Breath-holding spells in young children - Tips from Other Journals

Date: June, 1992

Breath-holding spells represent an involuntary, reflexive action that occurs during active or full expiration. The spells are a dramatic and commonly observed clinical phenomenon in otherwise healthy children. In a review article, DiMario summarizes the clinical, epidemiologic and pathophysiologic mechanisms of these involuntary spells and discuss recommended treatment approaches.

Breath-holding spells may be classified as simple or severe. During a simple spell, the child usually begins to cry after a provocation and eventually reaches a point of noiselessness. The child's and trunk may change color with the mouth wide open in full expiration. After a dramatic, noiseless pause, the spell may resolve with a labored inspiration. If the symptoms continue and the child loses consciousness, the spell is categorized as severe. Postural tone is limp and may progress to an opisthotonic posture. The severe breath-holding spell may be associated with body jerks and urinary incontinence.

Breath-holding spells occur most commonly within the first 12 months of life, and virtually all breath holders have had their initial spell by age two years. Children with severe spells may have multiple episodes each week. The spells cease by four years of age in about 50 percent of children with severe spells. Researchers suggest that dysregulation of the autonomic nervous system may predispose certain children to breath-holding spells. Resultant cerebral anoxia leads to loss of consciousness in children with severe breath-holding spells.

Since studies have not yet proved that anticonvulsant therapy is effective prophylaxis against breath-holding spells, treatment should be based on an understanding of the mechanisms involved. Parents should be reassured that it is neither feasible nor helpful to avoid all circumstances that may provoke emotional upset in their child. Instructions should be given to place the child in a lateral, supine position when a spell occurs to protect the head from inadvertent injury. Cardiopulmonary resuscitation should be avoided when a chance of aspiration exists. Selected therapies using atropine, transdermal scopolamine, oral theophylline and pacemakers may be used for carefully selected patients. (American Journal of Diseases of Children, January 1992, vol. 146, p. 125.)

COPYRIGHT 1992 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

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