fall. It is caused by a nervous response that slows the heart rate, resulting in paleness and loss of consciousness. Unlike the cyanotic form, the child becomes pale and limp during the episode.

Symptoms to recognize

Symptoms of a spasm of a breath-holding spell include:

• A very upset child who cries intensely
• Sudden cessation of breathing
• Loss of consciousness, usually of short duration
• A bluish (cyanosis) discoloration around the mouth or pallor (in the case of a pallid spell)

In most cases, the child will regain consciousness and breathing in less than a minute. However, some situations require immediate medical attention.

When should I ask for emergency help?

It is important to consult an emergency room if:

• Your child is less than 6 months old.
• They have symptoms with no apparent triggering event.
• It takes time for them to regain consciousness.
• Your child experiences convulsions. 
• Your child recovers slowly and appears disoriented for several minutes after the episode.

These signs may indicate other underlying health problems requiring in-depth medical evaluation. 

Although breath-holding spells are not dangerous, consult a doctor after the first episode.

How can I prevent breath-holding spells?

Prevention is key to reducing the frequency of breath-holding spells. Here are some effective strategies:

Avoid triggering situations

Identify situations likely to provoke the breath-holding spells and try to minimize them.

Teach your child how to calm down

Use simple techniques, such as breathing slowly or asking your child to do a small task that requires concentration, to divert your child’s attention from the crisis. 

Positive encouragement

Praise your child when they manage to calm down without giving in to anger.

How do you react in a crisis?

When a breath-holding spell occurs, it's natural for parents to feel anxious. However, here are a few steps you can take to ensure your child's safety:

1. Lay your child on its side: This prevents it from choking on their own saliva.
2. Keep dangerous objects away: Make sure your child is in a safe environment.
3. Apply a cold washcloth: Putting a cold washcloth on their forehead can help shorten the episode.
4. Stay calm: Avoid shaking the child or putting anything in his mouth.
5. Let them rest: some children may sleep after an episode. It's important to let them rest.
6. Treat the episode as normal: Once the episode is over, reassure your child without punishing him or giving in to the demands that provoked the crisis.

Conclusion

Although worrying, breath-holding spells do not usually cause long-term problems. As a parent, it's essential to recognize the symptoms, know when to ask for help and react appropriately during an episode. By better understanding this phenomenon, you can support your child while alleviating your concerns.