Breath Holding Spells (BHS) usually occur between the ages of 6 months and 5 years in children; but may start as early as first month of life. The spells are clinically observed in two forms as cyanotic form and pallid form.
The frequency of the episodes is variable; they may occur a few times a day or every 3-4 months.
In Pallid breath-holding spells, the child screams briefly, usually following minor injuries and painful stimuli (falling, hitting the head) followed by hypotonia, loss of consciousness, and pale skin occur. Sudden bradycardia caused by a vagal response causes the event.
Cyanotic breath-holding spellsare triggered by pain, anger or fear. Prolongation of expiration during crying may result in apnea leading to cerebral anoxia and change in colour. During severe episodes, generalized hypertonia may be observed. Loss of tone and rarely myoclonic jerks may accompany.
The children are healthy between episodes. Treatment is usually unnecessary. Reassurance to the family is beneficial. Iron therapy should be given, if anemia is present. Antiepileptics are not used for treatment of breath-holding spells. In case of recurrent pallid spells, ECG should be done to rule out a long QT syndrome.
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