Breath Holding Attack Flashcards
Define breath holding attack.
A developmental condition in which the child experiences a brief episode of apnoea.
What are the two types of breath holding attack?
Pallid (white) breath holding attack
Cyanotic (blue) breath holding attack
Explain the aetiology/risk factors for pallid breath holding attacks.
Abnormally sensitive response to carotid sinus or ocular compression with the production of temporary asystole or marked bradycardia.
Explain the aetiology/risk factors for cyanotic breath holding attacks.
Mechanism unclear; however, includes centrally mediated reduced respiratory effort and altered lung mechanics, which may inappropriately stimulate pulmonary reflexes, thus resulting in apnoea and hypoxia.
Summarise the epidemiology of breath holding attacks.
Occurs in 1–2% of children between the ages of 6 months and 5 years, 75% of which occur between 6 and 18 months. Breath-holding spells usually occur from 1–2 times a day to 1–2 times a month. 60% have cyanotic type, 20% pallid type and 20% a combination.
25% of children have a positive family history of breath holding attacks.
What are the presenting symptoms of a pallid breath holding attack?
Painful stimulus (knock to head or falling) > Child stops breathing and loses consciousness > Child becomes pale and hypotonic > Reflex anoxic seizure
What are the presenting symptoms of a cyanotic breath holding attack?
Triggered by anger, frustration or upsetting event > Child cries and holds breath in expiration > Rapid onset of cyanosis > Brief tonic-clonic jerks, opisthonotonos > Bradycardia
What are the signs of breath holding attack?
Should be unremarkable. If neurological examination does reveal focal signs, consider other causes.
What are investigations for a breath holding attack?
- EEG: Only if diagnosis is unclear. Should show generalized slow waves with flattening during the breath-holding attacks.
- ECG: To rule out cardiac arrhythmia.
What is the management of a breath holding attack?
Parental education: Reassurance and emphasis on consistency and not reinforcing the child’s behaviour pattern after the attack. Child should lie flat during attack to aid cerebral perfusion.
Medical:
- Check iron levels.
- Atropine sulphate may be considered in refractory pallid attacks to block the vagus nerve.
What are the possible complications for a breath holding attack?
No immediate complications except if the child collapses in an unsafe environment.
What is the prognosis of a breath holding attack?
Children usually stop having the attacks after the age of 5 or 6 years. Children who have pallid attacks have an increased incidence of syncope in adulthood. There is no increased incidence of epilepsy in either type.
