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Breath-Holding Spells (BHS) or Expiratory Apnea
By Stephanie Spear, MA, and Patrick C. Friman, Ph.D., ABPP
Your baby is crying. Between sobs, she appears to be holding her breath for what seems like an eternity. You’re not sure why, or what you should do. You only know that it scares you, and you’re concerned about your child.
| What We Know About BHS
Here are some research findings about age of onset, frequency and numbers of children affected (approximations):
- Generally begins at between 3 and 18 months of age, although as many as 10% of cases begin before 3 months and a similar percentage begin after 18 months.
- Frequency ranges from several times a day to as low as once a year, with the majority of children exhibiting several episodes per week.
- Peak frequency is in a child’s second year; spells gradually but continuously diminish.
- The average age at which BHS end is 3 years; BHS are rare after age 8.
- 4.6% of young children suffer from severe BHS (loss of consciousness and/or seizures).
- 27% of young children suffer from simple BHS (distress and silent respiration, to a change in skin color).
- 54% to 62% of afflicted children exhibit bluish or purplish discoloration of skin.
- 19% to 22% of afflicted children exhibit paleness or deficiency in skin color.
- 12% of afflicted children exhibit both types (skin discoloration and paleness).
- 12% of afflicted children exhibit an indeterminate type.
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Your child may be suffering from Breath-Holding Spells (BHS), also known as Expiratory Apnea. BHS can affect healthy, otherwise normal infants and young children, and often occurs when they cry. We want you, as a parent, to know what this phenomenon is, how frequently it occurs, and how you can handle episodes when they occur.
Breath-Holding Spells are often terrifying for parents. Many believe their child is holding his or her breath on purpose, but these spells are actually involuntarily and reflexive. They occur while your child is awake and engaging in active breathing. Spells usually last from 2 to 20 seconds, but can last as long as a minute or more.
A typical BHS episode involves an event that makes your child upset or distressed, such as pain (falling or getting hurt) or discipline (taking away a toy). This event leads to the child crying, which diminishes to quietness or leads to BHS. If the child has a BHS episode, there can be a change in his or her skin color and the episode can end with the child disoriented and either conscious or unconscious.
In most cases, a doctor will give you information about BHS and reassure you how it is not harmful to your child. We also would add that a BHS diagnosis should not lead to dramatic changes in the way you treat or attend to your child, with two exceptions. First, don’t be overly anxious or concerned about your child, either prior to or following BHS. Second, don’t surrender your authority to the child in an attempt to keep him or her from ever being upset. A doctor may also tell you, if your child is anemic, physician-guided treatment with iron supplements can decrease the frequency of BHS. Although medication is rarely beneficial for children with BHS, children with severe and frequent BHS may benefit from it.
When BHS occur, you should lay your child on his or her back and protect them from head injury and aspiration until recovery occurs. If necessary, you should clear out their mouth and airway to prevent choking. Try to do these things without overreacting and while staying calm.
Although reports of serious health consequences following Breath-Holding Spells are rare, the spells are often frightening for parents. Just be reassured, they are common in babies and children, and very few are seriously hurt by them. Research your family history and mention BHS to your family doctor and to people who may care for your child when you are gone. If you ever feel it is necessary, contact your local emergency hospital immediately. Generally, being aware and informed about BHS should make the spells less terrifying.
Recommended readings
Spear, S., & Friman, P.C. (2003). Breath-holding spells. In T. Ollendick and C. Schroeder (Eds.). Encyclopedia of pediatric and child psychology, (pp. 71-73). New York: Kluwer.
Blum, N.J. (2002). Breath-holding spells. In F.D. Burg, J.R. Ingelfinger, R.A. Polin, and A.A. Gershon (Eds.), Current pediatric therapy (17th Ed) (pp. 380-381). Philadelphia: Saunders.
Breningstall, G.N. (1996). Breath-holding spells. Pediatric Neurology, 14, 91-97.
DiMario, F.J. (1992). Breath-holding spells in children. American Journal of Diseases of Children, 146, 125-131.
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