Our toddler held his breath after we said no!

Last week our twenty-month-old Peter became very agitated when he asked for a cookie right before dinnertime and we told him "no".  He started to scream and cry and was on his way to a major league tantrum when he suddenly gasped, turned totally white, and fell over backward.  It looked as if he was having a seizure.  He started crying again in just a minute but wasn't as wild.  We called our doctor, who said it sounded like a "breath-holding" spell and not to worry, but we're still wondering.  Is this normal?  Can Peter get brain damage from this?

Your description of Peter's behavior does sound very typical of a "breath holding" episode, which can be very upsetting to parents but is harmless to a child.  Sometimes when a toddler is having a tantrum he gets so worked up that he takes in a deep breath to cry and then forgets to breathe out.  If he keeps holding his breath, his skin will begin to look white or gray or even blue, and he may pass out.  As frightening as this may appear to parents, it is not a danger to your child.  That's because as soon as he has held his breath long enough to turn blue or go unconscious, his body's natural reflexes take over and he will begin breathing again. (The physiological explanation is that the decrease in blood oxygen level causes the pale or blue appearance, and the corresponding increase in blood carbon dioxide level causes the child to automatically take a new breath).

However, a breath holding episode sometimes frightens parents so much that they panic and try to appease their child every time he begins to scream.  A smart toddler may respond to his parents' anxiety by getting into the habit of breath holding every time he gets upset!  Although repeated episodes are no more damaging than occasional ones, it's not a very easy habit to break.  If your child has a breath holding episode and you are feeling anxious, talk to your health care provider.  You may need to have Pete seen for a pediatric visit to ease your fears. You won’t be the first parents to need this kind of reassurance!