Need a Human Doctor?

We guide you when professional in-person care is required.

Symptom Checker
Jeremy Lopez

Breath-Holding Spells in Toddlers: Why They Turn Blue or Pass Out During a Tantrum

A breath-holding spell happens when a toddler cries hard and stops breathing for several seconds, turning blue around the lips (cyanotic type) or going pale and limp (pallid type) before breathing resumes on its own. It is a reflex set off by anger, fear, or a minor bump, not a deliberate act.

Breath-Holding Spells in Toddlers: Why They Turn Blue or Pass Out During a Tantrum
Children's HealthBreath-Holding Spellswhen-to-worry
Written By: DocAi Health Editorial Team
Last Updated: 2026-09-30
Medical Disclaimer: This article is for general informational and educational purposes only and is not medical advice. It does not create a doctor-patient relationship and is not a substitute for professional diagnosis or treatment by a qualified healthcare provider. Never disregard or delay seeking professional medical advice because of something you have read here. If you think you may have a medical emergency, call 911 or your local emergency number right away. Health information can change and this guidance is general and US-focused, so consult a licensed clinician in your own country about your specific situation.
A breath-holding spell happens when a toddler cries hard and stops breathing for several seconds, turning blue around the lips (cyanotic type) or going pale and limp (pallid type) before breathing resumes on its own. It is a reflex set off by anger, fear, or a minor bump, not a deliberate act. The American Academy of Pediatrics (AAP) says that in a typical spell, normal breathing starts again in less than a minute. Some spells include a brief faint or stiffening that can look like a seizure. This article covers what to do and which signs need same-day or emergency care.

What Is Actually Happening Inside Your Toddler's Body

A breath-holding spell is a reflex, not a choice. When a toddler becomes intensely upset, frightened, or hurt, the reflex briefly changes breathing, heart rate, and blood flow to the brain. In the more common cyanotic form, the child cries, exhales fully, and then simply does not take the next breath for several seconds, and the lips and face turn bluish until the reflex releases and breathing restarts on its own. In the pallid form, a sudden fright or a minor injury such as a bump to the head is a common set-off, and the reflex instead slows the heart rate, so the child goes pale, goes limp, and briefly loses consciousness rather than turning blue. Both patterns are involuntary, and both occur while a child is awake, so an episode during sleep needs a different evaluation.

Cyanotic and Pallid: Two Different Reflexes

Cyanotic spells are the more common type and often follow a tantrum, frustration, or being told no. The sequence is crying, a sharp exhale, silence, and a few seconds of blue-tinged lips or face before breathing restarts, sometimes with the child briefly going limp or stiff.
Pallid spells are less common and often follow something sudden and painful, such as a fall, a bumped head, or a scare, rather than anger. There may be little or no crying beforehand. The child goes white or gray, drops to the floor, and can briefly stop breathing or lose consciousness for a few seconds because the heart rate slows. Pallid spells may lead a pediatrician to consider an EKG (a tracing of the heart's rhythm), particularly if episodes are atypical or there is a family history of unexplained fainting or sudden cardiac death, because a heart rhythm problem is an uncommon but important look-alike.
A typical breath-holding spell follows crying, a fright, or a minor injury, and the AAP says spells most often start between 6 months and 2 years of age (MedlinePlus notes that some babies begin as early as 2 months). An episode in a baby younger than 6 months, or a first episode with no obvious trigger, is less typical and needs prompt evaluation, as covered in the emergency guidance below.

Not Defiance, and Not a Sign of Epilepsy

It is natural to wonder if your toddler is holding their breath to get their way. MedlinePlus notes that breath-holding spells are not thought to be a willful act of defiance, even though they often occur with temper tantrums. A child cannot start, extend, or stop a spell by will, and because the reflex is involuntary, punishing one is not expected to reduce how often they happen. It can also frighten a toddler who is already scared.
Parents are also often afraid that the stiffening or jerking that sometimes happens during a spell points to epilepsy. Brief stiffening or a few jerking movements can occur when blood flow or oxygen to the brain briefly falls. These movements can look like a seizure but do not by themselves mean that your child has epilepsy, and MedlinePlus notes that children who have a seizure during a breath-holding spell are not at higher risk for having seizures otherwise. MedlinePlus lists seizures lasting more than 1 minute as a reason to call 911, and movements that continue after your child's color and breathing return to normal also need emergency care. A first episode is still worth having checked, because a clinician needs to sort a breath-holding spell from a seizure or another cause.

