What is Breath-Holding Spells?
A breath-holding spell is a common but harmless event that affects up to 5% of children. It can be scary for both kids and their parents. These spells come in two kinds: cyanotic and pallid. A cyanotic spell is usually triggered when a child is angry or frustrated, causing them to hold their breath until their face turns blue or purple. On the other hand, a pallid spell typically happens after a sudden fright, causing the child to stop breathing. Despite these episodes lasting up to a minute, the child usually makes a full recovery afterward.
These spells happen among children who are otherwise healthy, and do meet age-appropriate milestones for growth and development. However, during these episodes, kids may pass out and can even have a seizure. To reduce the occurrence of these episodes, it can help to distract the child, steer clear of emotional triggers, and provide emotional support to both the child and the parents.
Also, it’s important to check for certain conditions like iron deficiency anemia and long QT syndrome when examining a child. Any other warning signs should be followed up with a more thorough examination. Thankfully, these breath-holding spells have a good outcome. They usually stop happening by the age of 6 and don’t have any impact on the child’s future brain development.
What Causes Breath-Holding Spells?
It was previously thought that breath-holding spells in children were a cry for attention. However, current studies indicate that these spells are actually an involuntary reflex. There are two common types of breath-holding spells, cyanotic and pallid, although some children may experience a combination of the two. These episodes commonly last less than a minute and end on their own.
The more common type, cyanotic breath-holding spells, occur in over 60% of children with this condition. These spells are often triggered by the child’s anger or frustration. When a spell happens, the child may cry briefly, stop talking and breathing, and turn bluish. In some cases, the child might pass out or have a seizure, but the episode itself is not dangerous and will end by itself. However, if a spell lasts longer than a minute, other health conditions should be investigated.
The pallid type of breath-holding spell usually happens after something frightening or painful. Through these spells, the child’s heart rate slows down, they stop breathing, lose consciousness, and become pale. They may also sweat and jerk, or even lose bladder control. Fortunately, these episodes are typically short, and children regain consciousness on their own.
Although the exact cause of breath-holding spells isn’t clear, some scientists believe that a malfunction in the part of the nervous system that controls automatic body functions might play a role. Additionally, some children with this condition have higher blood pressure and heart rates than usual. Differences in parts of the brain measured by MRI have also been noticed in children with this condition. Furthermore, children who experience breath-holding spells are believed to have more irregular breathing patterns compared to other children.
It’s also important to note that a lot of children with breath-holding spells have been found to be deficient in iron, and giving them iron supplements has been found helpful. Another study found reduced levels of certain antioxidants in children with breath-holding episodes. Mothers who experience high levels of stress during pregnancy, who are depressed, or who are overly protective, may also contribute to a child developing breath-holding spells. Finally, breath-holding spells have been linked to low frustration tolerance in the affected children.
Risk Factors and Frequency for Breath-Holding Spells
Breath-holding spells are pretty common in young kids and can happen to up to 5% of them. They usually start before the child is 18 months old and stop by around age 6. It’s not unusual for a child to show signs of both blueness (cyanosis) and paleness (pallor) during these episodes.
These spells tend to occur more in boys than in girls. In one research study, there seemed to be a link between older dads and a higher chance of their kids having breath-holding spells. Also, the more kids a family had, the less likely the younger ones were to experience these spells. About a third of kids with breath-holding spells have family members who’ve also had them.
There doesn’t appear to be any meaningful differences among different groups of people when it comes to the types of breath-holding spells they experience. However, some studies suggest that kids who have pallid (or pale) spells may start getting them at an older age than those with cyanotic (or blue) spells.
In a study focusing on kids with severe breath-holding spells, the researchers believe this condition is most likely passed down from parents to kids in a certain way (autosomal dominant with reduced penetrance). Meanwhile, other conditions like familial dysautonomia, long QT syndrome, and 16p11.2 microdeletion syndrome could also increase a child’s chances of having breath-holding spells.
Signs and Symptoms of Breath-Holding Spells
For a child with either cyanosis (bluish or purplish skin discoloration) or episodes of fainting, it’s crucial to get a complete history from the parents. This history should highlight a specific emotional trigger event, followed by either a bluish or pale breath-holding spell. There shouldn’t be any warning symptoms before this event, and the child shouldn’t exhibit any signs of confusion or disorientation after recovery.
The child’s physical exam results should generally indicate good health. However, if there are any findings that do not align with this history, further tests should be carried out promptly. This may require referring the child to specialty branches of pediatrics, like pediatric cardiology (heart health), pediatric neurology (brain and nervous system health), or genetics.
