Breath-holding spells

Pediatr Neurol. 1996 Feb;14(2):91-7. doi: 10.1016/0887-8994(96)00006-9.


Two particularly common, and frequently frightening, forms of syncope and anoxic seizure in early childhood are pallid and cyanotic breath-holding spells. Pallid breath-holding spells result from exuberant vagally-mediated cardiac inhibition. Cyanotic breath-holding spells are of more complex pathogenesis, involving an interplay among hyperventilation, Valsalva maneuver, expiratory apnea, and intrinsic pulmonary mechanisms. The history is the mainstay of diagnosis; videotape documentation may be possible. Performance of an electrocardiogram to evaluate for prolonged QT syndrome should be strongly considered. In patients with pallid breath-holding spells, a characteristic sequence of changes may be documented on an electroencephalogram with ocular compression, if this study is performed. Spontaneous resolution of breath-holding spell, without sequelae, is anticipated. Reassurance is the mainstay of therapy. Occasionally, pharmacologic intervention may be of benefit.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Apnea / physiopathology*
  • Child, Preschool
  • Cyanosis / diagnosis
  • Cyanosis / physiopathology*
  • Epilepsy, Tonic-Clonic / diagnosis
  • Epilepsy, Tonic-Clonic / etiology
  • Epilepsy, Tonic-Clonic / physiopathology*
  • Female
  • Humans
  • Hyperventilation / diagnosis
  • Hyperventilation / physiopathology
  • Hypoxia, Brain / complications
  • Hypoxia, Brain / diagnosis
  • Hypoxia, Brain / physiopathology*
  • Infant, Newborn
  • Male
  • Syncope / diagnosis
  • Syncope / physiopathology*