Breath-holding spells in children

Types of breath-holding spells

There are two distinct disorders that are called "breath-holding spells".

Blue breath-holding spells

Blue breath-holding spells are the most common type of breath-holding disorder, and often occur during vigorous crying or sobbing that's triggered by pain, frustration, anger or fear.

The child usually cries vigorously for less than 15 seconds and then becomes silent, their breath held on the outward breath, unable to take an inward breath (inhale).

They turn blue particularly around the lips and lose consciousness. Milder attacks without loss of consciousness will be familiar to most parents.

The child will become either floppy or stiff and remain unconscious for less than a minute before regaining consciousness and breathing normally again. They may appear tired for a while afterwards.

Blue breath-holding spells are caused by an involuntary reflex that's part of the crying mechanism. In some children, particularly in toddlers, it's so intense that they get stuck in an outward breath for so long that they faint .

In the pre-school years some children may have several fainting episodes a week. However, most children will grow out of them by the time they start school.

The episodes are involuntary, aren't dangerous and don't cause brain damage. They're not a sign of a difficult child or poor parenting. They're not epileptic seizures.

The episodes will improve with age, but may get more frequent before they become less frequent and disappear altogether.

If the child is iron deficient, treatment with iron supplements can help. A simple blood test can be used to determine whether the child is anaemic or iron deficient.

Reflex anoxic seizures

Reflexanoxic seizures are often triggered by a sudden unexpected fright or pain, such as a fall with a minor head injury . The seizure isn't caused by the injury itself, but by the sudden fright or pain.

The child will often open their mouth as if they're going to cry, but make no sound before turning a deathly pale grey colour and losing consciousness.

They'll become either limp or more often stiff, with their eyes rolling upwards and their fingers clawed. Their body may also jerk a few times.

The seizure will usually last less than a minute. Afterwards the child will regain consciousness, but may appear sleepy and confused for a few hours.

Reflex anoxic seizures are caused by an involuntary slowing of the heart rate, to the extent that the heart actually stops beating for 5-30 seconds. This is why the child looks so deathly pale.

However, the heart is normal and the slowing is caused by an excessively strong reflex signal from the brain via the vagus nerve.

The vagus nerve is one of 12 nerves in the head. It runs down the inside of the head, passes through the neck, and into the chest and abdomen.

After five seconds of the heart beat stopping, the child will start to lose consciousness, and after 10 seconds they'll be deeply unconscious. Usually, by 30 seconds the vagus nerve starts to lose its signal strength and the heart starts beating again on its own.

The heart will always automatically start to beat on its own as the strength of the vagus nerve signal fades.

In the pre-school years some children may have several reflex anoxic seizures a month, but most will grow out of them by the time they start school. Some children will continue to occasionally have them into adult life.

Reflex anoxic seizuresare involuntary, aren't dangerous and don't cause brain damage or death. They're not a sign of a difficult child or poor parenting. They're not epileptic seizures.

The seizures will improve with age, but may get more frequent before becoming less frequent or disappearing altogether.

If the child is iron deficient, treatment with iron supplements can help. A simple blood test can be used todetermine whether the child is anaemic or iron deficient.