When a Child Holds His Breath
What breath-holding spells can teach us about parenting, fear, and the particularity of love
A Frightening Moment in the Exam Room
Josiah was six months old. His six-month-old checkup visit had gone well. He was sitting up longer than expected, laughed, even at me, and was eating purées like a champ. I walked out of the exam room and started toward the next room when a sudden outburst called me back.
Josiah had been crying loudly when he suddenly stopped. Not only had he stopped crying, but he also wasn’t breathing. His skin turned purple, then blue. His mom’s eyes widened in alarm. The room fell quiet, and then he breathed. He cried again. His color returned. His mom held him close, and within a few minutes, he was fine. She still wasn’t.
This was Josiah’s first breath-holding spell. Oddly, his spells occurred only in response to vaccinations. He repeated the performance at his 12- and 15-month visits. When the 18-month visit came around, his mom asked whether she could delay his single vaccination by a week or two because she “couldn’t handle passing out today.”
Understanding Breath-Holding Spells
Initially, breath-holding spells sound and look dangerous, but most are not. They are dramatic and frightening, but for most kids, they are brief and self-limited. They are fairly common, affecting up to 5% of healthy children, typically between 6 months and 5 years of age. Although they are usually triggered by pain, frustration, or anger, they are involuntary and are not temper tantrums or deliberate attempts at manipulation. Some children might turn blue during breath-holding spells, while others become pale, and some may even progress from pallor to a bluish color. Most children who have breath-holding spells outgrow them by age 3-4.
Although these types of spells are common, children should be evaluated if episodes are prolonged, occur without an obvious trigger, cause lingering drowsiness or confusion, or are accompanied by movements or symptoms that raise concern for a seizure or another medical problem.
What Parents Can Do in the Moment
When facing frightening situations like this, it’s helpful for parents to gently remind themselves of what’s happening, reassure themselves that it will pass quickly, and do their best to stay calm and centered. For many, it helps to have a short action plan, such as placing the child somewhere safe on the floor or in a lap and holding them until the episode passes.
This is good pediatric advice and can apply generally to all kids with breath-holding spells. But it’s not quite specific enough. Like my 6-month-old patient, who held his breath after vaccination, these kids aren’t “being difficult” or trying to manipulate. Their bodies respond to specific triggers, which can differ quite a bit from one child to another.
The Child Behind the Spell
This patient’s spell was probably his body’s response to surprise and physical pain. Another child may hold their breath because they were unexpectedly left alone, another due to strong emotions like fear, frustration, or anger. For some children, spells may be more likely when they are already stretched thin by hunger, fatigue, or overstimulation.
Beyond the general advice about how to handle these spells when they happen, parents who try to understand what’s behind their child’s breath-holding may be able to do something to help prevent them.
If painful procedures like vaccinations are the trigger, parents could try holding the child differently and perhaps more reassuringly during the shot. Other children may need careful preparation for sudden transitions. Some parents may be able to prevent these spells by learning to recognize their children’s strong emotions early, so they can comfort them before their feelings escalate. Others may find that sticking closely to a schedule for snacks or naps makes breath-holding less likely.
Parenting the Child You Actually Have
While managing breath-holding spells is just a small part of parenting, it offers a chance to learn more about the overall parenting journey.
Good parenting is not simply applying the same rule to every child. It usually only takes parents a few days to realize this when they have a second child. The little sister quickly declares that she’s not like the first and that what worked for the first child won’t work for her.
Children need their parents to help them learn who they are and what they uniquely need. One child may need verbal reassurance, while another needs less talk and more hugs. One needs firm boundaries, while another needs a bit more freedom. One may need more help calming a nervous system that disintegrates quickly, while another may self-regulate easily.
Parents gain wisdom when they move from asking, “What do children need?” in the abstract to asking, “What does this child need, here and now?”
God’s Love Is Not Generic
I think this is one way parenting can teach us something about God. A loving parent doesn’t respond to every child the same way. Love can be consistent without being mechanical. It can have a steady aim without taking the same form in every moment. It always points to overall flourishing, but the form love takes in a moment depends on the child, their feelings, capacities, and the available possibilities.
Just as loving parents guide and respond to their children individually, God’s love is not generic. God responds uniquely to each of us and to all of creation here and now.
God relates to us as individuals, not as interchangeable replicas. God knows who we are and, in every moment, sees our history, fears, hesitations, aspirations, and capacity, guiding us toward the best possibilities for flourishing. How God guides and responds to me in one moment will not be the same as how God interacts with you. Not because God is inconsistent, but because love is attentive and responsive.
Love Learns, Watches, and Adapts
I agreed to Josiah’s mom’s request to return another day for the vaccination. When they returned, Josiah didn’t hold his breath. I don’t know whether he had outgrown his breath-holding spells or whether his mom had learned new ways to calm him that prevented one that day. In either case, he didn’t hold his breath that day and hasn’t since.
That’s how a parent’s love works. It learns, watches, and adapts. It provides safety when needed, reassurance when fear takes over, guidance when the path is unclear, and response in each new moment.
I think God’s love is like that also. Rather than being a distant rule applied from “above,” God’s love is a dynamic presence that knows us deeply, meets us individually, and keeps inviting us toward flourishing every moment.
image: ChatGPT
Beautiful!