How can I stop my child from holding her breath until she passes out when she is frustrated?

By Patrick J. McGrath, OC, PhD, FRSC

Dr. Pat

Question:

My four-year-old daughter becomes upset, frustrated, or angry over the slightest thing. When she becomes upset she often holds her breath. These episodes are very alarming to watch. It's almost like she's unable to breathe, rather than she's deliberately holding her breath. She does this until she passes out, then her breathing begins again. How can we stop her from doing this?

Dr. Pat responds:

Your child is showing the typical picture of "breath-holding spells." Some children pass out because of the brief lack of oxygen. Some children just turn very, very pale. Some children can even have a very brief seizure due to lack of oxygen getting to the brain. None of these causes any long-term trouble for your child. But, you should have her checked out by her doctor to make sure there is nothing more significant.

The very good news is that children grow out of breath-holding spells and show no long-term consequences.

The cause of breath-holding spells in most cases seems to be a delay in the control of part of the autonomic or involuntary nervous system. This is the system that controls things that we don't have to pay attention to doing, such as breathing, blinking, heart rate, swallowing, etc. Try to remember that breath-holding is not done purposely by your child.

Breath-holding often runs in families. Were you or your husband breath-holders?

Some children with breath-holding spells have iron deficiency and respond very well to iron supplements. Discuss this with your doctor.

Parenting a child with breath-holding spells is stressful. It is hard not to panic if your child stops breathing. You may be always afraid of disciplining her because she may have a spell. It is important not to let the breath-holding control your parenting.

Don't forget:

• She is not trying to manipulate you.
• The spells are not causing her harm.
• They are not painful.

Show her how to calm herself. Model becoming a bit upset and talk out loud what you do to calm down. "Ow, I bumped myself." "I'll just relax my body." "Breathe deep and slow." "Ah, that feels better."

Have your daughter teach a doll or teddy bear to calm down to feel better.

Practice with your daughter by pretending. Use a cue word like "calm" to remind her in these practices. Encourage her to do this when she starts to get upset.

Pay attention to every success.

Do not criticize her when she can't calm herself and has a breath-holding spell.

Thanks to Carol Camfield, a paediatrician at the IWK Health Centre for consultation.

Patrick J. McGrath OC, PhD, FRSC is a clinical psychologist and a researcher. He is Professor of Psychology, Pediatrics, and Psychiatry at Dalhousie University and Vice President - Research at IWK Health Centre in Halifax. Read more "Ask Dr. Pat" columns Ask Dr. Pat a question