pediatrics
Breath Holding Spells
Cyanotic breath holding spell
During a cyanotic breath-holding spell, children hold their breath (without necessarily being aware they are doing so) until they lose consciousness. Typically, the child cries out, exhales, and stops breathing. Shortly afterward, the child begins to turn blue and unconsciousness ensues. A brief seizure may occur. After a few seconds, breathing resumes and normal skin color and consciousness return. It may be possible to interrupt a spell by placing a cold rag on the child’s face at onset. Despite the spell’s frightening nature, parents must try to avoid reinforcing the initiating behavior. As the child recovers, parents should continue to enforce household rules. Distracting the child and avoiding situations that lead to tantrums are good strategies. Cyanotic breath-holding has been found to respond to iron therapy ( Reference ), even in the absence of anemia, and to 1.Hamed SA, Gad EF, Sherif TK: Iron deficiency and cyanotic breath-holding spells: The effectiveness of iron therapy.Pediatr Hematol Oncol35(3):186–195, 2018. doi: 10.1080/08880018.2018.1491659 