Child Behavior Management for Breath-holding Spells

This page gives child behavior management strategies for breath holding spells, which are very frightening for parents, but usually cause no harm in the toddlers.

There are two main types of breath holding spells, depending on the color your child turns during the spell: 

- Blue breath holding spells

- White breath holding spells.

This page answers these questions:

  • Blue Breath Holding Attacks:
  • White Breath Holding Spells
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What is a blue breath holding spell?

Usually blue breath holding spells occur when your child is crying, often because she hasn't got her way. When crying, your toddler holds her breath. She then goes blue and falls to the ground unconscious. Within seconds, she is awake and fine.

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What causes a blue breath holding spell?

Children have a sensitive vagal nerve that gets stimulated when the breath is held. This stimulation slows the heart rate. This causes less oxygen flow and so the blue color and also the brain shuts down momentarily so your child goes unconscious. Then the body's natural defense kicks in to normalize everything. Usually your child will fall to the ground, the heart rate will pick up and the blood will flow again and your child will regain her normal color.

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Are blue breath holding spells dangerous?

No. The body's natural defenses ensure we can't make ourselves stop breathing. So your toddler will try to hold her breath and will be successful for a few seconds and then the body will take over as your toddler loses consciousness. Your toddler will lose consciousness just briefly enough for the body to ensure she can't damage herself by holding her breath. It's a safety mechanism.

RecoveryPositionSideOn

Very occasionally, your child will have a brief convulsion (seizure) when she has an blue breath holding attack (read more). This often happens if your toddler can't get to lie flat (which is what the body needs to do) - either because she fell on something or because you have picked her up.

Don't panic. She'll be fine. Put her in the recovery position (as in the photo above) with her head no higher than her heart.

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Why does my toddler have blue breath holding spells?

It is normal for a toddler to want the world to revolve around her. If things don't go according to her plan, a breath holding spell is a pretty effective way of getting your undivided attention. Part of your child behavior management technique is to teach her that this doesn't work.

Read more on the ABC of Understanding Toddler Behavior.

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What should I do when my toddler has a blue breath holding attack?

As mentioned on the main Toddler Behavior page, the best child behavior management technique to stop an unwanted behavior, like blue breath holding attacks, is to ignore the behavior and not reinforce the behavior with attention.

It is pretty hard to ignore a blue breath holding spell, but that is what you have to appear to do. Your child has to think that the attack had no impact at all.

While your child is in the brief unconscious phase, you will want to check she is safe and has fallen flat on the ground. Once she is awake, you must appear completely nonchalant and unaffected by the whole thing. I advise parents to pretend they are reading a book or the paper (or so it will seem to your child but you can be peeking over the top) or to look in a mirror (so your back is to your child but you can see everything). It's a child behavior management strategy that works.

Remember, there is no need to panic as these are not dangerous. It is best to let your child fall flat to the floor so the body can do what it needs to do. If your child has a brief convulsion (seizure), put her in the recovery position.

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What should I do after the blue breath holding spell?

Just act normally. Give your toddler a chance to save face. It is a good child behavior management strategy to always give your child alternative ways of behaving - things that are acceptable. So give them options and eventually you may find that they take up the acceptable option because the alternative doesn't work.

Remember that whatever your child wanted in the first place should not be given just after a breath holding spell - that will only teach your child that holding her breath works (so she'll try it again).

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Are there any treatments for blue breath holding spells?

It would be a good idea to have your child's iron levels checked if she has breath-holding attacks. Studies have shown that children with low iron are more susceptible to having blue spells and that correcting the low iron (by giving a course of oral iron supplements) can reduce the frequency of breath holding attacks. The iron would be in conjunction with the child behavior management outlined above - so you don't reward the behavior you want to change.

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What is a white breath holding spell?

Usually white breath holding spells (reflex anoxic seizures) occur when your child has been startled or frightened in some way or has hurt herself. Your toddler will hold her breath, go white and then falls to the ground unconscious very briefly. Within seconds, she is awake and her color will return.

Children don't necessarily have seizures although white breath holding attacks are also known as reflex anoxic seizures - your child may just go white and fall unconscious on the ground. The mechanism causing the attack is also stimulation of the vagal nerve but unlike blue spells where the child cries, in white spells, there is usually some form of fright or hurt.

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Are white breath holding spells dangerous?

No. The body's natural defenses ensure we can't stop breathing. So your toddler will lose consciousness just briefly enough for the body to ensure she can't damage herself. It's a safety mechanism.

Very occasionally, your child will have a brief convulsion (seizure) when she has an white breath holding attack. This often happens if your toddler can't get to lie flat (which is what the body needs to do) - either because she fell on something or because you have picked her up.

Don't panic. She'll be fine. Put her in the recovery position with her head no higher than her heart - see the photo above..

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What should I do when my toddler has a white breath holding attack?

While your child is in the brief unconscious phase, you will want to check she is safe and has fallen flat on the ground. Once she is awake, you should comfort her. If your child has a brief convulsion (seizure), put her in the recovery position.

The child behavior management for white breath holding attacks is different from the child behavior management for blue breath holding attacks because the triggers are different. Children have usually been frightened or hurt before a white breath holding spell and it is only natural that you will want to comfort your child in that situation.

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References

  • Green C. Toddler Taming. Doubleday. 2001. ISBN: 1 86471 053 5
  • Cameron C Grant et al. Policy statement on iron deficiency in pre-school-aged children. Journal of Paediatrics and Child Health 43 (2007) 513–521
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Last reviewed 30 May 2011

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Dr Maud MD

Dr Maud MD (MBChB, FRACP, FRCPCH), a specialist pediatrician, provides health information and medical advice for parents of babies and toddlers. Read more about Dr Maud.



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