Breath-Holding Spells in Toddlers: Scary but Usually Harmless

If a crying toddler stops breathing, turns blue or pale and goes limp, lay the child on their side on the floor, keep them away from hard edges, and time it. Don’t shake them, don’t splash water on the face and don’t put anything in the mouth. A breath-holding spell looks terrifying, but the body restarts breathing by itself, usually within a minute, and the spells are almost always harmless.

What to do during a breath-holding spell

1. Stay with your child and note the time. Seconds feel like hours. Check a clock.
2. Lay them on their side on the floor or a flat bed, head level, away from furniture corners, stairs and water.
3. Loosen anything tight around the neck.
4. Keep hands and objects out of the mouth. The tongue can’t be swallowed. Fingers get bitten.
5. Don’t shake, pinch, splash water, or blow hard on the face. None of these restart breathing faster, and shaking a small child can injure the brain.
6. Watch. Colour usually comes back within seconds of the first gasp, and your child may then be sleepy, clingy or cry for a while, which is the body recovering from a big fright rather than a sign that anything has gone wrong.
7. Afterwards, comfort them. Then carry on. Write down what happened, how long, and what triggered it for the doctor.

If your child is not breathing after about a minute, or not waking, call emergency services now and follow their instructions. If you know infant or child CPR, start it if breathing doesn’t return.

What is a breath-holding spell? (meaning in Urdu and Hindi)

A breath-holding spell (sometimes called “saans rok lena” or “rote rote saans ruk jana”) is a reflex, not a choice. It isn’t naughtiness. Something upsets them, they cry hard or get a sudden fright, and at the end of a big breath out, breathing pauses. Oxygen dips, the child may go floppy and briefly lose consciousness, then the body’s automatic breathing kicks back in.

There are two common types:

• Blue spells (cyanotic): the more common kind. Hard crying from anger or frustration, then silence, the lips turn blue, and the child may go limp.
• Pale spells (pallid): usually after a sudden fright or a minor bump. The child may barely cry, goes white and floppy, and may faint. The heart briefly slows as a reflex.

Either type can end with a few jerks of the arms or legs, or a stiff body for a few seconds. That doesn’t automatically mean epilepsy, but it does mean the doctor should hear about it.

Breath-holding spells by age

• Under 6 months: uncommon. A young baby who goes blue or stops breathing needs a doctor the same day, and an ambulance if it lasts or recurs.
• 6 to 12 months: spells can begin here.
• 1 to 3 years: the peak. Some children have them often, even daily.
• 3 to 6 years: they become less frequent, and most children have stopped by 6.
• Over 6: new episodes of fainting or going blue are not typical breath-holding spells and need a doctor.

How to tell it apart from a fit or fainting

The clue is the order of events. In a breath-holding spell, there is always a trigger first (anger, pain, fright), then crying or a gasp, then colour change, then limpness. In an epileptic fit, the jerking usually comes first, often without any trigger, and can happen during sleep or play. Filming an episode on your phone (once your child is safely on their side) helps the doctor enormously.

Older children and adults who faint after a fright have a similar reflex; the fainting first-minute guide covers that.

Iron deficiency and breath-holding spells

Children who have frequent breath-holding spells are more often low in iron, and in some children the spells become less frequent once low iron is corrected. That makes it a good question for the doctor: “Should we check haemoglobin and iron stores?” A blood test decides, not guesswork. The doctor sets any treatment and amount; don’t start iron drops or tonics on your own, as iron is dangerous in overdose for small children. Iron-rich family foods (daal, eggs, meat, green leafy vegetables with a squeeze of lemon) are fine for toddlers anyway; the anaemia foods guide has ideas.

How to manage breath-holding spells day to day

• Don’t live in fear of upsetting your child. Giving in to avoid a spell teaches that spells get results, and they can become more frequent.
• Handle tantrums the usual calm way. Safe, close, one calm line, wait.
• Avoid avoidable triggers: hunger, overtiredness, long queues.
• Tell caregivers (grandparents, daycare, the maid) exactly what to do: side, time, no shaking, no water.
• Keep a simple diary: date, trigger, how long, colour, any jerks. Take it to appointments.

Myth: splashing cold water or blowing in the face brings the child back

It’s what many families do. The child comes round, so it seems to work. But breathing restarts by itself in these spells, whatever you do. Water can go into the nose and mouth of a floppy child, and shaking can cause real injury. Side, time, and calm is all that’s needed.

Another myth: that the child is doing it deliberately. The first cry may be a tantrum, but the pause in breathing is an automatic reflex.

Did you know?

• A child cannot hold their breath long enough to cause harm on purpose; the body’s own breathing drive takes over once oxygen dips.
• Breath-holding spells often run in families. Many parents of children who have them had them too.

More child-health first aid is collected in Bachon Ki Sehat.

Breath-holding spell questions