Is Your Child Holding Her Breath or Having a Seizure?


One of the most common questions I get asked in my pediatric neurology practice is how to tell if a child is having a seizure. Most likely, if the child is an infant or a toddler experiencing a breath-holding spell, it’s not a seizure. So how can a parent tell the difference?

Breath-holding spells can occur in infants and toddlers when something sudden, scary or emotional happens to them, like a fall or an injury. They get upset and cry, and sometimes that leads to a pause in their breathing when air is not getting in or out of their lungs. In some cases, the child may pass out and even shake, get stiff or roll their eyes.

These symptoms may look like a seizure, but most likely that isn’t the case. At the infant or toddler stage, breath-holding is an involuntary reflex that the child cannot control.

While this kind of episode can be frightening for a parent or caregiver to watch, the child should recover within a minute and is not harmed.

There are two types of breath-holding episodes:

  • Cyanotic, which is usually triggered by the child becoming frustrated or angry then may cry intensely, become silent for a few seconds, turn blue and lose consciousness.
  • Pallid, which is triggered by a sudden fright, pain or head injury. The child becomes pale, loses consciousness and becomes limp.

Many studies have documented the biologic changes that occur in these episodes that prove these episodes are not a behavior problem and cannot be controlled by the child, according to information presented by the Child Neurology Foundation. Changes in the child’s heart rate and blood pressure trigger the loss of consciousness.

Although there is no specific treatment for breath holding spells, iron supplementation in children with iron deficiency may improve the frequency or severity of the spells. Breath-holding episodes occur in a small subset of the population: just 4-5% of babies and toddlers. Also, children grow out the condition as they mature, usually by the age of four.

If you can “tell the story” of a sequence of events that led up to the breath-holding incident – Did a sibling push them over? Was their finger pinched in a door? – then likely the child will be just fine. If you are at all concerned about your child, you should contact his or her doctor or take them to an ER.

Pediatricians usually refer patients to a practice like mine when a child is not developing appropriately, they’re not walking or talking, or if they child has headaches, muscle weakness, tremors, or there’s a concern for seizures. Any concern you have about a child should be discussed with their doctor to determine a course of action and whether there is a need to see a specialist.


About Dr. Benjamin Ross

Recognized as a “Top Doctor” by 5280 Magazine, Dr. Ross is a board-certified pediatric neurologist at Rocky Mountain Pediatric Neurology & Sleep Medicine. His special interests include seizures/epilepsy, headache/migraine, cerebral palsy/spasticity and stroke. He is a member of the American Academy of Neurology and the Child Neurology Society and locally has been involved with the Epilepsy Foundation of Colorado. When not in his office at Rocky Mountain Hospital for Children, Dr. Ross is spending time with his family or skiing, snowshoeing, golfing, hiking and biking. For more information, visit his website or call (303) 226-7230.


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