Breath Holding Attacks

Question 1

Define

Answer 1

Common event in infants and young children from 6 months to 6 years
* Most have their first episode < 18 months
* This is a paroxysmal disorder- is it NOT a form of epilepsy

Aetiology - May be triggered by:
* Sudden shock or pain
* Strong emotions e.g. fear, upset or anger

Question 2

Symptoms

Answer 2

Cyanotic breath-holding spells (MORE COMMON):

Child cries vigorously for <15 seconds and then becomes silent

• The child becomes very angry or upset in response to a reprimand or mild injury
• Breath hold on outward breath -> turns blue -> loses consciousness -> child may become floppy or stiff
• This is followed by collapse with limpness and LOC
• Cyanosis can appear faster than anticipated
• Can be come bradycardic
• Will regain consciousness <1 minute later and breathe normally

Pallid breath-holding spells (LESS COMMON):
* Child loses consciousness after minor fall or blow to the head or upper body
* LOC may be delayed up to 30 seconds after minor trauma
* Child then stops breathing
* Becomes pale, diaphoretic, limp

If lasts more than few seconds- generalised increased tone of trunk and extremities, incontinence, low-amplitude clonus

Episode lasts < 1 minute: Child is confused and or sleepy for several minutes afterwards

Question 3

Investigations

Answer 3

Examination

Basic observations

Bloods- FBC

EEG if distinguish between seizure

Question 4

Management

Answer 4

MANAGEMENT (Lissauer/ NHS Website)

• Attacks resolve spontaneously
• Lie child on their side
• Make sure child cannot hit their head, arms or legs
• Behaviour modification therapy
• May need to give iron supplementation

Complications
* Pallid- severe attacks may lead to bradycardia or asystole

Prognosis
* Excellent
* Should grow out of it by 4-5 years