Breath-Holding Spells: A Parent's Guide to a Child Who Stops Breathing While Crying

What are breath-holding spells, and are they dangerous? What to do in the moment, when to call 112 and how to keep setting limits without fear of another spell.

Your fourteen-month-old bumps their head on the edge of the coffee table. They start crying, let out one, two deep screams, and then the sound stops. Their mouth is open but they aren't breathing; their lips first darken and then turn blue. A few seconds later their eyes roll and they go limp in your arms. While you scream, your partner starts shaking the baby. And just as quickly, it is all over: the baby takes a deep breath, their colour returns, and they seem a little sleepy but fine. At the emergency department, the doctor says this was a breath-holding spell (known in Turkish as katılma nöbeti). From that moment on, your own breath catches every time they cry. Breath-holding spells are one of the most frightening childhood experiences for parents; yet they are usually harmless and pass as the child grows. In this article we look at what these spells are, how you should act in the moment, in which situations you need to call 112 (emergency services) and the emotional burden this experience places on the family.

What Are Breath-Holding Spells?

This condition is the involuntary stopping of a child's breathing in response to crying, anger, fright or sudden pain. The child does not hold their breath on purpose; it is a reflex reaction of the nervous system. It is generally seen between six months and six years of age, and most often between one and three. It is common for there to be a similar history in the family.

Spells generally take two forms:

The type with turning blue (cyanotic): This is the most common form. The child cries intensely because of anger, being thwarted or frustration; at the moment they breathe out, their breathing stops, and their lips and face turn blue. They may briefly lose consciousness, and their body may go limp or stiff.

The type with turning pale (pallid): This is seen more often after a sudden fall, a knock or a fright. The child cries very little or not at all, suddenly turns white and may lose consciousness. In this type, a sudden slowing of the heart rate is thought to play a role.

In both types, a few seconds of stiffening or twitching may be seen during the spell. Although this looks like an epileptic seizure to parents, it is generally a temporary reaction of the brain to a brief drop in oxygen. When consciousness is lost, the body starts breathing again by itself.

Are Breath-Holding Spells Dangerous?

This is the first question on every parent's mind. In general, typical breath-holding spells are brief, pass by themselves and are accepted as leaving no lasting harm on the child's brain development. Most children grow out of these spells before they reach school age.

However, making this assessment is a doctor's job. Every child who has a spell like this for the first time must be examined by a paediatrician. The doctor takes a detailed history to understand whether the episode is a typical breath-holding spell; if necessary, they may request additional tests to assess heart rhythm or to distinguish it from epileptic seizures, or refer you to paediatric neurology and paediatric cardiology specialists. Because iron deficiency can be found in some children who have these spells, your doctor may also want to check blood values. Any decision on treatment is made only by the doctor.

Recording a spell on your phone helps your doctor a great deal in making an assessment. Although this is hard to do in that moment of panic, if there is another adult at home you can agree on this task in advance.

What to Do During Breath-Holding Spells

Witnessing a spell can throw even the calmest parent into panic. Knowing in advance what you will do makes it easier to act correctly in those seconds.

What to do

• Try to stay calm and note the time. Spells are often shorter than they seem; in a moment of panic, seconds feel like minutes.
• Lay the child down somewhere safe. Lay them on the floor or a bed, on their side. Protect their head from hard surfaces and move dangerous objects away from around them.
• If there is food in their mouth and it can be removed safely, remove it; but do not put a finger, spoon or anything else into their mouth.
• Stay with them until the spell passes. When their breathing returns, take the child into your arms and soothe them.
• Let them rest afterwards. Some children are tired and sleepy after a spell; this is to be expected.

What to avoid

• Shaking the child
• Splashing water on their face, blowing into their mouth or onto their face
• Holding them by the feet and turning them upside down
• Forcing something into their mouth
• Trying medicines or home remedies on your own

Suggestions often heard from those around you in Turkey, such as "splash cold water on their face" or "blow into their mouth", may be well-meant, but they do not help the child and can sometimes do harm.

When should you call 112?

In the following situations, call 112 (emergency services) without delay:

• If the child is having such a spell for the first time and has not yet been assessed by a doctor
• If the spell lasts longer than a minute
• If breathing and colour do not return quickly
• If stiffening or jerking goes on for a long time
• If the spell occurred without a trigger such as crying, anger or pain, for example during sleep
• If after the spell the child does not come round for a long time, cannot be woken or does not recognise you
• If they had a spell after a hard blow to the head

Taking a basic first aid course for babies and children is a great source of confidence for parents of children who have these spells. Such training teaches you both what to do during a spell and how to recognise a real emergency.

What Triggers Breath-Holding Spells?

Spells with turning blue often appear in the following situations:

• A request being refused or a game being interrupted
• Tiredness, hunger or overstimulation
• Conflict with a sibling or a friend
• An intense crisis of anger or frustration

Spells with turning pale are seen more often:

• After a sudden fall or a knock to the head
• After an unexpected fright, for example a loud noise
• After painful medical procedures such as vaccinations or blood tests

Knowing the triggers helps reduce those that can be prevented. For example, keeping mealtimes regular, preventing lack of sleep and giving the child a chance to rest in crowded settings lowers the likelihood of a crisis.

