February Week 3: Breath Holding Spells and Tantrums


Anemia and Breath Holding – Cochrane Review 2010

Tantrums and Breath Holding Spells – Chapter 2. Child Development & Behavior. Edward Goldson, MD, Ann Reynolds, MD


A father brings his 9 month old boy into clinic because of an episode that freaked out the parents. He wanted a cup of water that his brother had and when he couldn’t get it, started crying and then “stopped breathing.” A similar episode happened at day care later in the week when he was crawling toward a toy and a little girl took it before he could get to it. After each episode he’s immediately back to normal and there are no abnormal movements or shaking while he is “passed out”.

What do you tell the parents you think is going on with their son?

The parents are wondering, “Isn’t he a little young for this? When will he outgrow it?” What can you tell them?

What advice can you give to parents for when these episodes happen?

Are there any labs or tests you would want to order on this patient? Any other medical problems you would want to rule out?

Would you start this child on iron supplementation? What does the literature show?

A 2 year old girl has started having temper tantrums in public and her parents are mortified. Last week they had to leave the restaurant because she was making such a scene when they wouldn’t let her play with the knife on the table. She will scream, bite, and kick until she gets her way. When they try to reason with her or talk her down during a tantrum, it doesn’t seem to work. She is having one of these episodes a week.

Parents want to know, is it normal for their sweet daughter to suddenly be acting this way? She seems to be having these tantrums frequently – is this more than usual?

What advice can you give them on how to minimize these outbursts?

They often just give in to what she wants so that she stops screaming. Is this a good or a bad way to handle temper tantrums? What should they do instead?

Would you refer this child to a psychiatrist? If yes, why? If no, what would have to change to make you feel that such a referral is necessary?

Cases/Questions by Dr. Jessica Long