What to Do While It Is Happening

  • Stay close and stay calm. Your child may not respond to reassurance mid-spell, but staying calm helps you respond well and helps your child recover once it passes.
  • Lay your child down on the floor, on their side or back, away from furniture corners and stairs, since a pallid spell can cause a sudden fall. If you can see food in your child's mouth, take it out. The AAP notes that lying down helps blood flow to the brain, so avoid holding your child upright; if your child is unconscious but breathing, MedlinePlus's CPR guidance describes turning them onto their side (the recovery position).
  • Time the episode on a phone or watch. Spells often feel longer than they are, and the AAP notes that breathing almost always returns by 60 seconds. The exact time also helps you describe the episode to a doctor later.
  • Let a typical spell run its course while you watch your child's color and breathing, but do not wait if this is the first episode or it looks different from earlier ones. Follow the emergency steps in the box below if your child remains unresponsive and is not breathing normally, has trouble breathing afterward, looks or acts very sick, or has been passed out for more than 2 minutes by the clock even though breathing has returned (the AAP's threshold for seeking care right away).
  • If your child fell and hit their head during the spell, watch for vomiting, unusual drowsiness, or crying that will not stop afterward. Those are emergency signs.

Three Habits to Drop, and When CPR Does Apply

Shaking your child or putting anything in their mouth can do harm: the AAP specifically warns against shaking a baby and against putting anything in a child's mouth, which can cause choking or vomiting. A cold, wet washcloth on the forehead is the one extra step that both MedlinePlus and the AAP mention, and it should not take priority over keeping your child safe and watching their breathing.
The second habit is giving rescue breaths or chest compressions during a typical spell. They are not part of routine care, because your child starts breathing again on their own, and the AAP advises against mouth-to-mouth breathing for a spell that a doctor has already diagnosed as breath-holding. That changes if your child remains unresponsive and is not breathing normally: call 911 and start CPR, following the dispatcher's instructions. Do not wait if this is the first episode, if it looks different from earlier ones, or if you believe at any point that this is a life-threatening emergency. MedlinePlus's CPR guidance says CPR is for a child who is unconscious and not breathing, not for one who is breathing normally or coughing; for a baby younger than 1 year, see MedlinePlus's infant CPR page.
The third habit is over-reacting once your child recovers. The AAP's guidance is to give a brief hug and go about your normal routine, without giving in to whatever set off the tantrum.

The Iron Connection

A pediatrician can also check iron status. MedlinePlus lists iron deficiency anemia among the conditions in which breath-holding spells are more common, and it says iron drops or pills may be given if a child has an iron deficiency. Research on whether iron reduces how often spells happen is limited, but it suggests the benefit is greatest in children who are iron deficient. Young children can develop iron-deficiency anemia when they do not get enough iron in their diet, as the NHLBI notes, so if your toddler is a picky eater, was born early or at a low birth weight, or was breastfed exclusively without an iron supplement, mention it at the visit. If iron deficiency is suspected, your pediatrician may order a blood count and iron studies, which can include a ferritin level. Do not start iron supplements on your own: whether your child needs iron, and how much, depends on their blood tests, age, and weight, and too much iron can be harmful. Between spells, watch for paleness, low energy, or a smaller appetite than usual, since these can also point to low iron and are worth mentioning at the same visit.

