When a Toddler Holds Their Breath and Passes Out

Your child is crying about something small. Then the crying stops — not gradually, but completely — and they do not breathe in. Their lips go blue, or their face goes white. They go stiff, or limp, and for a few seconds they are not conscious. Then they take a breath and it is over.

Parents describe this as the most frightening thing they have witnessed, and then describe being told it was a tantrum.

It is not a tantrum, and searching for it usually leads to behaviour-management advice that has nothing to do with what is happening. This page is here because that mismatch leaves families frightened and no better informed.

Any episode where a child loses consciousness needs a doctor — at minimum the first one, to confirm what it is and to rule out other causes. Nothing here replaces that.

What is actually happening

A breath-holding spell is an involuntary reflex, not a decision. The child is not choosing to hold their breath, cannot stop it, and is not aware of it happening.

A narrative review in Current Pediatric Reviews summarising the evidence opens by calling them exactly what they are: "common, frightening, but fortunately benign events."

They affect 0.1 to 4.6% of otherwise healthy young children, and the onset is usually between 6 and 18 months. The mechanism is thought to be several things together: dysregulation of the autonomic nervous system, a vagally mediated slowing of the heart, immaturity of the brainstem, and — importantly for what follows — iron deficiency anaemia.

That last one is the reason this page is worth reading to the end.

The two types

Knowing which one you are seeing is useful, because the triggers differ.

Cyanotic spells — the blue kind — are the more common, and are usually set off by anger or frustration. The sequence is characteristic: a short, loud cry, then a sudden involuntary holding of the breath with the chest fixed in the out-breath position. The child becomes blue, then goes rigid or limp, then loses consciousness briefly, then takes a long-awaited breath and recovers.

Pallid spells — the white kind — are usually set off by pain or fear: a bumped head, a sudden fright, a fall. The crying may be minimal or completely silent, which is what makes these so alarming; there may be no warning at all. The breath-holding phase is briefer than in the blue kind before consciousness is lost, and the child goes pale rather than blue.

In both types the whole episode lasts roughly 10 to 60 seconds, though every parent who has watched one would swear it was longer.

Why this is not a tantrum, and why that matters

The distinction is not a technicality. It changes what you should do.

A tantrum is behaviour. It has a goal, it responds to how adults react, and it can be shaped. A breath-holding spell is a reflex — the child cannot start it deliberately, cannot stop it, and cannot learn not to do it. There is nothing to shape.

This has two practical consequences. Punishing a spell is pointless and cruel, because you are punishing something outside the child's control. And "giving in" to prevent one does not work either, because the spell is not being produced to get something.

What can happen — and this is where families genuinely get stuck — is that everything around the spell starts being managed. Parents stop saying no, stop imposing any limit, and stop letting the child become frustrated at all, in the hope of avoiding an episode. That is entirely understandable after watching your child lose consciousness, and it produces a second, separate problem: a child who is never allowed to be frustrated does not learn to handle frustration.

The advice that works is uncomfortable but consistent: treat the spell as a medical event that you manage safely, and go on parenting as you otherwise would around it. Our guide on discipline without hitting or shouting covers what the ordinary limits look like.

The iron question

This is the part most parents are never asked about, and there is a randomised trial behind it.

Published in The Journal of Pediatrics, the trial enrolled 67 children with breath-holding spells and randomised them to iron therapy or placebo, with comparable groups at baseline. They were assessed weekly for the first eight weeks and then fortnightly for eight more, measuring the change in how often spells occurred.

The children treated with iron showed an 88% reduction in the frequency of spells, compared with 6% in the placebo group. Baseline haemoglobin and total iron binding capacity predicted who would respond, and response to iron correlated strongly with improvement in blood indices — in other words, the children who were iron-deficient were the ones who benefited.

The practical implication is simple. Ask your doctor whether your child's iron has been checked. Iron deficiency is common in young children generally and more common here than in the countries where much of this research is published, and it is straightforward to test and treat.

Two honest caveats, because you should not act on a number without its limits. That trial is not large, and later work has questioned whether iron helps children who are not iron-deficient. It is not a reason to start giving iron on your own — too much iron is genuinely dangerous, and iron tablets are a common cause of serious poisoning in small children. It is a reason to ask for a blood test.

