Breath-holding spell

Background

  • Episode during which child holds breath, usually during excessive crying upon exhalation
  • May occur after painful/scary/irritating event or after being disciplined or becoming angry
  • Not intentional e.g. child is not trying to pass out[1]
  • Typically occur in children 6-18mo but can be up to 6yo
  • Occur in 5% of all children[2]

Clinical Features

  • Breath-holding during crying or intense emotion
  • May be associated with:
    • Syncope
      • LOC brief, spontaneously resolves
      • May have brief seizure-like activity, but NO postictal period
    • Cyanosis
    • Pallor

Differential Diagnosis

Syncope Causes

Evaluation

Management

  • No specific treatment
  • Reassurance- benign phenomena that does not typically result in injury and will resolve with time
  • Do not need cardiology or neurology outpatient referrals[4]

Disposition

  • Discharge

See Also

External Links

References

  1. Goldman RD. Breath-holding spells in infants. Can Fam Physician. 2015 Feb;61(2):149-50. PMID: 25676645
  2. https://pedemmorsels.com/breath-holding-spell/
  3. Movahedian AH1, Heidarzadeh Arani M2, Motaharizad D3, Mousavi GA4, Mosayebi Z5. Evaluation of QT Dispersion in Children with Breath Holding Spells. Iran J Child Neurol. 2016 Winter;10(1):25-30. PMID: 27057184
  4. Yilmaz U1, Doksoz O2, Celik T3, Akinci G4, Mese T5, Sevim Yilmaz T6. The value of neurologic and cardiologic assessment in breath holding spells. Pak J Med Sci. 2014 Jan;30(1):59-64. PMID: 24639832

Authors:

Claire