Keeping a simple spell diary for a few weeks is also useful. For each spell, note the date, the time, what happened just before the spell, roughly how long it lasted, whether the child's colour was blue or pale, and how they recovered afterwards. This record helps your doctor assess the type and frequency of the spells. At the same time, it may show you a pattern: many families only notice thanks to these notes that spells cluster in the tired late-afternoon hours, on days when the nap was skipped or after crowded visits to relatives. Seeing the pattern also reduces the anxiety created by uncertainty.

Being Too Afraid of a Spell to Set Limits

One of the least discussed but most important aspects of breath-holding spells is their effect on everyday family relationships. A parent who has once seen their child turn blue and faint may start fulfilling every one of the child's wishes so that it doesn't happen again. They become afraid to say "no", to end a game, to set a limit. Grandparents may also support this attitude by saying, "Don't make them cry, they'll have another spell."

Although this attitude is understandable, over time it creates difficulties. The child learns that intense crying gets them what they want every time, and tantrums may increase. More tantrums in turn mean a greater risk of spells. The important thing to know is this: the child does not have spells on purpose, but the family's reactions can affect how often tantrums happen.

For a balanced approach:

• Reduce preventable triggers, but don't give up necessary limits.
• Set the limit calmly and briefly. Long arguments and bargaining make the crisis grow.
• Soothe the child after the spell, but don't hand over the wish that was refused before the spell as a "reward". Keep the limit in a calm voice.
• Recognise the signs that warn of a crisis. When you notice the child getting tired or tense, changing the setting or redirecting their attention helps.

For age-appropriate suggestions on tantrums, take a look at our articles on the terrible twos and temper tantrums in children.

The way to protect a child from breath-holding spells is not to never let them cry; it is to be an adult who can stay calm when they cry and say "no" when needed.

Imagine a two-year-old girl who goes into an intense crying crisis every time it is time to leave the park and go home, and who has brief spells with turning blue a few times a month. After a check-up with the doctor, the family start giving her notice five minutes before leaving the park, "Two more goes on the slide and then we're going home," and turn leaving into a game: a race all the way home to see "who spots the red car first". When a crisis happens, the mother stays calm beside the child, gives her a hug after the spell has passed, but still does not agree to her wish to stay in the park. Within a few months the crises become shorter and the spells become noticeably less frequent.

The Family's Emotional Burden

Seeing your child stop breathing is a genuinely shaking experience for many parents. After the first spell, some mothers and fathers relive that moment in their minds for weeks, wake up at night to check their child's breathing and are afraid to leave them with a childminder or at nursery. These reactions are natural consequences of a frightening experience.

Blame within the family can increase this burden. Words such as "You make them cry too much" or "Nothing like this ever happened with our children" leave the parent who does most of the caring alone. Yet these spells are not the parent's fault.

Siblings may also be affected. An older sibling may have been frightened by seeing the younger one turn blue. Giving them a simple, age-appropriate explanation and saying, "If this happens, just let us know," both reassures them and protects them from the burden of responsibility.

When leaving the child at nursery or with a childminder, giving the carer written information on what a spell looks like, what to do in the moment and when to call 112 both reduces your anxiety and increases the child's safety.

When Should You Seek Psychological Support?

The medical follow-up of breath-holding spells is carried out by a paediatrician. Even so, in the following situations it can be helpful to talk to a psychologist:

• If fear of a spell has left you unable to set any limits for your child
• If the child's tantrums are becoming more and more frequent and longer
• If, after witnessing a spell, you continue to have symptoms such as intense anxiety, sleeplessness, being constantly on alert or reliving that moment over and over
• If this issue has turned into a constant source of conflict between partners or in the extended family
• If the child's general emotional regulation skills are clearly struggling for their age

How Are Breath-Holding Spells Addressed in Therapy?

Psychological support does not replace medical assessment; it complements it. Most of the work is done with the parents.

In parent guidance, the situations that trigger the child's tantrums are identified, preventive arrangements are planned and work is done on limit-setting skills. A concrete "spell and crisis plan" is created to support the parent in staying calm in a crisis.

A cognitive behavioural approach is useful in working with the parental anxiety that develops after witnessing a spell. Catastrophic scenarios, constant checking behaviours and avoidance are noticed, and the parent is supported in regaining confidence both in their child and in themselves.

For children in the later preschool years, play therapy can offer a safe space for recognising and expressing feelings. To learn more about this approach, you can visit our child and play therapy page.

Frequently Asked Questions

Do breath-holding spells turn into epilepsy?

Typical breath-holding spells are not epilepsy and are not expected to turn into epilepsy. However, because some types of seizure can look similar, an assessment by a doctor after the first spell is important. If spells occur without a trigger or during sleep, a detailed examination is definitely needed.

At what age do breath-holding spells stop?

In most children, spells decrease and disappear before they reach school age. As skills in expressing feelings in words and soothing themselves develop, the triggering crises also become less frequent.

How should I explain breath-holding spells to a childminder or nursery?

Share a short written note on what a spell looks like, what to do in the moment and in which situations to call 112. If possible, showing a video of a spell makes it easier for the carer to recognise the situation. This information prevents both panic and the wrong kind of intervention.

Does losing consciousness during a spell harm the brain?

In typical breath-holding spells, loss of consciousness is very brief and the body starts breathing again by itself. These spells are not considered to leave lasting brain damage. Even so, you should talk to your doctor about spells that last a long time, recur frequently or are not typical.

• #breath-holding spells
• #cyanotic spells
• #babies turning blue
• #tantrums

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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