Baby Breath Holding: Causes, Diagnosis, Treatment, and Outlook - Healthline

You've taken CPR and baby care courses. You've read all the parenting books. However, you weren't prepared to see your baby holding their breath until they turned blue.

If you've noticed your little one holding their breath, you may have a lot of questions: Why are they doing this? How should you handle it? Are there long-term health problems to worry about?

While it's always best to talk with your child's doctor if you have any questions about their health, we've gathered some information about young children holding their breath that may help you prepare for having this conversation.

As you might guess from the name, breath holding is when a child stops breathing, possibly for up to 1 minute, and often until they faint.

These episodes can be frightening, but the baby will breathe again once they faint. The episodes are too short to cause permanent harm to your child.

There are two main types of breath holding episodes in babies:

Blue or cyanotic breath holding spells

These are the most common type of breath holding episodes. They happen when a baby's breathing pattern changes as they hold their breath.

Your baby may cry, scream, or exhale. They may begin to turn blue around the lips. If they faint, they will become limp.

Pale or pallid breath holding spells

This type is less common. They may happen if a baby is injured or upset. They're caused when a baby's heart rate slows down.

Your baby may open their mouth but no sound comes out. They may become very pale and eventually faint. They may become rigid, especially their arms and legs.

These episodes are sometimes mistaken for seizures, but they are not.

Breath holding affects 0.1% to 4.6% of otherwise healthy young children. It typically starts occurring between 6 and 18 months of age.

Sudden shock or pain often triggers breath holding. It can also be the result of strong emotions like anger, sadness, or fear.

Researchers suggest the following reasons why some babies hold their breath and others don't:

• Autonomic nervous system dysregulation: This system regulates involuntary functions like heartbeat, blood pressure, and body temperature, and if it doesn't function fully, it may lead to episodes where the heartbeat or breathing slows.
• Vagally mediated cardiac inhibition: The vagus nerve is a large nerve in the chest that helps regulate things like heart rate and digestion. If it's not fully developed or isn't working correctly, it might affect the heartbeat and contribute to breath holding episodes.
• Delayed myelination of the brain stem: Myelination happens as neurons in the brain mature. If this process is delayed, it might contribute to breath holding spells.
• Iron deficiency anemia: A common type of anemia, iron deficiency anemia occurs when there's not enough iron in the body to produce enough hemoglobin in red blood cells. Without hemoglobin, oxygen cannot be transported to the brain.

During breath holding, your baby may cry and then become silent. They may also open their mouth like they are going to cry, but no sound comes out. They may become floppy or stiff, turn blue or gray, and even faint.

If your little one is holding their breath, you may feel scared or have a flood of adrenaline that pushes you into action. Whatever your reaction, you'll want to try to remember a few do's and don'ts.

It's important to call 911 or local emergency services right away if your child:

• can't be woken up after fainting
• is shaking or jerking
• is blue or gray
• struggling to breathe

These can be symptoms of breath holding, but they can also be related to more serious conditions. If your child's doctor has not previously told you your child is breath holding, get your little one promptly checked out by a doctor to confirm this is what's happening.

Talk with your child's doctor if:

• your child has already been diagnosed with breath holding and their episodes appear to be getting more frequent, longer, or otherwise more severe
• your child goes stiff, shakes for longer than 1 minute, or takes a long time to recover from an episode
• breath holding is beginning to impact their daily life

Your child's doctor may do further testing to see whether any underlying conditions, like unusual heart rhythms or epilepsy, are present.

Although it may give you a mini heart attack, it's usually harmless when your baby holds their breath. Many children outgrow this by the time they are 4 or 5 years old.

There's no known medication that will stop a baby from holding their breath.

In some cases, breath holding may be related to iron deficiency anemia. In these cases, an iron supplement may help decrease the frequency of breath holding.

In fact, a 2019 study found that iron supplements should be given in all breath holding cases regardless of anemia.

However, always discuss any medications or supplements with a doctor first before giving them to your child.

If breath holding increases in frequency or interferes with daily activities, your child's doctor may refer them to a neurologist (brain specialist) and cardiologist (heart specialist). These healthcare professionals can rule out an underlying medical condition.

You may find yourself breathless when you see your baby holding their breath until they turn blue. Chances are that they are just fine, though!

If your baby is holding your breath, you'll want to make sure that they're in a safe position, nothing is placed in their mouth, and they get any medical attention needed.