• Childhood breath-holding spells are a common and frightening phenomenon occurring in healthy, otherwise normal children. They have been well recognized for several hundred years. There appear to be two clinical forms: the cyanotic type and the pallid type, referring to the color change exhibited by the child during the episode. Prior research concerning the underlying pathophysiologic mechanisms involved in breath-holding spells has implicated an autonomic nervous system dysregulation. Cerebral anoxia is the ultimate factor responsible for the loss of consciousness observed in the severe forms of breath-holding spells. The clinical and epidemiologic aspects of breath-holding spells are herein summarized. The pertinent respiratory and neural physiologic interactions involved are delineated, as well as practical treatment approaches.