Breath Holding Spells Fact Sheet

Involuntary Breath Holding Spells (IBHS)

Fact Sheet

What are Involuntary Breath Holding Spells?

Brief periods when small children, infants, and toddlers are unable to breathe due to injury, upset or startle.  These Spells often cause changes in skin color, seizures and loss of consciousness.  Involuntary BHS can last anywhere from a few seconds to couple minutes.  But these spells areinvoluntary.  Age of onset varies per child but has been seen as early as birth to 6 months, and can last up to age 8.

Types of Involuntary BHS

Cyanotic Spells-caused by a change in the child’s usual breathing pattern, usually in response to the child being upset or startled, but can also occur with injury.  Cyanotic spells cause the child to turn blue-purple beginning around the lips and mouth and spreading to the rest of the face.  These are the most common of the spells

Pallid Spells-less common than cyanotic spells, these are caused by a slowing or stopping of the child’s heart rate, usually in response to pain.  Pallid spells are named due to the paleness of the child’s skin.

Simple IBHS-Simple spells are more of a category of this condition.  Simple spells are spells that do not cause the child to have a seizure or lose consciousness.  Your child will stop breathing, turn blue-purple or pale for a short period of time and be able to breathe again shortly after.

Severe IBHS-These severe spells can be very traumatizing to witness, especially on a daily basis.  Severe IBHS cause your child to stop breathing, turn blue-purple or pale, and a seizure and/or lose consciousness.  These spells can last anywhere from 1-3+ mins.  If your child is unconscious and unresponsive for 2 min call 911 and start rescue efforts to revive your child (see “In case of Emergency” section for more details).

Complex IBHS-Complex IBHS refers to a small percentage of children who experience both cyanotic and pallid spells.

Causes of Involuntary Breath Holding Spells

There are a few causes that have been identified for Involuntary Breath Holding Spells, however, the majority of the time an identifying cause is not found.  In some children IBHS may be related to iron deficiency anemia, a condition in which the body doesn’t produce enough red blood cells.  There are also cases where an underlying heart problem is identified.  In each of these cases treatment of the underlying problem should relieve the IBHS.

Symptoms

Involuntary Breath Holding Spells may cause:

• Fainting/Loss of consciousness
• Twitching muscles, a stiff body or a seizure
• Changes in skin color
  • In cyanotic spells skin may change red or blue-purple, especially around the lips
  • In pallid spells, skin may be pale and sweaty
• Changes in breathing or heart rate
  • In cyanotic spells your child may breathe too fast or too hard.  When your child breathes out, there may be a long pause before your child takes another breath.
  • In pallid spells, the heart may slow down considerably, almost to a stop, and sometimes stop completely.

How is Involuntary Breath Holding Spells Diagnosed?

Most doctors give a diagnosis based on your description of events and a few questions based on family history.  If a doctor feels your child may have had a seizure, or that there is a possibility of another underlying condition they may request additional testing.  However, the majority of cases are diagnosed without testing.  It is important to keep a detailed journal of your childs spells, and inform your child’s pediatrician of any changes in spells.

Treatment

Unless an underlying cause for your child’s Involuntary Breath Holding Spells, there is no treatment.  Your child will outgrow IBHS.  During this time it is important to remember that this is an involuntary medical condition.  When your child has a spell, lay them in a safe area, to avoid injury if they have a seizure.  If you think your child may have something in their mouth, turn them on their side to avoid choking or aspiration.  Keep their surroundings calm during a spell, talk soothingly to them, rub their back, head, hold their hand.  Most importantly, when a spell is over don’t be afraid to comfort your child.

In Case of an Emergency

The majority of cases of Involuntary Breath Holding Spells will never result in an emergency situation.  However, emergency situations have been reported, so it is important to have a plan should one arise.

If your child is unresponsive or seizing for 2 mins, call 911.  If your child is unresponsive with a faint pulse start rescue breaths.  If your child is unresponsive with no pulse, start CPR.  CPR can be an exhausting, so it is ideal to have some one with you to share the reps.  If you haven’t already, now is a perfect time to take a CPR class, or ask your child’s pediatrician to give you a lesson. (See "Home" page for CPR steps)

Summary

Involuntary Breath Holding Spells occur in 27% of otherwise healthy children.  Regardless of the type, category, or frequency of the spells they can be traumatic for both your child and those who witness them.  Although most cases of IBHS are diagnosed simply by your account of the spells and a short family history, if your child suffers a severe case it is best to have a cardiac and neurological workup to rule out more serious causes.  Unless an underlying cause is identified, there is no known treatment for IBHS.  Some parents find it helpful to keep track of their child’s spells in a detailed journal, and report any changes in spells to the child’s pediatrician.  Most importantly, find a group of people to connect with, who can provide you and your family with support.  Life with IBHS is difficult for all to cope with.