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BREATH-HOLDING SPELLS

IT’S a psychosomatic disorder seen commonly in children between 6 months to 6 years of age.
Breath holding spells actually means not intentional, these are due to immaturity of autonomic system. It occurs in developmentally normal child.

These are of two types:
• Pallid
• Cyanotic

Etiology: (Studies showed)
• Positive family history
• Immature myelination of brainstem
• Altered selenium and antioxidant levels

Pathogenesis:
• Both types of spells are due to altered cerebral blood flow
• Pallid spell is due to cerebral hypoperfusion causing bradycardia
• Cyanotic spell is due to prolonged expiratory apnea
• Anemia is also have strong associated with spells
• Low Haemoglobin causes low oxygen carrying capacity

Clinical features:
• A provocation stimulus
• Holding breath and color change
• Unconsciousness and abnormal posturing
• Stupor

Cyanotic breath holding spell:
• Most common
• It occurs as a result of anger, causing vigorous cry followed by breath holding event
• Unconsciousness is not common
• Abnormal posturing
• Regains consciousness within minute and become totally normal

Pallid breath holding spell:
• Uncommon
• Due to pain and unexpected event
• Child cry, holds breath, hypotonic and unconsciousness
• After regains consciousness, child tend to sleep for hours

Diagnosis:

It depends upon clinical history and course of events.

No imaging or lab investigation is required for diagnosis

Management:
• Educating and guiding parents regarding benign nature of breath holding spell is the mainstream of treatment
• Avoid provocation episodes
• During the event make child in lateral position
• Iron therapy for all children of breath holding spells

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