It's every parent's worst nightmare: after an all-out tantrum in the grocery store aisle, your out-of-breath toddler's laying motionless on the floor.
While it seems like a major issue, tiny tots passing out momentarily while screaming is actually a pretty common issue. Think about it: toddlers are naturally stubborn, and a singular trigger can set off rapid-fire screaming, no matter the situation or location. This phenomenon is actually known as cyanotic breath holding, a term used to describe a child's involuntary reaction of holding her breath when she's upset or stressed out. Other youngsters might scream until they turn purple or actually vomit, but the fainting spells are definitely the most worrisome.
The good news is that it's rarely a serious problem. A toddler fainting without a screaming spell would be reason to worry, but tantrums usually just mean you're the proud parent of a tiny tyrant. By understanding how to react or watch for warning signs, you can control the tantrums—at least, until you get out of the store.
When your kid holds her breath, she's proving that she has control over something. While it might seem like you saying "no" is the main trigger, a breathless tantrum usually has other causes. Hunger, tiredness or a lack of control are the usual suspects for promoting this type of reaction. When your little one is lacking food or sleep, she loses the ability to reason, which is why you're left with a completely visceral reaction to something seemingly small—such as not being able to eat candy without paying. Instead of listening to reason, your toddler simply loses control and starts with the cyanotic breathing patterns. When you try to calm her down, it could make the problem even worse. Her reaction is proving to her that she's in charge.
While a few spells of fainting or vomiting during an all-out tantrum can be terrifying for you, chances are that health-wise, her passing out isn't that big of a deal. Most likely, your toddler will come to and hop back up like nothing happened. The only time fainting is a serious problem is if it happens without any catalyst. If you're worried about your child's health, schedule an appointment with your pediatrician. ECG testing can be done to see if there's a real problem, of if your toddler just has a nasty case of the terrible twos.
Your response to your toddler's behavior has the biggest effect on future issues. Consider the two scenarios.
1) Your toddler throws the grandaddy of all meltdowns in the mall. You try to shush her, further controlling her actions and she becomes angry, holds her breath until she turns blue, and then passes out. You panic, and end up giving her even more attention, and eventually caving and giving her what she wanted in the first place.
2) Your toddler starts screaming in the grocery store. You ignore her completely as she kicks and screams, and avoid giving into her demands. You then direct her attention elsewhere to take her mind off of her tantrum.
Obviously, the second choice has the better outcome. Toddlers are often harder to pacify than diva celebrities—if you give into their demands, they learn positive reinforcement from negative behavior. Therefore, the next time your little one doesn't get the treat she wants, she'll revert back into tantrum mode—hey, it worked last time right?
Fraida Flaishman, a pediatric occupational therapist, suggests withholding attention to get the conniption fit to stop. "From a behavioral perspective, if the child realizes that passing out has gotten him attention or access to something he wanted, then he will continue to do this behavior (for those kids that are able to control this)," she notes. "In this case, making sure that you do not provide the gratification the child is looking for should be enough to extinguish the behavior."
That's why it's vital that you ignore the wheedling, kicking and wailing. Don't worry if she starts breathing quickly. If the behavior is not reinforced, it sends a strong message that it's ineffective, and even the youngest toddler can understand that. Instead, you can help by scooping up your red-faced babe and holding her steady. This shows that you're willing to help her gain control again, even if she continues to squirm. That way, if she does pass out, you've already got her secure in your arms.
It's always easier to try and head off bad behavior than to clean up the mess of a stage five blowup. Flaishman suggests an active approach. "From a proactive perspective, try to ensure that the child doesn't get to the point of being so upset that this will happen," she advises. "So, if the child hurts himself, reward him instantaneously for 'being such a good boy and not crying' before he gets to the point of starting to cry uncontrollably. In another instance, if he cries because you are not willing to give him a desired object like a snack or a cookie he wants, offer him an alternative right away such as another toys or acceptable snack to distract him or help him self console before he gets too upset."
Bottom line? Your toddler's scary behavior is totally normal. If you're worried, trust your gut reaction and contact your pediatrician. Otherwise, do what you can to extinguish the tantrums before they lead to drastic measures. Soon enough, your child will learn that she'll attract more flies with honey, and display more appropriate behavior to get the attention from you that she craves.