Breath-holding spells:

Most common between the ages of six months and two years, breath-holding spells are a benign, yet alarming event for parents to witness. Of the two types - cyanotic and pallid breath-holding spells - the former are most common.
Children who become pallid may also have a brief period of asystole believed to be due to an exaggerated vasovagal response.
There is no evidence to suggest serious consequences of either type of breath-holding spell, but some children may develop an increased incidence of vasovagal attacks in later childhood and adolescence which may extend into adulthood. This is often familial and may be due to an increased sensitivity of the vagal nerve to trauma or emotional upsets.
The key to diagnosing breath-holding attacks is the presence of a precipitating factor such as trauma (eg, a fall or bump on the head) or emotional distress. The child cries for a variable period and then there is silence. He or she becomes cyanosed or pallid and loses consciousness. Loss of muscle tone also occurs, mimicking an atonic seizure. Prolonged apnoea may produce myoclonic jerking due to hypoxia which parents may interpret as fitting.
Some children may have only a brief lead-up period and let out a short cry before losing consciousness. However, most cry for periods up to about two minutes. After the episode, the child generally recovers quickly and resumes normal activities.
Parents can be educated about signs leading to an attack and instructed to distract the child quickly at the time of a minor trauma. They can also be reassured that the child will grow out of the condition by four to six years of age.
If the GP is confident about the diagnosis, investigations are unnecessary. Physical examination is usually unremarkable.
There is some evidence that iron supplementation may be beneficial, even if the child is not iron-deficient. A presumed mechanism involves supersaturating haemaglobin which may reduce oxygen desaturation. This treatment is currently the subject of research and is reserved for children with frequent (eg, daily) attacks.
Blowing in the child's face during crying or splashing cold water on its face has not been shown to have any effect.

Developmental Red Flags
I. Red Flags: Birth to three month
A. Rolling prior to 3 months: Evaluate for hypertonia
B. Persistent fisting at 3 months: Evaluate for neuromotor dysfunction
C. Failure to alert to environmental stimuli: Evaluate for sensory Impairment
II. Red Flags: 4 to 6 months
A. Poor head control: Evaluate for hypotonia
B. Failure to reach for objects by 5 months: Evaluate for motor, visual or cognitive deficits
C. Absent Smile: Evaluate for visual loss - Evaluate for attachment problems - Evaluate maternal Major Depression - Consider Child Abuse or child neglect in severe cases
III. Red Flags: 6 to 12 months
A. Persistence of primitive reflexes after 6 months: Evaluate for neuromuscular disorder
B. Absent babbling by 6 months: Evaluate for hearing deficit
C. Absent stranger anxiety by 7 months: May be related to multiple care providers
D. W-sitting and bunny hopping at 7 months: Evaluate for adductor spasticity or hypotonia
E. Inability to localize sound by 10 months: Evaluate for unilateral Hearing Loss
F. Persistent mouthing of objects at 12 months: May indicate lack of intellectual curiosity
IV. Red Flags: 12 to 24 months
A. Lack of consonant production by 15 months: Evaluate for Mild Hearing Loss
B. Lack of imitation by 16 months: Evaluate for hearing deficit - Evaluate for cognitive or socialization deficit
C. Lack of protodeclarative pointing by 18 months: Problem in social relatedness
D. Hand dominance prior to 18 months: May indicate contralateral weakness with Hemiparesis
E. Inability to walk up and down stairs at 24 months: May lack opportunity rather than motor deficit
F. Persistent poor transitions in 21 to 24 months: May indicate pervasive developmental disorder
G. Advanced non-communicative speech (e.g. Echolalia): Simple commands not understood suggests abnormality - Evaluate for Autism - Evaluate for pervasive developmental disorder
H. Delayed Language Development: Requires Hearing Loss evaluation in all children
V. Immediate speech therapy evaluation indications
a. No babbling by 12 months
b. No pointing or gestures by 12 months
c. No single words by 16 months
d. No 2-word spontaneous phrases by 24 months
e. Speech not understandable by 24 months
f. Regression of skills at any age
g. Loss of language or babbling
h. Loss of social skills