KUALA LUMPUR, March 22 — Episodes of intense crying or overwhelming emotional distress in children may trigger a condition known as a breath-holding spell (BHS), where breathing briefly ceases before recovering spontaneously.

Dr Adli Hidayat Iman Kamarulzaman, a medical practitioner at a 24-hour clinic, said BHS most commonly affects children aged between six months and six years, largely due to the immaturity of their nervous system.

He explained that the condition occurs when the brain is unable to regulate emotional responses effectively, particularly during episodes of stress or pain.

“In most cases, the child will cry persistently before their breathing appears to pause or become obstructed temporarily. 

“When breathing stops, oxygen levels fall, causing the child’s face to turn bluish, and many may briefly lose consciousness. These episodes typically last about 60 seconds, after which normal brain function resumes and the child begins breathing again,” he told Bernama.

Dr Adli Hidayat Iman said BHS is rarely documented as formal medical cases because many parents regard it as a normal occurrence and therefore do not seek medical consultation or report it to doctors. 

“In Malaysia, there is a long-standing belief that if a child cries to the point of turning bluish, simply blowing on the child’s face will help restore normal breathing.

“As a result, many cases are never brought to medical attention, making it difficult to determine the true incidence,” he said.

Elaborating further, he noted that many parents also confuse BHS with seizures, although clinically, seizures are not triggered by crying.

He therefore encouraged parents to record a video of the episode, as this can assist doctors in determining whether the child is experiencing BHS or a more serious underlying medical condition.

He also advised parents to remain calm and place the child on a flat surface to ensure the airway remains open.

“Parents are advised not to carry or shake a child while they are unconscious, as this position may compromise the airway,” he said.

“If the child remains unconscious for more than about one minute, parents should seek immediate medical assistance or initiate cardiopulmonary resuscitation (CPR), which is an essential life-saving skill to learn,” he added.

He said that, in general, BHS is not life-threatening. However, studies indicate that children with iron deficiency are at a higher risk of experiencing such episodes.

“If the condition is confirmed by a doctor, investigations such as haemoglobin levels and iron studies are typically carried out. If iron deficiency is detected, the child may be prescribed iron supplementation to reduce the risk of recurrence,” he said. — Bernama