Pediatr. praxi. 2025;26(6):359-362 | DOI: 10.36290/ped.2025.069

Let's not underestimate breath-holding spells

MUDr. Jakub Malý1, MUDr. Miroslav Mamiňák2, doc. MUDr. Jan David, Ph.D.1
1 Klinika dětí a dorostu 3. LF a FNKV, Praha
2 Klinika dětské neurologie 2. LF a FN Motol, Praha

The breath-holding spell is defined as an age-dependent, sudden-onset, involuntary, non-epileptic event. While it may initially appear life-threatening, breath-holding spell is a benign condition with a favourable prognosis. Nevertheless, in certain clinical scenarios, it can mimic symptoms of serious medical conditions and thus presents a differential diagnostic challenge. This article outlines the etiopathogenesis and diagnostic approach in a paediatric patient with suspected breath-holding spell, with a focus on published case reports involving more severe underlying etiologies.

Keywords: breath-holding spells, iron deficiency anemia, nonepileptic events, cyanosis.

Accepted: December 10, 2025; Published: December 15, 2025  Show citation

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Malý J, Mamiňák M, David J. Let's not underestimate breath-holding spells. Pediatr. praxi. 2025;26(6):359-362. doi: 10.36290/ped.2025.069.
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    References

    1. Singh P, Seth A. Breath holding spells - a tale of 50 years. Indian Pediatr. 2015;52(8):695-596. Go to original source... Go to PubMed...
    2. Leung AKC, Leung AAM, Wong AHC, et al. Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence. Curr Pediatr Rev. 2019;15(1):22-29. Go to original source... Go to PubMed...
    3. DiMario FJ Jr. Paroxysmal nonepileptic events of childhood. Semin Pediatr Neurol. 2006;13(4):208-221. Go to original source... Go to PubMed...
    4. Hálek J. Afektivní záchvaty. Pediatr pro Praxi. 2010;11(6): 378-379.
    5. Anil BG, Nedunchezian K, Jayanthini V, et al. Breath holding spells: Evaluation of autonomic nervous system function. Indian Pediatr. 2005;42(9):923-927.
    6. Kolkiran A, Tutar E, Atalay S, et al. Autonomic nervous system functions in children with breath-holding spells and effects of iron deficiency. Acta Paediatr. 2005;94(9):1227-1231. Go to original source... Go to PubMed...
    7. Azab SF, Siam AG, Saleh SH, et al. Novel Findings in Breath-Holding Spells: A Cross-Sectional Study. Medicine (Baltimore). 2015;94(28):e1150. Go to original source... Go to PubMed...
    8. Gürbüz G, Perk P, Çokyaman T, et al. Iron supplementation should be given in breath-holding spells regardless of anemia. Turk J Med Sci. 2019;49(1):230-237. Go to original source... Go to PubMed...
    9. Jain R, Omanakuttan D, Singh A, et al. Effect of iron supplementation in children with breath holding spells. J Paediatr Child Health. 2017;53(8):749-753. Go to original source... Go to PubMed...
    10. Dilber B, Akbulut UE, Serin HM, et al. Plasma and Erytrocyte Oxidative Stress Markers in Children with Frequent Breath-Holding Spells. Klin Padiatr. 2021;233(4):173-180. Go to original source... Go to PubMed...
    11. Calik M, Abuhandan M, Aycicek A, et al. Increased oxidant status in children with breath-holding spells. Childs Nerv Syst. 2013;29(6):1015-1019. Go to original source... Go to PubMed...
    12. Saad K, Farghaly HS, Badry R, et al. Selenium and antioxidant levels decreased in blood of children with breath-holding spells. J Child Neurol. 2014;29(10):1339-1343. Go to original source... Go to PubMed...
    13. Calik M, Sen Dokumaci D, Sarikaya S, et al. Brain metabolite values in children with breath-holding spells. Neuropsychiatr Dis Treat. 2017;13:1655-1660. Go to original source... Go to PubMed...
    14. Calik M, Ciftci A, Sarikaya S, et al. Assessment of both serum S-100B protein and neuropeptide-Y levels in childhood breath-holding spells. Epilepsy Behav. 2015;47:34-38. Go to original source... Go to PubMed...
