A breath-holding spell is an episode in which the child stops
breathing involuntarily and loses consciousness for a short
period immediately after a frightening or emotionally upsetting
event or after a painful experience. Breath-holding spells occur
in 5% of otherwise healthy children. They usually begin in the
first year of life and peak at age 2. They disappear by age 4 in
50% of children and by age 8 in about 83% of children. The
remainder may continue to have spells into adulthood. Breath-
holding spells do not appear to be risk factors for true
epilepsy but may be associated with an increased risk of
fainting spells in adulthood. There are 2 forms of breath-
holding spells: Both forms are involuntary and readily
distinguished from uncommon brief periods of voluntary breath-
holding by stubborn children, who invariably resume normal
breathing after getting what they want or after becoming
uncomfortable when they fail to get what they want. During a
cyanotic breath-holding spell, children hold their breath (