Dear Grandparent,

This is a subject discussed before in this column, it’s worth revisiting since the question has come up again.

First of all, let me reassure you that your grandson can’t really hurt himself in this way.  Mother nature has given us built-in protection against committing suicide by breath-holding.  That protection consists of taking the conscious mind out of the picture so that natural reflexes can take over and allow us to breathe.

Breath-holding spells are almost always preceded by a frightening or upsetting event.  The child then usually gives one or two long cries and then holds his breath on an exhale.  His lips may then turn blue, he may pass out, and in one third of cases he may even have some jerking or twitching while he’s out.  Normal breathing begins again as soon as a child loses consciousness, and consciousness is usually regained within a minute or so.  These episodes, by definition, only happen when a child is awake (see your pediatrician if any abnormal events occur during sleep). Most children outgrow them age 4 or 5.  They do not cause brain damage, and they do not increase the risk that a child will have seizures later on.

The only real risk of these episodes is a spoiled child, since nearly every parent and grandparent reacts the way you describe.  Please stop catering to this little boy.  Instead, when he gets furious, observe him as calmly as possible.  Lie him down, if you can.  Time the length of a few of the episodes if he does lose consciousness – it will feel like forever, but should actually be only a minute or two.  Don’t start rescue breathing and don’t call 911 UNLESS there is no breathing for more than a minute or unless your child turns white instead of bluish.  (Breath-holding episodes usually don’t start before six months of age, so if a child has an episode that seems similar before that age, call 911.)

After an episode, give your child a little love and attention (but not whatever it was he was throwing a fit about), and then go on about your business.  Rewarding him for out-of-control behavior will only increase the likelihood of future spells.  The reverse is also true; if good things never come from a temper tantrum, his fits will gradually decrease in frequency.

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