Breath-holding spells, also known as breath-holding attacks, are involuntary episodes during which a child holds their breath, usually triggered by something upsetting or scaring them. They most commonly occur between 6 months and 2 years of age, but can occur up to 4-5 years. They are not harmful in the long term and do not lead to epilepsy.
Cyanotic Breath-Holding Spells
Cyanotic breath-holding spells occur when the child is really upset, worked up and crying. After letting out a long cry, they stop breathing, become cyanotic and lose consciousness. They regain consciousness, and breathing restarts within a minute. They may be tired and lethargic after an episode.
Reflex Anoxic Seizures
Reflex anoxic seizures, also known as pallid breath-holding spells, occur when the child is startled. The vagus nerve sends strong signals to the heart, causing temporary bradycardia or asystole (heart stopping). The child will suddenly go pale, lose consciousness, and there may be seizure-like muscle twitching. Within seconds, the heart restarts, and the child regains consciousness. Episodes can last up to 30 seconds or rarely longer. An episode may be isolated or occur in clusters with several episodes over days or weeks.
Management
After excluding other pathologies and making a diagnosis, parents can be educated and reassured.
Breath-holding spells have been linked to iron-deficiency anaemia. Supplementary iron may reduce further episodes.
Last updated January 2026
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