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A breath holding spell is an involuntary pause in breathing, sometimes accompanied by loss of consciousness. It usually occurs in response to an upsetting or surprising situation.
Breath holding is seen in some normal children from as early as age 2 months, but it can start as late as 2 years old. A small number of children have severe spells. Usually the spells stop by the time a child reaches ages 6 - 8.
Breath holding spells appear to be a response to fear, confrontation, a traumatic event (for example: pain), or to being startled. The sudden reaction can cause the nervous system to temporarily slow the heart rate or breathing, causing breath holding and color changes.
Although they often occur with tantrums, breath holding spells are not thought to be a willful act of defiance.
Breath holding spells can run in families. If a child's parents had similar spells in childhood, the child may be more likely to have spells. They also can occur with genetic conditions, such as Riley-Day syndrome or Rett syndrome. Children with iron deficiency anemia may also have increased episodes of breath holding.
Dalton R, Boris NW. Disruptive behavioral disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 28.
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