Severe breath-holding spells (BHS), both cyanotic and pallid, are a well-known clinical entity to primary care providers.^1-3 This misnomer describes a nonvolitional event triggered by emotional upset resulting in crying to the point of unconsciousness whereby the child's color becomes pale or cyanotic. Indeed, descriptions can be found in 15th century medical textbooks.⁴ The prevalence occurs between 1.7% to 4.6% of well-patient surveys.^5,6 Clinical manifestations, natural history, and a previously enigmatic pathophysiology have been more clearly defined and articulated.⁷ This symptom complex needs to be differentiated from specific etiologies mimicking BHS.⁷ It remains amazing how such dramatic physiologic consequences can result from what most children do wellcry. This sudden, emotion-laden, human response sets into motion a cascade of intricate and interrelated reflex phenomena resulting in expiratory apnea, color . . . [Full Text of this Article]