Child's Health/Specific Problems Behaviours: Breath-Holding

Breath-holding is one of the most frightening of all childhood behaviours. It is most disconcerting for parents to see a child suddenly stop breathing, often ending up limp and unconscious. It is often difficult to reassure parents that no harm comes to these youngsters. Breath-holding occurs in about 5% of children, generally between the ages of 6 months and 5 years, though it is in the young toddler age group that it is the most common.

Cause

The immediate cause of the breath-holding episode is anger or frustration on the part of the child, usually in response to not getting his own way, or else to pain or fear. It is not known why some children respond in this way and others do not.

Clinical features

There are two described sorts of breath-holding events, called blue (cyanotic) and white (pallid).

In the blue episodes, which are more common, the baby or child is upset and distressed, and after a period of increasingly intense crying, suddenly stops breathing. He becomes blue, limp, and sometimes may move arms and legs as if having a convulsion. After a brief period of time, usually half a minute or less, although it seems an eternity to the parents, he will resume breathing, and often crying, with no apparent ill effects.

The white or pallid episodes are usually a response to intense fear or pain. The crying is minimal or silent, and the baby or child stops breathing suddenly and without warning. He becomes pale, rigid, often arching his back, and the episode may end with movements of the limbs as if he is having a convulsion.

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