Breath-Holding Spells in Children: Why Does My Child Turn Blue While Crying?
Does your child sometimes cry intensely, stop breathing for a few seconds, and turn blue or pale?
As frightening as this looks, this is usually not a disease. In medical science, it is called a Breath-Holding Spell (BHS).
Breath-holding spells are common, harmless, and temporary conditions, most often seen in children between 1 and 5 years of age. They are involuntary, meaning the child is not doing this on purpose.
What Exactly Happens During a Breath-Holding Spell?
Understanding the process can help parents stay calm.
1. Trigger Event
A spell usually starts after a sudden emotional or physical trigger, such as:
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Anger or frustration
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Fear
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Sudden pain or injury
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Extreme excitement or sadness
The child begins crying forcefully.
2. Breath-Holding Phase
While crying, the child exhales a long breath (for example, “haaaaa…”) and then:
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Temporarily stops breathing, or
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The airway briefly closes
This happens automatically, not intentionally.
3. Drop in Oxygen Levels
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Oxygen normally enters the blood through the lungs
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When breathing pauses, oxygen levels fall
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Hemoglobin (the oxygen-carrying protein in blood) becomes low in oxygen
As a result:
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Lips, face, or nails may turn blue or purplish (called cyanosis)
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The body may feel cold
4. Body’s Safety Reset Mechanism
The brain quickly senses low oxygen and activates the autonomic nervous system:
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Muscles relax
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The child may appear unconscious for a few seconds
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A deep breath follows automatically
Within moments:
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Normal breathing resumes
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Skin color returns to pink
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The child becomes alert again
Is Turning Blue Always a Breath-Holding Spell?
Not always. Blue discoloration (cyanosis) can have other causes and must be evaluated carefully.
Possible Causes of Cyanosis
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Breathing or lung problems
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Airway obstruction (something stuck in the throat)
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Infections like pneumonia or bronchitis
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Heart conditions
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Congenital heart defects (e.g., hole in the heart)
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Mixing of oxygenated and deoxygenated blood
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Severe cold exposure
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If hands and feet are blue but lips and tongue are pink, cold may be the cause
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When Should You See a Doctor Immediately?
Seek urgent medical care if the child shows:
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Severe difficulty breathing
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Rib retractions while breathing
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Wheezing sounds
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Loss of consciousness for a prolonged time
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Persistent or frequent blue episodes
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Excessive or unusual crying
What Should Parents Do During a Breath-Holding Spell?
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Immediate Care
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Stay calm – panic can worsen the situation
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Lay the child safely on their side
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Loosen tight clothing
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Ensure fresh air
Important Don’ts
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❌ Do not put fingers, water, or objects into the child’s mouth
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❌ Do not shake the child
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❌ Do not attempt mouth-to-mouth resuscitation
Helpful Actions
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Sprinkle a little cold water on the face
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This can activate the body’s natural reflex and help recovery
Once the child recovers:
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Stay calm
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Do not immediately give in to demands that triggered the spell, or the behavior may repeat intentionally for attention
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Prevention and Long-Term Management
1. Check for Iron Deficiency
Iron deficiency is commonly associated with breath-holding spells.
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Blood tests: CBC and serum ferritin
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Use iron syrup only if prescribed by a doctor
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Include iron-rich foods:
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Spinach
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Beetroot
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Eggs
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2. Behavior Management
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Distract the child during anger or frustration
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Avoid fulfilling every demand instantly
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Prevent extreme tiredness or hunger
3. Healthy Routine
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Ensure regular meals
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Adequate sleep
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A calm, structured daily routine
Reassurance for Parents
Breath-holding spells:
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Are not epilepsy
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Do not damage the brain
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Do not affect intelligence
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Usually disappear on their own by 5–6 years of age
Your calm response is the most powerful treatment.
