Parents have been holding their breath waiting for me to tell them what to do when their young children have what we call “breath holding spells,” especially when they get angry. I don’t want anyone to get blue in the face over this topic, so let me provide some information.

Breath holding is a fairly common behavior in most toddlers. About five percent of healthy, breath-holding toddlers will get so upset that they exhale forcefully and then decide not to breathe to the point they may turn blue or pale and literally fall to the ground limp, sometimes even with shaking of the arms and legs. We call this type of episode an “official”breath holding spell.

Though these episodes are extremely scary to watch, they resolve quickly. Within 30 to 60 seconds a child will catch their breath and begin to cry. These spells are usually an involuntary response to strong emotions, such as being angry or frustrated. Rarely has a spell been associated with a seizure disorder or heart problem. Breath holding spells are rare before 6 months of age, peak at the age of 2 and then disappear by age 5.

If your child has a breath holding spell, lay your child flat on the floor to increase blood flow to the brain. If they start to throw up as they regain consciousness, roll them over onto their side so they don’t start choking on what’s coming up.

After your child recovers, which usually happens within seconds, it is good to speak with your child’s health care professional to make sure that your child has had a typical breath holding spell as opposed to their having a more serious problem involving the brain or heart. Sometimes being anemic due to low iron stores can contribute to the problem.

The most important thing a parent can do is figure out what provokes these spells and try to prevent them. For example, say a child gets angry because they don’t want to leave the playground when you need to. Try distracting them with a sudden appearance of their favorite stuffed animal. That may be all it takes to prevent the full-blown tantrum and breath-holding spell from occurring.

Once you know it is a breath holding spell, stay relaxed. Give your child a hug when it’s over and go about your business. If you are frightened, don’t let your child know it. It’s possible they will do this more frequently to get their way or seek your attention.

Hopefully tips like this will allow you to breathe more easily the next time your child has a breath holding spell.

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Lewis First, MD, is chief of pediatrics at the University of Vermont Children’s Hospital and chair of the Department of Pediatrics at the Robert Larner, MD, College of Medicine at the University of Vermont. You can also catch “First with Kids” weekly on WOKO 98.9-FM and WPTZ Channel 5, or visit the First with Kids video archives at www.uvmhealth.org/medcenterfirstwithkids.