When 3-year-old Rozalynn Cevetto has at least two things wrong -- she is hungry, tired, hurt or just not getting her way, she looks as if she is going to cry, but never takes the "big breath."
The first breath-holding incident occurred when Rozalynn was only 14 months old.
"She would start crying, but then appear to take a big breath, but really, she was just sitting there with her mouth agape until she passed out from not breathing," said her mother, Sarah Cevetto, 31. a mother of four from Niles, Ohio.
"It was frightening, at first," she said. "Her eyes would roll back, her lips would turn blue and her face would get really tight."
Cevetto herself was a breath holder when she was little, as was her father. In the 1980s, doctors treated her with medication for seizures, diagnosing her as an epileptic.
But Rozalynn's doctors tell her to just wait, the toddler will outgrow it.
"However, they are not harmful in healthy children because if the child actually holds his breath until he passes out, the body's natural mechanism to breathe -- just like when you are sleeping -- kicks in and overrides the child's forced breath-holding."
Even so, many parents and some child psychologists worry that the incidents are not physiological but behavioral, and worry that a child will take advantage of their parents' terror and learn to be manipulative.
"Bottom line," said Brown. "Don't let your toddler's breath-holding hold your parenting discipline strategy hostage."
Brown estimated, "1 in 100 or 1,000, but not 1 in 20,000" children are breath-holders.
The only time these attacks deserve a medical evaluation is if they occur on a regular basis or happen more frequently. A small number of children actually have an iron deficiency that can cause the incidents.
According to the online Baby Center, one of the largest online resources for childbirth and parenting, breath-holding spells usually happen in response to pain, fear, frustration, anger or surprise.
Sometimes trauma can trigger an attack. It can happen rarely or up to several times a day. Sometimes, a child will turn blue and behave as if having a seizure. Most outgrow breath-holding by the time they are 8.
"While these spells sometimes occur with tantrums, they're not willful," according to Baby Center. "Your child is not holding her breath on purpose."
Jessica, a 33-year-old first-time mother from Virginia, has watched her 2-year-old son hold his breath until he turns blue. The attacks began just this year.
"He was having an off day and was kind of crabby," said Jessica, who didn't want to give her last name for privacy reasons. "He was having milk and cookies and wanted more. I told him couldn't have any. He walked away and I knew he was mad or just upset and hadn't started to cry.
"His mouth was wide open like the wires got crossed and he didn't start screaming because his mouth was open and stuck," she said. "I could see he wasn't breathing and he walked toward me and fell on his knees and collapsed on the floor like he had died."
Jessica scooped up her son and checked his mouth for choking. After 10 to 20 seconds, he started crying and breathing. But he seemed "really out of it" for the rest of the afternoon.
"It was really scary," she said.
Later, doctors found nothing wrong with him and told his parents to "keep an eye on him."
Since then, Jessica has learned to blow air in his face to restart the breathing, a trick doctors say works.
However, since then, the temper tantrums have escalated and Jessica worries about reinforcing the behavior.
"Now," she said, "it's hard to tell her no."
Toddlers and Temper Tantrums
"My mother used to tell me she babysat for a girl 5 or 6 who was a little monster and held her breath," said Jessica. "Her parents gave her everything to keep her from doing it.
"She thinks it's terrible and tells me never to give in to him," she said. "So we treat him like he is having a normal temper tantrum, but we stop and listen to see if he is going to stop breathing."
Elizabeth Smith, who works for the federal government in Tennessee, said that her 2-year-old, Hazel, has no control over her breath-holding spells, which are triggered by hitting her head.
The first time, she fell from a work trailer that was sitting in their driveway. In the second incident, Hazel had fallen off the toilet.
"Her eyes rolled back, she stopped breathing and got really red, then really white and her mouth dropped open," Smith said. "I was so terrified, when she fell limp in my arms, I ran out in the street screaming my child was dead."
At first, doctors suspected a seizure, but a CT scan revealed that Hazel was normal, just a clumsy child.
"We should really put a helmet on her," said Smith.
In subsequent episodes, her parents blew in her mouth and Hazel began breathing again.
"We weren't as scared," said her mother. "We knew she would come to and be OK, but it was terrifying nonetheless."
As for Rozalynn Cevetto, she got a clean bill of health and her parents are convinced she is not breath-holding on purpose.
"Usually, it is more like she is tired and stubs her toe and will do it," she said. "Honestly, I worry more that she won't breathe again."
By the time she was 18 months old, Rozalynn had a seizure while the family was eating out at a restaurant.
"Rozalynn didn't want to sit in the high chair and was tired and hungry," said her mother. "I noticed the signs of an impending pass out, except this time, she started convulsing. Her arms were out straight, stiff and wouldn't go down."
The restaurant staff called 911 and by the time paramedics arrived, the toddler was convulsing. She underwent blood work and other basic tests, as well as a CT scan and stayed the night.
"She was very active and happy once we were admitted to the pediatrics floor," said Cevetto.
A neurologist concluded that, sometimes, children "seize to reset" something in their brains, but never do it again.
That was the case with Rozalynn.
"It's been two years now and, so far, that's been true," said Cevetto.
"Basically, I had everything checked out," she said. "I know I used to have it [breath-holding] and didn't have it again since I was about 4," said Cevetto. "I figure I'm OK, she's OK."