Objective: To determine breath holding spells mimic Seizures document the natural history of severe breath-holding spells (BHS) among children with both cyanotic and pallid BHS who were referred forpaediatric consultation. Patients and Method: Study Design: Descriptive type (Prospective cohort study). Place of Study: It was conducted in department of Paediatric medicine and Neurology on outdoor patients from 1stJanuary 2006 to 31st Dec 2011 at CMC, ShaheedMuhatarma Benazir Bhutto University Larkana.Data collection was based on structured interview was undertaken at the time of initial consultationand diagnosis of BHS was based on a detailed history of multiple episodes (3 or more) defined byclinical presentation and regarding type of BHS, frequency of spells, associated phenomenon,sequelae, family history, and age at termination of spells. Result: Two hundreds thirty cases of breath holding spells were included who have had H/O provoking event,cry, apnea, cyanosis, (Cyanotic spells) 56.5% (n=130) in most of cases while some presented withpallid spells and few with hypoxic convulsions 20.9% (n=48) with loss of consciousness, most ofcases had history of anticonvulsant with no response 60% (n=138). One hundred thirty 56.5 %(n=130)cases were male and 43.5% (n=100) females, from 2month to 4 years of age were included and mostcommon age of presentation was 9 to 12 months. Out of 230 cases only 39.1% (n=90) presented withfamily history of breath holding spells and all cases had been reassured. Conclusion: The common type of breath holding spells in outdoor patients is cyanotic. The common clinicalpresentations were cry, over breathing, cyanosis, few present with clonicjerks, hypertonia, and pallorness, outcome was excellent.