What it is

The NHS describes breath-holding as "when a baby or child stops breathing for up to 1 minute and may faint. It can happen when a child is frightened, upset, angry, or has a sudden shock or pain." Its verdict: "it's usually harmless but can be scary for parents, particularly when it happens for the first time."

The most important thing to understand is that it is not deliberate. The NHS states it directly: "your child is not holding their breath on purpose and cannot control what happens when they have a breath-holding episode." It is a reflex, not a tactic.

The first time: get it checked

The NHS is unusually careful here, and this is the part to read before anything else. It says to call 999 if your child faints and cannot be woken up, if they are stiff, shaking or jerking, or if their lips, tongue, face or skin suddenly turn pale, blue or grey — noting that on black or brown skin this may be easier to see on the palms of the hands or the soles of the feet.

Then it adds the crucial qualifier: "these could be symptoms of breath-holding, but could also be related to other, more serious conditions. If a doctor has not previously told you it's breath-holding, it's important to get it checked immediately."

So the rule is simple. Until a doctor has seen your child and told you this is breath-holding, treat an episode as something that needs urgent assessment. After that, you can manage it at home.

What an episode looks like

The NHS says that during breath-holding a child may cry and then be silent while holding their breath; open their mouth as if going to cry but make no sound; turn pale, blue or grey; be floppy or stiff, or their body may jerk; and faint for 1 or 2 minutes. Afterwards they may be sleepy or confused for a short while.

The Royal Children's Hospital Melbourne separates two types. Blue spells are the most common: the child cries or screams, breathes out forcefully, then holds their breath and turns blue, especially around the lips, for a few seconds, and may become floppy and lose consciousness. Pale spells are less common, are caused by a slow heart rate, and are often mistaken for a seizure: the child opens their mouth as if to cry with no sound, faints and looks very pale, and may briefly stiffen or lose bladder or bowel control.

RCH notes that both types "only last a few seconds" and "do not cause any long-term damage".

What to do during one

The NHS list is short and specific.

Stay calm — it should pass in less than a minute.
Lie the child on their side. Do not pick them up.
Stay with them until the episode ends.
Make sure they cannot hit their head, arms or legs on anything.
Act normally afterwards, reassure them, and make sure they get plenty of rest.

And what not to do:

Do not shake your child or splash them with water. RCH says the same: there is no need to splash cold water or blow air in their face.
Do not put anything in their mouth, including your fingers.
Do not give mouth-to-mouth or CPR.
Do not tell them off — "they're not doing it deliberately."

RCH adds a point about afterwards that is easy to get wrong: "once your child has recovered, it is important to act normally. Don't punish or reward them or make a big fuss. Treat your child as if nothing has happened."

How common, and how long it lasts

RCH says breath-holding is common, especially in children aged six months to six years, that most children who have spells will have their first before 18 months, and that most grow out of it by six. Children who breath-hold usually have one to six spells a week, though up to a quarter have multiple spells each day.

The NHS says a child "should grow out of it by the age of 4 or 5", that episodes usually last less than a minute, and that they "are not epileptic seizures".

The iron connection

One detail is worth knowing because it is actionable. The NHS notes that "breath-holding is sometimes related to iron deficiency anaemia", that a child's blood iron levels may be checked, and that they may need iron supplements if their levels are low.

That is a decision for a GP after a blood test, not something to start at home. The NHS carries a specific warning that iron supplements must be kept out of the reach of children, because an overdose of iron in a young child can be fatal.

When to see a GP again

Once breath-holding has been diagnosed, the NHS says to see a GP if episodes happen more often than before or seem worse, or if they are affecting everyday life. The GP will try to find out whether there is a more serious underlying condition, and may suggest an ECG to check the heart rhythm.

RCH gives similar prompts: see a GP if spells are very frequent — more than once a day or several times a week — if your child has a seizure lasting longer than a couple of minutes and is then confused or drowsy for several hours afterwards, or if you are concerned for any other reason. It also says to seek medical advice if a child has knocked their head during a spell.

Reducing how often it happens

There is no treatment that prevents breath-holding, and the NHS says medicines are rarely used. What helps is reducing the triggers, which are the ordinary triggers of toddler distress.

RCH points out that children sometimes hold their breath during a tantrum when they cannot have something, and that distraction can be a good way of avoiding the tantrum and so preventing the spell. The HSE's general advice on big feelings applies too: be realistic in what you expect, stay calm, anticipate the moments when a child is hungry, tired or bored, keep to a routine, and name the emotion out loud rather than arguing with it.

What you should not do is start giving in to avoid spells. That is understandable and it teaches something you will have to unteach. The AAP's general point about tantrums holds: changing your mind to end the episode makes the episode more likely next time. Breath-holding is frightening to watch, but it is not harmful, and your child will start breathing again on their own.

Toddler Holds Breath and Goes Blue: Breath-Holding