Breath Holding Spells in Children:Pharmacologic Treatment,Diagnosis

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BREATH HOLDING SPELLS IN CHILDREN

Dr Ira Shah

M.D, DCH(Gold Medalist), FCPS, DNB

Q.Why does a child with a breath holding spell becomes unconscious ?
It has been postulated that loss of consciousness in a cyanotic spell is due to centrally mediated inhibition of respiratory effect. In pallid spells the vagally mediated bradycardia is through to be responsible.

Q. How does one diagnose a case of breath holding spells ?
Breath holding spells are usually diagnosed clinically. However seizures and syncope (due to cardiac or vasovagal stimulation) should be considered in the differential diagnosis.Seizures unlike breath holding spells usually do not have a precipitating factor, are associated with post-ictal drowsiness and convulsive activity precedes the change in color.

Vasovagal syncope is rare in children below 12 years of age.

Usually investigations are not necessary in a classical case of breath holding spasm. However an EEG and ECG may be done to rule out epilepsy and cardiac arrhythmias respectively. Inter-ictal EEG in breath holding spasms are normal.

Q. How does one manage a case of breath holding spells ?
The most important aspect of treatment consists of parental support and reassurance. Though these episodes are innocuous, they usually cause lot of parental fear and anxiety. Parents should be told about the involuntary nature of the attacks and cautioned against giving in to the child's wishes. They should be reassured that breath holding spells are not dangerous and do not lead to epilepsy or brain damage. The parents should be encouraged to handle the episode in a relaxed manner. During an attack, the parent should not hold the child upright, instead should make him lie down flat to prevent head injury. Nothing should be put in the child's mouth as it could cause choking or vomiting. After the attack is over, the parents should not give in to the child's wishes.

Parents can also be taught how to prevent a spell. Some children can be distracted from their breath holding if intervened before they becomes blue by distracting them or making them look at something interesting. The parents should be cautioned against running and picking up the child every time he cries to decrease an undue number of attacks.

Behavior modification program may help if a child has frequent tantrums. Parents should be reassured that long term prognosis is very good.

Q. What pharmacologic treatment is available for breath holding spells ?
Pharmacological treatment is usually not required. Anticonvulsants have no role in breath holding spells. Atropine sulphate may be tried in children with frequent pallid spells. Though there are reports of iron therapy in breath holding spells (as these children usually have iron deficiency anemia), its usefulness is still not completely documented .

Q. What is the prognosis of children with breath holding spells ?
Prognosis is excellent. Most of the episodes resolve by the time the child is 4-5 years old. Children with pallid spells may have an increased incidence of syncope as adults.

Last created on 23-02-2001
Last updated on 20-04-2007

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