THE SCREAMING 2-year-old suddenly falls silent, turns blue in the face and passes out. He's not breathing. His mother calmly lays him flat on the floor and sits nearby, waiting for him to revive. Why isn't she panic-stricken? Because she's the experienced mother of a breath-holder.
"Breath-holding is fairly common among toddlers, who typically have little control over their emotions," says Dr. Catherine Dundon, a pediatrician in Nashville. About a quarter of children ages 3 months through 4 years experience some form of it. (Most spells end before the child passes out.)Breath-holding episodes are most often triggered by anger, frustration or fear, and they generally last no longer than 30 to 45 seconds. Some children experience these spells only once or twice, while repeat performers may have several episodes a day. Experts aren't in complete agreement about the cause of breath-holding or the ability of a child to control it. Some doctors believe that kids can consciously precipitate the experience. But according to new research by Dr. Francis DiMario, an associate professor of pediatrics and neurology at the University of Connecticut, these kids may have an imbalance in the autonomic nervous system, which controls the body's involuntary functions, such as the heartbeat and respiration.
No matter what the cause, breath-holders' unusual behavior has gained them the reputation of being "difficult" children. But DiMario's studies indicate that although the spells are often brought on by temper tantrums, youngsters who have them cannot simply be regarded as behaviorally difficult. In fact, they have no more tantrums than other kids - they just conclude some of them more dramatically. "This is an important point," says DiMario, "because it shows parents that breath-holding is not a conscious attempt by the child to manipulate them."
A genetic link to the syndrome provides additional evidence that breath-holders may not just be willful, DiMario says. If a parent was a breath-holder, the child's much more likely to be one. The trait is more often traced to the mother's side than to the father's, he says.
What happens to a child during a spell depends on the type of breath-holding he experiences. According to DiMario, there are two classifications: "cyanotic," in which oxygen in the blood decreases, and "pallid," in which the circulation and heart rate slow, diminishing the flow of blood and oxygen to the brain. In both cases, the youngster loses his breath and sometimes passes out. Within seconds, though, he automatically starts to breathe again. Fortunately, there's no harm done.
A breath-holding episode can be terrifying to watch, especially the first or second time it happens. Parents are apt to contact their pediatrician immediately, and rightly so. "It's important that a child who is breath-holding be diagnosed to rule out other possibilities, such as epileptic seizures," says Dundon. But once parents know that their child is a breath-holder, what they need most is a big dose of reassurance and a little bit of advice (both of which they should pass on to the child's other caregivers).
The most practical thing a parent can do is to clear the area when an episode seems likely (when a breath-holder begins a tantrum, for example), so the child won't get hurt if he falls to the floor. If a child passes out, lay him flat (or elevate his feet) to allow blood to reach his head.
Experts also caution parents to respond calmly and firmly during a spell. Doctors don't know why, but most breath-holding diminishes as children grow physically and as they learn to communicate their emotions. In about 50 percent of cases, this happens roughly by age 4. But breath-holding can persevere if children continue to have temper tantrums. It's still not a voluntary behavior, theorizes Dundon, but a child can learn to precipitate an episode by purposely getting himself worked up. When parents protect a breath-holder from everyday frustrations, give in to his outbursts, and baby him during a spell, they are feeding the behavior - and may prolong it. "You can't choose if your child is a breath-holder," says Dundon, "but you can choose how to respond to it."