Breath holding attacks

Breath retention episodes are episodes in which a child immediately after an event that has frightened or upset him, or after a painful event, ceases to breathe involuntarily and for a short period of time loses consciousness.

Attacks of respiratory arrest are noted in 5% in otherwise healthy children. Usually they appear at the age of 2 years. By the age of 4, they disappear in 50% of children, and by the age of 8 - in about 83% of children. In the remaining children, seizures can persist even in adulthood. Episodes of respiratory arrest can be either cyanotic or pale. The cyanotic form, which is the most frequent, often arises as a part of outbursts of anger, or in response to the child being scolded, or to other events that upset him. Pale form is usually the result of a painful event, such as falling and hitting your head, but it can also follow an event that frightens the child. Both forms are involuntary and can easily be differentiated from infrequent short periods of arbitrary breath holding by obstinate children who necessarily return to normal breathing after they receive what they want or when they begin to feel uncomfortable if they do not get what they want.

During the cyanotic episode, the child holds his breath (while not necessarily realizing that he does it) until he loses consciousness. Usually a child screams, exhales and stops breathing. Soon after this, the child gradually develops cyanosis, and as a result, he loses consciousness. There may be a short episode of seizures. After a few seconds, breathing is restored and normal skin color and consciousness return. It may be possible to interrupt an attack, at the very beginning of it putting a cold diaper on the child's face. Despite the frightening nature of seizures, parents should avoid reinforcing the behavior causing the attack. When the child is restored, parents should continue to insist on observance of house rules; the child's desires should not dominate the house just because he developed an attack of stopping breathing with an outburst of anger. A good tactic is to distract the child and avoid situations that lead to outbursts of anger.

During a pale episode of respiratory arrest, stimulation of the vagus significantly slows down the heart rate. The child stops breathing, quickly loses consciousness and becomes pale, languid and lifeless. If the attack lasts more than a few seconds, muscle tone increases, convulsions and incontinence may occur. After an attack, the heart rate is restored, respiration begins again, the consciousness returns without any treatment. Because this form is rare, further diagnostic examination and treatment may be required in case of frequent seizures.

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