Breath-holding attacks

Question 1

Features

Answer 1

This is a dramatic emergency.

There are two types:

1. one related to a tantrum (description follows)
2. a simple faint.

They can manifest as;

1. ‘blue attacks’ (breath holding with closed glottic) or
2. ‘white attacks’ known as reflex anoxic seizures
   * usu. with pain.

Question 2

Clinical features

Answer 2

Age group—usu. 6 mths to 6 yrs (peak 2–3 yrs)

Precipitating event (minor emotional or physical)

Children emit a long loud cry, then hold their breath

They become pale and then blue

If severe, may result in unconsciousness or even a brief tonic-clonic fit

Lasts 10–60 secs

Question 3

Management

Answer 3

Place child in coma position

Reassure the parents that;

• attacks are self-limiting
• not harmful and
• are not associated with epilepsy or mental retardation
• usu. resolve by 3 yrs

Advise parents to maintain discipline and to resist spoiling the child

Try to avoid incidents known to frustrate the child or to precipitate a tantrum: try distraction techniques