What are breath-holding spells and why is my baby having them?

It happened. Your baby was upset, cried and then suddenly, nothing – no breathing and no noise – just your child holding their breath.

The phenomenon, called breath-holding spells, had social media users reeling Saturday when some people saw for the first time what a more extreme breath-holding spell looks like.

The video has 19.2 million views as of Wednesday and shows a child who appears to be crying silently and holding his breath.

“Breathe, buddy,” an individual says, holding him and blowing air into his face.

According to the people in the video, the child had been holding his breath for about 21 seconds. He held his breath for a bit longer and then finally exhaled and cried.

The child’s lips are visibly blue towards the end of the video.

Breath-holding spells are typically triggered by something such as pain or something upsetting, causing the child to cry, said Dr. Jonathan Miller, the chief of primary care at Nemours Children’s Health in Delaware.

“A typical story is something happens that makes the child cry … kind of hard and then all of a sudden, you see them hold their breath,” Miller said. “Quicker than you would expect, they might sort of look like they're passing out, they lose tone, they become limp.”

Sometimes breath-holding spells will come after a child gets a mild head injury such as banging their head on something, he said.

“Within 10 or 20 seconds of that, they have a breath-holding spell where they sort of go limp,” he said. “It can be a frightening episode for parents to witness their child having a breath-holding spell but fortunately these are benign. They tend not to be serious or dangerous in any way.”

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What do breath-holding spells look like?

Breath-holding spells can sometimes look like small seizures, said Dr. Lynette Grandison, a board-certified pediatrician with Sutter Gould Medical Foundation based in Modesto, California.

The spells typically last for a minute or less though and children who have them are normally fine after this period.

“It almost seems like your child's going to die,” she said. “That's how the parent feels but my biggest (goal) at the end of the visit is to reassure these parents.”

She added that while there are no known causes for them, breath-holding spells are part of a spectrum. Some episodes are less severe, like when children work themselves up, cry, inhale and go silent for a bit.

Pediatricians see these less severe breath-holding spells often when administering vaccines to babies in clinics.

“It can be as brief as that,” Grandison said. “Not every breath-holding spell is going to be where your child turns blue and lays on the floor and loses tone,” she said. “It's a spectrum.”

She said the number of children whose breath-holding spells cause them to lose consciousness is very small.

Usually children who are ages 6 to 18 months old have breath-holding spells, Grandison said. The spells are not harmful, though, and children normally outgrow them by the time they reach kindergarten or first grade.

Miller, from Delaware, said for most kids who have breath-holding spells, they’re completely gone by the time they reach 7 or 8 years old.

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What’s causing my baby’s breath-holding spells?

Doctors say there is no known cause for the spells.

Grandison said many babies who experience breath-holding spells are otherwise healthy. They haven’t had any heart surgery, head injuries or any other health issues.

“They have no control,” she said. “They can't help it, holding their breath. It gets to the point where they're crying and then they just hold their breath and then they pass out or lose consciousness.”

Grandison said iron supplements have been known to help children who commonly have breath-holding spells and some researchers have looked into how these supplements alleviate symptoms of the spells.

This may be because there is an association between anemia and breath-holding spells.

According to Miller, the pediatrician in Delaware, researchers found a higher rate of anemia in kids who have breath-holding spells.

“People have tried to treat anemia and have found, at least in one study, that kids have less breath-holding spells if their anemia is managed appropriately,” he said. “One of the things that families have kids who have breath-holding spells, or health care providers, should really be thinking about is whether there is some form of anemia, such as iron-deficiency anemia, that can be tested for and can be treated.”

What can I do when my baby has a breath-holding spell?

If a child in your care does experience a breath-holding spell, it’s best to lay the child flat on their back, Grandison said. This can be on the floor or in their crib.

Miller, from Delaware, said it’s important to make sure there’s nothing sharp near the child, especially while they’re in a limp state. Clear the area and make them comfortable, he said.

“If it's the first time you've seen such a thing, I think it's important to give your pediatrician a call to talk through what just happened so that you know you can be sure you're dealing with a breath-holding spell rather than something else,” he said.

In the video circulating online this month, the person holding the child blew spurts of air into the baby’s face to get him to respond. Miller said it’s fine to try and stimulate the child this way.

“Almost all kids start to breathe after 30 or 60 seconds but … maybe there is a chance that you can get them to sort of stimulate and start breathing again,” he said. “A puff of air in a baby's face usually will make them take a breath.”

What should I do when my child wakes up or their breath-holding spell is over?

Grandison said once breath-holding spells pass, it’s best to let the child know things are OK.

And while children have no control over breath-holding spells, they may sometimes be brought on by tantrums or fits. Parents should remain vigilant when it comes to discipline, Grandison said.

If a child had a breath-holding spell because they wanted a third cookie and they were told 'no', cried, and that led to a spell, don’t give in.

“You don't want them to wake up and you say ‘OK, here's five cookies,’” Grandison said. “That is not the point of the situation. If your child is having tantrums, you would treat this as any disciplinary action. So that means that you want to set expectations with your child.”

She encourages parents to be mindful of their child’s triggers to calm them down or distract them from working themselves up to a breath-holding spell.

“Make sure your child has their naps,” she said. “Make sure they're not hungry. Try to distract them, if you can, from getting to that point where they work themselves up so much.”

Lastly, Miller said parents whose children have breath-holding spells should make sure teachers, babysitters and family members know what breath-holding spells look like.

“Make sure you've described it and what to do so those people don't freak out,” he said. “It can look a little bit scary.”

Visit www.tinyurl.com/KidsHealthBHS for more information on breath-holding spells.

This article originally appeared on USA TODAY: Does your baby have breath-holding spells? What parents should know.