What a Doctor Checks Before Confirming It

A first breath-holding spell is worth a visit even though the episode itself usually needs no treatment. The exam is mostly about ruling out look-alikes: a detailed description of exactly what happened, in what order, and for how long; a physical exam; and, in some children, blood tests for iron deficiency. If the spells are pallid, happen without a clear trigger, run in the family alongside unexplained fainting, or otherwise do not fit the typical pattern, the pediatrician may order an EKG to check the heart's rhythm or an EEG to check for seizures, or refer your child to a pediatric cardiologist or neurologist. A test or referral is meant to rule out other causes and does not necessarily mean that something is seriously wrong.

Telling Daycare, Preschool, and Other Caregivers

If your toddler has recurring spells, give any regular caregiver a short written note: what a typical spell looks like, roughly how long it lasts, what to do while it is happening, and when to call you versus call 911, following this article. A caregiver who has not seen a breath-holding spell before can panic, or just as unhelpfully write it off as bad behavior. A brief heads-up before drop-off spares everyone a scarier version of an ordinary spell.

When Most Toddlers Outgrow This

According to the AAP, breath-holding spells most often start between 6 months and 2 years of age. MedlinePlus says most children outgrow them by the time they are 4 to 8 years old, and the AAP puts it around age 6. Frequency varies widely, from one or two spells a day to one or two a month according to the AAP. Treating iron deficiency when it is present may reduce how often spells happen, and keeping routines predictable and responding to tantrums calmly and consistently may make episodes easier to manage.

Lowering How Often Spells Happen

You cannot eliminate breath-holding spells by managing tantrums perfectly, since the reflex itself is not something a toddler or a parent controls. But cutting down on the surges of frustration and fear that set them off may lower how often they happen, and MedlinePlus suggests making sure your child eats and sleeps at their usual times, since an overtired or hungry toddler has less capacity to handle being told no. Give a warning before transitions instead of an abrupt stop. Name big feelings out loud in simple words, stay calm, and respond consistently: try not to change your usual limits or routines because of a spell, and offer comfort once your child has recovered.

When to Seek Medical Care

When to Seek Urgent or Emergency Care

Most breath-holding spells end on their own in under a minute and need nothing more than the steps described above. The list below is specific to breath-holding spells and flags the patterns that fall outside that typical picture. The time limits in this list come from guidance published by the American Academy of Pediatrics and MedlinePlus. In the second list, the first four items need a call to your pediatrician right away, and the rest can be raised at the next available appointment. This guidance is in addition to, not a replacement for, the general disclaimer above.

Emergency, call 911 or go to the emergency room immediately if:

  • Breathing has not started again after 1 minute by the clock, or your child remains unresponsive and is not breathing normally. Call 911 and start CPR, following the dispatcher's instructions, and do not wait if this is the first episode or it looks different from earlier ones. Also call 911 if you believe at any point that your child's life is in danger
  • Your child has trouble breathing after the spell ends
  • Jerking or stiff, seizure-like movements continue after your child's color and breathing return to normal, or the movements themselves last more than a minute
  • Your child has been passed out for more than 2 minutes by the clock even though breathing has returned, will not wake up, or looks or acts very sick
  • Your child fell and hit their head during the spell and afterward vomits, seems unusually drowsy, or will not stop crying

See a doctor soon (same-day or next available appointment) if:

  • This is your child's first breath-holding spell of any kind, even if it ended normally on its own, so call your pediatrician right away, or seek care now if you cannot reach them. If there was no clear trigger such as crying, a fright, or a bump, say so, so the clinician can look for another cause rather than assuming it was a breath-holding spell
  • The episode happens in a baby younger than 6 months old. That is less typical for a breath-holding spell, so call your pediatrician right away for an urgent evaluation, and go to the emergency room if you cannot reach them promptly
  • The episode happens during sleep. Breath-holding spells occur while a child is awake, so a sleep episode needs a prompt evaluation for another cause
  • There is a family history of unexplained fainting, seizures, or sudden death in a young relative. Tell the pediatrician promptly, particularly after a first or unusual episode
  • Spells are becoming more frequent, lasting longer, or looking different than they used to
  • Your child has pallid (pale, limp) spells rather than the more common blue-tinged cyanotic type
  • Your toddler seems unusually pale, tired, or is a picky eater between spells, which can point to low iron
  • You need a written care plan for daycare, preschool, or a babysitter
  • A spell looks different from the usual pattern in a way that worries you
Still concerned about your symptoms?
Use the DocAi Health AI Symptom Checker to organize your symptoms, explore possible explanations, and understand what level of care may be appropriate.
Start Your Assessment →

Frequently Asked Questions

Is my toddler holding their breath on purpose to get what they want?