    15. Bhat J, Martinez J, Maertens P. Atypical Cyanotic Breath-Holding Spells in an Infant With 16p11.2 Microdeletion Syndrome. Clin Pediatr (Phila). 2018;57(3):365-367. Go to original source... Go to PubMed...
    16. Subbarayan A, Ganesan B. Temperamental traits of breath holding children: A case control study. Indian J Psychiatry. 2008; 50(3):192-196. Go to original source... Go to PubMed...
    17. Demirtas MS, Alici N. The reliability and quality of YouTube videos as a source of breath holding spell. Ital J Pediatr. 2024;50(1):8. Go to original source... Go to PubMed...
    18. Hellström Schmidt S, Smedenmark J, Jeremiasen I, et al. Overuse of EEG and ECG in children with breath-holding spells and its implication for the management of the spells. Acta Paediatr. 2024;113(2):317-326. Go to original source... Go to PubMed...
    19. Falsaperla R, Marino S, Pavone P. Non-Epileptic Paroxysmal Events: Clinical features and diagnostic differences with epileptic seizures. A Single Tertiary Centre Study. Clin Neurol Neurosurg. 2021;207:106739. Go to original source... Go to PubMed...
    20. Chorny LE, Nordli DR, Galan F. Breath-holding spells: A typical case with EEG and video correlate. Epileptic Disord. 2025;27(2):314-315. Go to original source... Go to PubMed...
    21. Musa Z, Gowder A, Bergman H, et al. Rare seizure presentation in 3-year-old male: Case of focal epilepsy associated with squatting and running. SAGE Open Med Case Rep. 2025;13:2050313X251364080. Go to original source... Go to PubMed...
    22. Cui S, Zhang S, Geng L. Fatal Case of Acute Epidural Hematoma in an Infant With Concurrent Breath-Holding Spells. J Craniofac Surg. 2025. Go to original source... Go to PubMed...
    23. Chiba K, Aihara Y, Kawamata T. Breath-holding spells after endoscopic third ventriculostomy in a post-ventriculoperitoneal shunted patient. Childs Nerv Syst. 2022;38(4):813-816. Go to original source... Go to PubMed...
    24. Kolterer B, Gebauer RA, Janousek J, et al. Improved quality of life after treatment of prolonged asystole during breath holding spells with a cardiac pacemaker. Ann Pediatr Cardiol. 2015;8(2):113-117. Go to original source... Go to PubMed...
    25. Aman M, Abou Turk CA, Carlson JC. Case report of vaccine-induced anaphylactic reaction reclassified after vaccine challenge. J Allergy Clin Immunol Glob. 2025;4(3):100484. Go to original source... Go to PubMed...
    26. Arslan M, Karaibrahimoğlu A, Demirtaş MS. Does iron therapy have a place in the management of all breath-holding spells? Pediatr Int. 2021;63(11):1344-1350. Go to original source... Go to PubMed...
    27. Hecht EM, Layton MR, Abrams GA. Iron Supplementation for the Treatment of Breath-Holding Spells: A Systematic Review and Meta-Analysis. Clin Pediatr (Phila). 2020;59(8): 819-822. Go to original source... Go to PubMed...
    28. Sawires H, Botrous O. Double-blind, placebo-controlled trial on the effect of piracetam on breath-holding spells. Eur J Pediatr. 2012;171(7):1063-1067. Go to original source... Go to PubMed...
    29. Sharawat IK, Dawman L, Panda P, et al. Efficacy of piracetam in children with breath-holding spells: a systematic review and meta-analysis. Eur J Pediatr. 2024;184(1):89. Go to original source... Go to PubMed...
    30. Abbaskhanian A, Ehteshami S, Sajjadi S, et al. Effects of piracetam on pediatric breath holding spells: a randomized double blind controlled trial. Iran J Child Neurol. 2012;6(4):9-15.
    31. Sato A, Oda Y, Asakai H. Severe pallid breath-holding spells treated with low-dose theophylline. Brain Dev. 2021;43(2): 348-351. Go to original source... Go to PubMed...
    32. Dai AI, Demiryürek AT. Effectiveness Oral Theophylline, Piracetam, and Iron Treatments in Children With Simple Breath-Holding Spells. J Child Neurol. 2020;35(1):25-30. Go to original source... Go to PubMed...

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