A breath holding spell (BHS) is a reflexive response that occurs in some healthy young children, usually between the ages of about eight months and two years.
About 20 percent of affected children have the pallid form of BHS in which the child turns pale.
About 25 percent of affected children-particularly those who experience pallid BHS-have a family history of BHS or fainting.
About 60 percent of affected children have the cyanotic form of BHS, in which the skin and lips turn bluish.
An electroencephalogram (EEG) that records electrical activity in the brain is normal in all forms of BHS, whereas it may be abnormal with epilepsy.
Cyanotic BHS may be a component of a temper tantrum or a child's attempt to gain control over a situation.
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Families need to be reassured that BHS is not a harmful or dangerous event and that no treatment is needed.
However, in some situations a child may learn how to trigger a cyanotic BHS.
However, some studies have suggested that boys are more susceptible and that the average onset of BHS in boys is earlier (13-18 months) compared with girls (19-24 months).
In a cyanotic BHS the long exhalation following crying causes breathing to stop.
In a pallid BHS the brain sends a signal via the vagus nerve that severely slows the heart rate, leading to a temporary cessation of breathing and loss of consciousness.
In a severe or complicated BHS, the child may have a small seizure while unconscious.
In a simple BHS the child may faint or briefly lose consciousness.
Seizures are much more likely with the pallid form than with the cyanotic form of BHS.
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The change in skin color and loss of consciousness with BHS occur before any seizure-type jerking.
The only treatment for cyanotic BHS is to not encourage or reward the behavior.
The pallid form of BHS occurs frequently.
The pallid form of BHS typically follows a frightening or painful experience.
The primary treatment for BHS is to reassure the parent or caregiver that the spells are completely harmless and that they usually disappear by the age of two or two-and-a-half.
Up to 17 percent of children with pallid BHS will experience syncope (fainting spells) as adults, usually in response to fear, injury, or emotional stress.