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Make the area safe. Check response and normal breathing. Shout for help and note the time.
First Aid GaragePaul Kenny TrainingFree nursery staff resource
Breath-holding spells in nursery
Clear, proportionate guidance to help early-years teams recognise a spell, protect the child and know when to escalate.
- Evidence informed
- Early-years focused
- Guidance checked July 2026
RecogniseProtectEscalate
Emergency memory prompt
If a child collapses
Start with response and breathing. Then choose the correct pathway.
Unresponsive + not breathing normally?
Call 999 and start paediatric basic life support / CPR. Follow your training and the call handler's instructions.
Breathing - known spell
Lay the child on their side on the floor. Do not pick them up. Protect from injury, clear the area, stay and time the spell.
Nothing in the mouthNo dummy · no fingers · no food · no drink
999
Call 999 immediately if the child:
- faints and cannot be woken
- is stiff, shaking or jerking
- has lips, tongue, face or skin that suddenly turn pale, blue or grey
Recognise the pattern
What staff may see
A spell often follows crying, pain, fright, frustration or upset. The child may become silent, change colour, go floppy or briefly faint.
A trigger occurs
Strong emotion, shock or pain may be followed by crying and then silence.
Protect and stay
Place the child safely on their side, clear hazards and remain with them.
Reassure and rest
Check recovery against their usual baseline and follow the written plan.
Do
Keep the response calm and simple
- Note the start time
- Lay the child on their side on the floor
- Protect the head, arms and legs from injury
- Stay, observe and reassure after recovery
Never
Avoid unsafe or punitive responses
- Do not shake the child or splash water
- Do not put a dummy or fingers in the mouth
- Do not give food or drink during the spell
- Do not tell the child off — the spell is involuntary
After the episode
Recover, communicate and record
- Reassess. Confirm normal breathing and recovery towards the child's baseline.
- Reassure. Offer quiet rest in an appropriately supervised area.
- Inform. Tell the manager and parent or carer promptly.
- Record. Note timings, trigger, presentation, action, recovery and any clinical advice.
- Review. Revisit the plan after a severe, changing or emergency episode.
For nursery managers
Make the child-specific plan work in practice
Agree it in advance, make it accessible and remove ambiguity during an incident.
Clinical picture
Record the diagnosis or advice received, usual triggers, presentation, duration and recovery.
Exact actions
Set out staff actions, individual 999 criteria, emergency contacts and collection arrangements.
Team readiness
Brief permanent, relief and agency staff. Keep the plan where it can be found quickly.
Suggested policy wording
A proportionate collection clause
“Following a severe, prolonged or unusual episode, or where emergency services attend, the parent or carer will be contacted promptly. Collection will be requested where the child is not back to their usual baseline, requires closer observation than the setting can safely provide, or clinical advice indicates home or hospital care. Staff will follow the child-specific plan and record the incident.”
Ambulance attendance alone does not create a universal automatic exclusion rule. Decisions should reflect clinical advice, the child's condition, the written plan and whether the setting can safely meet their needs.
Free resource pack
Download, print and brief your team
Use the materials together: present the slides, issue the handout and display the poster.
A4 emergency poster
Large, numbered memory prompts for staff to scan during an emergency.
Download resourceStaff quick-reference
Recognition, response, recovery, recording and the child-specific plan.
Download resourceStaff-awareness presentation
A ready-to-use team briefing for nurseries and childcare settings.
Download resourceOfficial guidance
Read the source information
This is a staff-awareness resource, not a diagnostic tool. It does not replace accredited paediatric first-aid training, current clinical advice, the child-specific plan or the setting's emergency and safeguarding procedures.