My 11-month-old started having breath-holding spells just before she turned 9 months. The first time, she was trying to crawl and ended up face-planting on the floor, and she “forgot” to breathe while she cried, turned blue, and passed out in my arms. It was terrifying. Since then, she’s had three more spells in the past two months. One time, I’m pretty sure she had a seizure once she took the first breath — she was staring off into the distance and breathing very shallowly. Her pediatrician says it’s just something she’ll grow out of, but I’ve read low iron can be a cause. Could an iron supplement put an end to these episodes?
—Holding my breath for an answer
Breath-holding spells are really scary for parents, despite being common in children this age. Children hold their breath, typically after a crying-related event, as you describe. These can present like seizures or trigger small seizures. As frightening as these are, the prognosis is excellent, and children grow out of them — on average by 4 years and nearly always by 8.
To your question, one of the treatments that has good support is iron supplementation. There is at least one randomized trial that shows evidence of efficacy, and a number of supporting observational studies. A typical dose would be based on weight: 5 to 6 milligrams of iron per kilogram of weight per day. The studies are not very precise — they are fairly small, so the statistical power is not great — but the size of the effects is large.
A caveat is that the value of this treatment seems to depend (unsurprisingly) on iron status. The benefits have been shown when a child is anemic (has low iron levels), and it’s less clear that there would be benefits if your child is already at an adequate iron level. So the first step is likely a test for anemia, and definitely, if they are anemic, treatment with iron supplementation could help.
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