Last Wednesday, 1-year-old Stephen Albert was playing under the wide arm of the couch in his family's Cheverly, Md., home. But as he moved to stand up, his head collided with the couch arm and he sat back down again, hard.
"All of a sudden, he let out a wail," said Stephen's mother Jessica Albert, 31. "He was crying, so I picked him up. He wailed for a few seconds and then all of a sudden, he went very still and silent and I noticed his eyes rolling back in his head... He wasn't breathing and he was a gray color."
Stephen awoke in a few seconds and a trip to the emergency room confirmed that he was fine and had no long-term damage. But Stephen had experienced what is known as Breath Holding Spell (BHS) -- a brief period when a young child will stop breathing.
"It terrified me," Albert said. "It's a good thing that it wasn't more serious, but it also scares me now every time he bumps his head that he'll stop breathing again."
BHS occurs in about 5 percent of infants and toddlers up to about age 5 -- children aged 1-3 are particularly at risk -- and is usually associated with a need for attention, to express emotion or, in rare cases, to indicate an underlying medical condition.
"[BHS] falls into the category of attention-seeking behaviors when a child is very, very frustrated and upset and has not learned socially appropriate ways to express themselves," said Rahil Briggs, an infant and toddler psychologist and director of the Healthy Steps child development program at Montefiore Medical Center, in New York .
No Limits on Getting Attention
Other attention-seeking behaviors children may exhibit can include banging their head against a wall or vomiting on command.
But breath holding is a real eye opener, for parents and doctors. "It works because it's scary," Briggs said, adding that children often turn blue, purple or gray as they hold their breath. "It's striking to look at until you understand the mechanism behind it."
British opera singer Charlotte Church told the U.K.'s Daily Mail that her 2-year-old daughter, Ruby, suffers BHS when she has tantrums, which frightens her and her husband, rugby player Gavin Henson.
"She will hold her breath until she passes out -- the first time it happened it was absolutely horrendous," Church said. "Every time it's happened, she's been fine afterwards, but it causes Gavin and I a lot of worry."
Kids Can't Hurt Themselves by Holding Their Breath
Added to their inability to communicate their needs, infants and toddlers crave any kind of attention from parents, be it positive or negative.
"An attention Siberia is the worst place in the world for a 1-year-old," Briggs said.
While such schemes can seem dramatic and even dangerous, it is almost impossible for a child to hold their breath long enough to do bodily or mental harm because their reflexes kick in, physicians say.
Shock or surprise can also induce breath holding in very young children, exacerbated, or as a result of the accompanying crying or hyperventilating, such as with Stephen. However, most breath holding spells do not last longer than a few seconds.
But BHS can be associated with medical conditions such as seizure disorders, anemia or, rarely, cardiac disorders, and parents may want to rule out these conditions after their child's first BHS.
"They are rapidly evolving beings at that point," said Keith-Thomas Ayoob, associate professor of pediatrics at the Albert Einstein College of Medicine in New York City. "Medical problems can be expressed at this time."
Kids Will Grow Out of Bad Behaviors
But Ayoob pointed out that, without a solid underlying problem resulting in BHS, there is little treatment available. In fact, children will grow out of behavioral problems such as BHS as they learn to express themselves in more sophisticated ways.
Briggs noted that, if the problem is purely behavioral, BHS will dissipate quickly if parents do not respond to episodes with attention.
"If you give children lots of positive attention in other ways, it decreases the amount of time they need to look for attention in negative ways," Briggs said. "But if they're in a safe place and not going to fall off a table or chair, then you really just have to ignore it."
Albert said her son is not the type to have tantrums and hold his breath because he is angry, but she is still nervous when he plays.
"It's terrifying to see," she recalled. "But of all the things that it could be, it's lowest on my list of worries now."