Testing for Breath-Holding Spells
Typically, when it comes to diagnosing breath-holding spells in patients, there isn’t a universally agreed-upon test or method. Usually, doctors make the diagnosis based on the account of what happened during the spell. It’s important to discuss anything that may have triggered the episode, as this could help to distinguish it from a seizure disorder.
The lapse can be categorized as either cyanotic (blueish skin tone) or pallid (pale skin tone) based on the patient’s skin color during the episode. Doctors may also carry out iron level tests, as iron deficiency is common in kids who experience these spells. In addition, an EKG (a test checking for problems with the electrical activity of your heart) might be done to ensure that a cardiac condition isn’t causing these episodes.
Sometimes, it can be difficult to distinguish breath-holding spells from seizure disorders. As a result, an electroencephalogram (EEG), a test that tracks brain activity, might be conducted. However, usually, this test isn’t recommended unless there’s compelling evidence to suggest it’s needed. If an EEG is carried out, a special eye pressure test can help differentiate a seizure from a breath-holding spell.
Generally, scans like MRIs or CTs aren’t necessary because people experiencing these spells typically have normal brain structures. It’s important to rule out other conditions that might be causing fainting or seizures, such as epilepsy or irregular heart rhythms. However, if there are no other signs or suspicious symptoms hinting towards another cause, additional tests or evaluations usually won’t be needed.
Treatment Options for Breath-Holding Spells
Although breath-holding spells in children can be alarming for parents, they don’t have long-term effects. So parents are often advised to not overly react to these episodes in order to avoid the child developing behavioural issues. Yet, given the distressing nature of these incidents, it can be helpful for parents to work with a professional counsellor to learn the best ways to cope.
In fact, a study found that therapy aimed at teaching and guiding (psychoeducational therapy) reduced mothers’ anxiety and depression levels and also resulted in fewer breath-holding spells with the child. It’s safe to say that reassurance and behavioural intervention remain the main treatment methods. Keep in mind that while other treatments may work, their benefits and risks must be carefully considered, especially because breath-holding spells usually improve on their own over time.
For example, some studies have found a link between iron deficiency anaemia and breath-holding spells in children. As a result, iron supplements can help reduce the frequency of these episodes. They can be given even if the child doesn’t have an iron deficiency, as it may still lessen the occurrence of spells.
There’s growing evidence that certain medications, like piracetam or levetiracetam, can help to decrease the frequency of breath-holding spells. In scientifically controlled trials, piracetam significantly reduced these spells as compared to a placebo. However, more studies are needed to determine which medication is more effective. Another study suggested that a combination of iron and levetiracetam was more successful in controlling breath-holding spells than using levetiracetam alone.
What else can Breath-Holding Spells be?
While breath-holding episodes are fairly common in children, it’s important for doctors to also consider other possible health conditions that might cause similar symptoms. These can include:
- Birth-related voice box problems (congenital laryngeal stridor)
- Irregular heartbeats (arrhythmia)
- Pause in breathing in premature babies (apnea of prematurity)
- Genetic disorders
- Seizure disorder (epilepsy)
- Serious infection (sepsis)
- Injuries not due to an accident (nonaccidental trauma)
- A heart defect that’s dependent on a patent ductus arteriosus (PDA-dependent congenital heart lesion)
This means that your child’s doctor might need to rule out these issues in order to accurately diagnose a child who is having breath-holding spells.
What to expect with Breath-Holding Spells
Contrary to what some might assume, breath-holding episodes aren’t harmful and don’t lead to any brain damage. If a child’s neurological development is already normal, it should remain the same. Typically, by the time children reach the age of six, these episodes tend to stop.
Interestingly, a study using a type of brain imaging called magnetic resonance spectroscopy found no difference in the brain chemistry of kids with breath-holding episodes compared to those without. This biochemical evidence supports clinical findings, demonstrating that these episodes don’t result in any lasting brain damage.
Possible Complications When Diagnosed with Breath-Holding Spells
These events can cause a lot of stress for both the family and the child, potentially leading to an overall rise in home tension.
Even though iron therapy could theoretically lead to complications, the side effects are often minimal when prescribed for this particular condition. In most cases, there’s no need to adjust the treatment because of these side effects.
Preventing Breath-Holding Spells
Parents should be given information on how to manage situations when their child has a breath-holding spell and reassured that these episodes don’t have any long-lasting health effects. It’s also worth noting that these incidents can sometimes result in stress for parents. So, if these episodes are causing tension in the family, they might find it helpful to seek guidance from a counselor. Plus, parents should be offered support so they can handle the stress effectively. They would also benefit from learning about different ways to discipline their children.
