Coping With Our Child When Holds Their Breath Until Turning Blue

     When a child cries to the point of turning blue in the face, the situation can be quite alarming for many parents. Although such episodes may appear frightening and concerning, in reality, the child will naturally resume breathing without intervention. These episodes do not cause brain damage nor do they affect the child’s development. Furthermore, the condition typically improves and eventually disappears as the child grows older.

What Are Breath-Holding Spells?

     Breath-holding spells are relatively common in children and often occur in response to emotional stimuli such as frustration, intense anger, pain, or dissatisfaction. During these episodes, the child may cry so hard that they momentarily stop breathing, which can lead to cyanosis (bluish discoloration of the skin) or even brief loss of consciousness. This condition most commonly affects children aged 6 months to 4 years. In about half of the cases, symptoms resolve after the age of 4.

Types of Breath-Holding Spells

Breath-holding spells are classified into three types based on symptoms:

1.  Cyanotic Breath-Holding Spell

     This type occurs when a child cries intensely and then stops breathing, leading to a bluish discoloration around the mouth and face due to a temporary lack of oxygen.

2.  Pallid Breath-Holding Spell

     This type is caused by an exaggerated autonomic nervous system response, leading to a slow heart rate. The child may appear to faint, similar to older children experiencing a vasovagal response.

3.  Mixed Episodes

     A combination of both cyanotic and pallid features.

Causes of Breath-Holding Spells

Several factors can trigger breath-holding spells in children:

1.  Expression of Emotional Needs

     Most breath-holding spells are triggered by emotional stress, such as being denied something or facing disappointment. This can lead to extreme frustration, anger, or irritability, causing the child to cry intensely. In some cases, the child may temporarily lose consciousness or experience brief convulsive movements.

2.  Immature Nervous System

     Some studies suggest that breath-holding spells may be due to dysregulation in the autonomic nervous system, which controls involuntary body functions such as heart rate and blood pressure. Impaired function in this system can contribute to pallid-type spells.

3.  Family History

     Many children with breath-holding spells have a family history of the same condition, particularly among parents or siblings who experienced similar episodes during childhood.

4.  Iron Deficiency

     Nearly 50% of children with breath-holding spells are found to have underlying iron deficiency. Insufficient iron can reduce the brain's oxygen supply, making children more prone to cyanotic episodes.

Preventing Breath-Holding Spells

• Parents should aim to offer choices to children to reduce resistance and avoid emotional escalation. Providing alternatives, even in small matters, can help divert the child’s attention.
• If a child begins to cry due to frustration, it may help to implement a “time-out” by placing the child in a safe and secure area, such as lying them flat on a mattress or bed. Avoid shaking or lifting the child abruptly.

Most importantly, caregivers should take these preventive measures early in the crying episode, before it escalates to the point of breath-holding and turning blue.

• After the child has calmed down, it is advisable to gently explain that while feeling angry is understandable, intense crying or tantrums are not acceptable behaviors.
• If a physician has prescribed iron supplements, they should be administered regularly as directed. However, if these strategies prove ineffective, or if the child experiences prolonged loss of consciousness or convulsive episodes lasting more than a few minutes, medical attention should be sought promptly.