Involuntary episodes during which child holds their breath, usually triggered by something upsetting or scaring them.
Typically occur between 6-18 months.
Not harmful in long-term. Most outgrow them by 4 or 5 years old.
Making Diagnosis
Clinical Features
Cyanotic Breath Holding Spells ⇒
Occurs when child is really upset. After letting out a long cry they stop breathing, become cyanotic and lose consciousness.
Toddler upset → cries and holds breath → goes blue, lose consciousness and goes limp.
Within a minute they regain consciousness and start breathing.
Can be tired and lethargic after episode.
Reflex Anoxic Seizures ⇒
When child is startled (in response to pain/emotional stimulus).
Vagus nerve sends signals to heart to stop beating (cardiac asystole due to vagal nerve inhibition). Child will go pale, lose consciousness and may start having some muscle twitching.
Within 30 seconds the heart restarts and the child becomes conscious again.
<aside>
💡 Child goes pale, falls to floor, rapid recovery. (Rapid recovery can differentiate from epileptic seizures).
</aside>
Investigations
Management Plan
Educating and reassuring parents about breath holding spells.
Reassure + Discharge.
Treat iron deficiency anaemia if present (linked association).