No. MedlinePlus notes that breath-holding spells are not thought to be a willful act of defiance, even though they often occur with temper tantrums. The nervous system briefly changes breathing and heart rate after intense crying, fear, or pain, and your child has no more control over it than over a sneeze. It is not a behavior your child can choose to repeat or stop.

Can a breath-holding spell turn into epilepsy?

A breath-holding spell is not epilepsy. Brief stiffening or a few jerking movements can occur when blood flow or oxygen to the brain briefly falls, and these movements can look like a seizure without meaning your child has epilepsy. MedlinePlus notes that children who have a seizure during a breath-holding spell are not at higher risk for having seizures otherwise. A first episode is still worth a doctor's visit to confirm the pattern.

Should I give my child CPR or rescue breaths during a spell?

Not during a typical spell, because breathing returns on its own and the AAP advises against mouth-to-mouth breathing for a diagnosed spell. Lay your child down in a safe place, stay close, and watch. If your child remains unresponsive and is not breathing normally, call 911 and start CPR, following the dispatcher's instructions, and do not wait if this is the first episode or it looks different from earlier ones.

Why does my toddler pass out and go stiff during a breath-holding spell?

A brief drop in blood flow or oxygen to the brain during a spell can cause your child to lose consciousness for a few seconds and briefly stiffen or jerk. This looks alarming, but the AAP says that in a typical spell normal breathing starts again in under a minute and a child is fully alert in under 2 minutes. Follow the emergency steps in this article if your child remains unresponsive and is not breathing normally, or has been passed out for more than 2 minutes by the clock even though breathing has returned.

Does a breath-holding spell mean my child has a heart problem?

Most breath-holding spells, especially the more common cyanotic (blue) type, are not related to the heart. Pallid spells, where a child goes pale and limp after a fright or minor injury, involve a reflex that slows the heart rate, so a pediatrician may consider an EKG to check the heart's rhythm, particularly if episodes are atypical or there is a family history of unexplained fainting or sudden cardiac death.

At what age do breath-holding spells usually stop?

According to the AAP, spells most often begin between 6 months and 2 years of age. MedlinePlus says most children outgrow them by the time they are 4 to 8 years old, and the AAP puts it around age 6. Treating iron deficiency when it is present may reduce how often spells happen.

Can iron supplements actually help with breath-holding spells?

MedlinePlus lists iron deficiency anemia among the conditions in which breath-holding spells are more common. Treating a deficiency when it is found may reduce how often spells happen in some children, although the research is limited. Talk with your pediatrician before starting iron: whether your child needs it, and how much, depends on their blood tests, age, and weight.

What is the difference between a cyanotic and a pallid breath-holding spell?

Cyanotic spells are the more common type and often follow anger or frustration, with the child crying, exhaling, and turning blue around the lips before breathing resumes. Pallid spells often follow a sudden fright or minor injury, involve little or no crying, and cause the child to go pale, go limp, and briefly lose consciousness because the heart rate slows.

Should I punish my child or give in to stop a spell from happening?

Neither is recommended. A breath-holding spell is not a behavior choice, so punishment is not expected to prevent the next one. The AAP's guidance is to give a brief hug once your child has recovered and go about your normal routine, without giving in to whatever set off the tantrum. Respond the same calm, consistent way you would to any tantrum.

Sources

Need a Human Doctor?
We guide you when professional in-person care is required.
Connect with a Doctor