Breath holding spells

Reflexive events initiated by provocative events that lead to anger, frustration or pain that cause a child to cry.

• Rare before 6 months of age,

• Peak at 2 years

• Disappear by 5 years

Manifestation :

1.Crying stops at full expiration

2.Child becomes apneic

3.Becomes cyanotic or pale

4.May lose consciousness, become hypotonic and fall

5.Brief tonic-clonic seizure may occur

6.Spells revert on their own in a few seconds and the child resumes normal activity or falls asleep

Diagnosis:

is made based on events and a thorough examination is done.

-If child had become pale during the event, an ECG should he performed to rule out arrythmias and long QT syndrome

Differential diagnosis :

1.Seizures

2.Brainstem malformation

3.Cardiac arrythmias

Management :

The parents should be explained that the spells are self limiting and do not cause any injury to the brain.

Parents should remain calm during the event.

Avoid picking the child up as this reduces blood flow to the brain.

The child should be turned to his side to drain the secretions.

When the child recovers, they should avoid exhibiting undue concern and should not give in to the demands of the child if anger had provoked the spells.

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