breath holding attacks

Question 1

how can breath holding attacks be split up?

Answer 1

• cyanotic

- pallid

Question 2

what age group do cyanotic breath holding attacks occur in?

what tends to precipitate them?

Answer 2

• babies and toddlers up to 18 months

- crying due to pain or temper

Question 3

what is the classic presentation of a child during a cyanotic breath holding spell?

Answer 3

• child cries, takes a deep breath, stops breathing, becomes deeply cyanotic and the limbs extend
• they may have transient LoC or convulsive jerks
• child then becomes limp, resumes breathing and after a few seconds is fully alert again
• lasts up to a minute

Question 4

what is the key to diagnosis of a breath holding spell?

Answer 4

• crying and breath holding

- absence of post-ictal phase

Question 5

what is the age range for reflexic anoxic seizures (pallid)?

what is the cause?

Answer 5

• “white” breath holding attacks
• peak age is 6 months to 2 years
• excessive vagal reflex causing transient bradycardia and circulatory impairment

Question 6

describe a typical reflex anoxic attack

Answer 6

• transient apnoea and limpness followed by rapid recovery after 30- 60 secs
• there may be eye rolling and incontinence and sometimes stiffness of the limbs
• no tongue biting
• child may be tired and emotional for a few hours after
• not post octal

Question 7

what investigations do you do to investigate the cause of this?

Answer 7

• EEG
• ECG
• 24 hour ECG
• blood glucose
• pH monitoring (apnoea in infants may be due to GOR)

Question 8

how should reflex anoxic spells be managed?

Answer 8

• reassure and encouraged to treat the child normally

- warn parents it can happen several times a week