Which of the following describes what occurs during a breath-holding spell?

A breath-holding spell typically occurs in young children and involves a sequence that includes crying, a breath-holding episode, and subsequent physiological responses. The correct choice describes this process accurately: during a breath-holding spell, a child often begins to cry intensely, which leads to a period of breath-holding. This can result in noiseless expiration—meaning the child may not exhale air forcefully as one would expect during normal respiration—and is often accompanied by a change in color, such as paleness or cyanosis (a bluish tint) due to a temporary lack of oxygen.

This phenomenon can be alarming for parents and caregivers, as the child may appear unresponsive or faint, but it is generally harmless and resolves quickly once the breath-holding ends, often with spontaneous recovery. Understanding this sequence helps caregivers differentiate breath-holding spells from other serious medical conditions. Other options do not accurately capture the full sequence of events associated with breath-holding spells and may present an incomplete or misleading depiction of the clinical scenario.