Introduction:
If a child experiences brief unconsciousness followed by waking up after an emotional outburst, there is no need to panic if this condition is understood. The condition named breath-holding spells, mainly affecting children below three years, is what the child is experiencing, often misinterpreted as seizures or other medical conditions.
What Are Breath-Holding Spells?
After crying about an ungranted wish or a denied request by the parent, the child holding their breath and remaining motionless for a minute or even less is called a breath-holding spell. These are usually scary to experience as a parent but are not harmful to the child.
What Happens in a Breath-Holding Spell?
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In almost all cases, the sequence of events in a breath-holding spell is typical.
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The child will have a long cry at first, usually after being denied a demand.
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The crying usually stops at a vigorous level with the expiration of rapid breaths.
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The child then holds their breath and becomes unconscious with almost no movement for not more than one minute.
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They also usually turn blue or pale and lie stiff.
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The child may also present with symptoms like a few jerks in the body, can experience severe sweats, or even wet themselves in some cases.
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They usually wake up in a minute, sometimes with a deep gasp.
What Are the Causes of a Breath-Holding Spell?
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The exact cause of such spells is still unknown and remains a puzzle. These spells are common and can be seen in healthy children as well. It is often a behavioral problem that causes the child to cry for something that is denied, leading to breath-holding spells. These spells are not an act done purposely by the child but an involuntary response of the body to certain events that suddenly upset or scare the child.
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Breath-holding spells can occur in children starting from six months. It usually peaks around three years of age and disappears at about five to six years. They are uncommon in children less than six months old.
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Also, they are more common in children with a familial history of such spells.
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Though the exact cause is unknown, children with iron deficiency anemia are supposedly more prone to such spells.
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It is also said that children with breath-holding spells tend to faint more often in their adulthood as a response to similar stimuli.
What Are the Types of Breath-Holding Spells?
There are two types of breath-holding spells such as:
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Cyanotic Spells - Cyanotic spells usually happen if the child is frustrated or angry about something. The child cries hard, keeps exhaling continuously, and ends up fainting and turning blue. Cyanotic spells are more common when compared to pallid spells.
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Pallid Spells - Pallid spells are usually experienced when the child gets startled after experiencing a scary incident or pain from getting hit or banging onto something. The child might shout following the pain; they will stop breathing, fall unconscious, and turn pale in this case. The pallid spell does not necessarily follow a cry.
How Is Breath-Holding Spell Management Done?
Effectively handling a breath-holding spell episode involves strategic spell management at various stages. Different approaches involved in breath-holding spell management include:
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The parent or the guardian should stay assured and avoid unnecessary panic as the child usually wakes up in less than a minute.
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Stay near your child and clear the space around them.
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Breath-holding spells do not require special treatment or medication as they last for a brief period, and the child will be completely normal afterward.
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It is safe for the child to lie on the floor facing sideways during such spells to drain the secretions in the mouth.
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The child should not be picked up as it can decrease the blood flow to the brain.
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A blow on the baby's ears or face can sometimes wake them from the spell, but it cannot necessarily wake up every child.
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Ensure that no food or random particles are ingested as it could choke them.
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If the child is anemic or has an iron deficiency, it can be ruled out through blood tests and managed by giving them supplements after consulting with their pediatrician.
What Is the Post-care Advice for Breath-Holding Spells?
Understanding all aspects of breath-holding spells is important. Breath-holding spells may occur from one to two times a day to one to two times a month. Children typically outgrow them by age 6.
While breath-holding spells may be frightening for parents, they are harmless occurrences. Normal breathing naturally resumes without intervention. These spells do not lead to seizures (epilepsy). The following care advice may prove helpful.
Lie Down:
- Encourage the affected child to lie down during the spell, promoting increased blood flow to the brain.
- Remove any food from their mouth and avoid holding them upright, as it can decrease blood flow, potentially causing muscle jerking.
Cold Washcloth to Forehead:
Apply a cold, wet washcloth to your child's forehead until normal breathing resumes. This simple care is generally sufficient.
Monitoring the Duration of Breath-Holding:
- Although breath-holding spells may seem prolonged, there are a few occurrences of using a watch with a second hand.
- Breathing typically resumes within 60 seconds.
Other things to be considered during and after breath-holding spells:
- Avoid unnecessary interventions like mouth-to-mouth breathing. Refrain from placing anything in the child's mouth to prevent choking or vomiting. Never shake the child, as it may lead to brain bleeding.
- The child can feel exhausted or tired after a spell and fall asleep.
- Some spells may begin with a temper tantrum, such as when the child is denied something.
- Refrain from punishing the child or rewarding them so that they will feel better, as these can negatively alter their behavior.
- Maintain consistency in response both before and after the spell. Offer a brief hug and resume normal activities.
- The child should not be taunted for fainting; instead, they should be made comfortable and reassured that it was not their fault.
When to Seek Medical Help for Breath-Holding Spells?
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If the spell exceeds three minutes, it should be considered an emergency, an ambulance should be requested, and CPR (cardiopulmonary resuscitation) should be started.
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If the child gets a seizure following the spell, it is better to seek medical help, but having a seizure does not put them at long-term risk.
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If the child gets such spells frequently, they should be taken to a doctor to know the cause, and behavioral therapies can be given.
How to Prevent Breath-Holding Spells in Children?
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If the child experiences a breath-holding spell for the first time, it is necessary to know that they are prone to such spells in the future.
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Breath-holding spells can occur as frequently as several times a day to just once a year.
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Kids usually outgrow such spells with age.
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If parents are excessively worried about the spells, they can take the child to a pediatrician who usually will be able to diagnose just by hearing what initiated it and will guide them with the factors that can trigger such spells so that an alteration in the approach towards the child can be made.
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The parents should make sure not to give in to avoid such spells as they can negatively influence their behavior.
Conclusion:
Children usually outgrow these spells as they grow and do not require any treatment other than helping them overcome emotions like frustration, fear, and anger. Identifying the cause and using calm discipline protocols can help one’s child overcome such spells. Contact the doctor if spells become more frequent, if there are any changes like the spells if there is a belief that the child requires medical attention, or if the child's condition worsens.