What to do during an episode

Do

• Lay your child down on their side, on the floor, somewhere they cannot fall from. This protects them if they stiffen or jerk, and helps blood return to the head.
• Stay with them and keep the area clear.
• Note how long it lasts and what happened immediately before. Doctors ask exactly this.
• Be calm and matter-of-fact afterwards. Comfort them briefly and move on. A large, frightened reaction teaches a child that something terrible just happened to them.

Do not

• Do not shake your child, slap them, or throw water on their face. None of it shortens the episode and all of it can cause harm.
• Do not put anything in their mouth.
• Do not try to force them to breathe or blow into their face.
• Do not pick them up and run unless you are moving them somewhere safe — carrying an unconscious child is how people fall.

Get emergency help — Rescue 1122, or the nearest hospital — if

• The episode lasts longer than about a minute, or your child does not recover quickly afterwards
• There is jerking that continues after breathing has resumed
• Your child is confused, floppy or not themselves for a prolonged period afterwards
• The episode happened with no crying or trigger at all — that pattern needs a different set of questions
• It is the first time, or anything about it is different from the usual pattern

What a doctor will want to know

Write these down before the appointment. It is the difference between a five-minute reassurance and a proper assessment.

1. What happened immediately before — anger and frustration, or pain and fright?
2. Did your child cry first, and was the cry loud or almost silent?
3. Did they go blue or white?
4. How long from the start of the episode until they were breathing again?
5. Was there stiffening or jerking, and did it continue after breathing resumed?
6. How long until they were fully themselves afterwards?
7. How often is this happening, and is it becoming more frequent?
8. Is there a family history of the same thing? It often runs in families.

If you can film one on a phone, that is worth more than any description — the same advice as for absence seizures, and for the same reason: doctors are used to being shown these, and what a parent remembers and what the video shows are frequently different.

Your doctor may check iron, and may occasionally arrange an ECG, particularly for the pallid type, because a small number of episodes that look like this have a cardiac cause. A review published in Acta Paediatrica has raised concern about overuse of EEG and ECG in these children, so if tests are not offered that is not necessarily an oversight — ask why rather than assuming.

Does it stop?

Yes. The evidence review is clear that spells usually disappear on their own by around five years of age, and children who have them do not go on to have a higher rate of problems as a result.

The same review makes a point worth repeating: "Although breath-holding spells are benign, they can be quite distressing to the parents. Confident reassurance and frank explanation are the cornerstones of treatment."

That is unusual language for a clinical review, and it is right. For most families the treatment is understanding what this is — not a medicine and not a behaviour plan.

Tell everybody who looks after your child

This matters more than it sounds. An adult who has never seen one of these will panic, may do something harmful in the panic, and may never look after your child again.

Grandparents, the maid, the driver, the nursery, an older sibling — all of them should know what it looks like, that it stops on its own, to lay the child on their side, and not to shake or slap or splash. Write it on a single sheet and keep it where it can be found.

Do the same for school or nursery in writing, including who to call.

Where we fit

The medical part is not ours, and we will send you to a doctor before anything else if you have not already been.

Where families come to us is the aftermath, and it is a real and specific problem: a household that has stopped saying no. Once a child has passed out during a moment of frustration, most parents understandably start removing every source of frustration — and six months later there is a child who cannot tolerate being told no about anything, which is a much harder problem than the spells were.

That is fixable, and it is ordinary work: rebuilding the limits gradually, teaching a child to handle frustration in small doses, and helping parents recover their own nerve, which is usually the harder half. Our page on looking after yourself exists because that part is real.

A consultation is Rs 1,500 and lasts up to 50 minutes, we work in Urdu or English, and you do not need a referral.

Sources

• Leung AKC, Leung AAM, Wong AHC, Hon KL. Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence. Current Pediatric Reviews. PubMed 30421679
• Daoud AS, Batieha A, al-Sheyyab M, et al. Effectiveness of iron therapy on breath-holding spells. The Journal of Pediatrics. PubMed 9108851
• Emergency number 1122 — Emergency Services Department, Government of the Punjab.

The other frightening episode families confuse this with is a fever fit, which has a different cause and a different response — see febrile convulsions.

Where the episodes sit alongside wider difficulty managing feelings, see our page on emotional dysregulation.

For episodes that happen in sleep rather than after crying, see night terrors.