Materiały źródłowe

• #1 Breath-Holding Spells – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK539782/

  Breath-holding spells commonly affect up to 5% of all infants. While they are benign, they might be a frightening experience for children and, consequently, for their caregivers. Breath-holding spells occur in children with benign neurological examination findings and children who meet age-appropriate developmental milestones. Typically breath-holding spells do not affect the subsequent neurological development of a child. […] Breath-holding episodes usually follow an inciting event in which the patient is disciplined, angry, or irritated, followed by crying and breath-holding, resulting in the loss of consciousness. These episodes can be reduced by distracting the child and avoiding the triggers. While benign, knowing these spells’ pathophysiology and differential diagnosis is essential so other pathological conditions may be ruled out.

• #2 Breath-Holding Spells – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/behavioral-concerns-and-problems-in-children/breath-holding-spells

  A breath-holding spell is an episode in which the child stops breathing involuntarily and loses consciousness for a short period immediately after a frightening or emotionally upsetting event or after a painful experience. […] Breath-holding spells occur in 0.1% to 5% of otherwise healthy children. They usually begin in the first year of life and peak at age 2. They disappear by age 4 in 50% of children and by age 8 in about 83% of children. The remainder may continue to have spells into adulthood. […] Breath-holding spells do not appear to be risk factors for true epilepsy but may be associated with an increased risk of fainting spells in adulthood. […] During a cyanotic breath-holding spell, children hold their breath (without necessarily being aware they are doing so) until they lose consciousness.

• #3 Breath-holding spells – UpToDate

  https://www.uptodate.com/contents/breath-holding-spells

  Breath-holding spells (BHS) are frightening but innocuous episodic events that can affect infants and young children. The two clinical types are cyanotic and pallid. Both types are typically preceded or provoked by an injury or emotional upset. Brief unresponsiveness, loss of consciousness, or seizures may result. […] The pathogenesis of BHS events is not clear. Some studies support a primary role for dysfunction of the autonomic nervous system. Iron deficiency anemia is more prevalent in children with BHS compared with controls and might contribute to the occurrence of BHS and the underlying dysautonomia. An association between BHS and other types of anemia, including transient erythroblastopenia of childhood (TEC), has also been described. Other possible mechanisms include vagally mediated cardiac inhibition and delayed myelination of the brainstem. […] A family history of BHS is present in 20 to 35 percent of patients, and an autosomal dominant trait has been reported in some families.

• #4 Breath-Holding Spells – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK539782/

  Breath-holding spells were once considered attention-seeking behavior, but studies have shown that these episodes are not intentional and result from an involuntary reflex. […] The exact mechanism for cyanotic breath-holding spells is not clear. Pallid breath-holding is caused by an increased parasympathetic response, causing a reduced blood flow to the brain. This can be demonstrated by the fact that these spells can be incited by increasing the vagal tone via ocular compression. In both types of cases, the association of iron deficiency anemia indicates that if a child’s oxygen-carrying capacity is reduced from anemia (including iron deficiency anemia, sideroblastic anemia, or transient erythroblastopenia of childhood), the child may be more prone to these spells and loss of consciousness.

• #5 Breath-holding in babies and children

  https://www.nhs.uk/conditions/breath-holding-in-babies-and-children/

  Breath-holding is when a baby or child stops breathing for up to 1 minute and may faint. It can happen when a child is frightened, upset, angry, or has a sudden shock or pain. It’s usually harmless but can be scary for parents, particularly when it happens for the first time. […] Breath-holding is usually harmless. […] Breath-holding is not something a child does deliberately. […] It’s usually triggered by a sudden shock or pain, or strong emotions like fear, upset or anger. […] There are 2 types of breath-holding: blue breath-holding spells this is the most common type of breath-holding and happens when a child’s breathing pattern changes; reflex anoxic seizures this type of breath-holding happens when a child’s heart rate slows down.

• #6 Breath-holding spells: Scary but not serious

  https://www.contemporarypediatrics.com/view/breath-holding-spells-scary-not-serious

  Breath-holding spells represent an interplay among the central nervous system respiratory control center, the autonomic nervous system, and cardiopulmonary mechanics. […] The pathophysiology of cyanotic spells is more difficult to explain, but a major feature appears to be hyperventilation followed by a valsalva maneuver that reduces blood return to the heart, decreasing cerebral blood flow. […] Although the exact physiologic mechanism of breath-holding spells is not well understood, it is clear that children with breath-holding spells respond differently to negative stimuli than other children.

• #7

  https://journals.lww.com/md-journal/fulltext/2015/07030/novel_findings_in_breath_holding_spells__a.25.aspx

  The mechanism of breath-holding spells (BHS) is not fully understood and most probably multifactorial; so, this study was designed to clarify the pathophysiology of BHS through assessing some laboratory parameters and electrocardiographic (ECG) changes which might be contributing to the occurrence of the attacks. […] Autonomic dysregulation evidenced by frequent RSA is considered to be an important cause of BHS in children and is correlated with the frequency of the attacks. Low serum ferritin is additional factor in the pathophysiology. Both pallid and cyanotic BHS are suggested to be types of the same disease sharing the same pathophysiology. […] The pathophysiologic mechanism of BHS remains controversial and no study had identified the exact etiology of the attacks. […] Our study revealed a significant correlation between the frequency of RSA in Holter monitoring and the frequency of BHS obtained from parental history, which is an important evidence indicating the basic role of cardiac rhythm abnormality in the pathophysiology of BHS and strengthen the results of other studies which concluded that autonomic dysregulation is the primary abnormality in children with BHS that leads to defective cerebral blood flow followed by the sequence of events observed. […] Last, among all clinical, laboratory, and ECG data obtained from the present study no significant difference was found between cyanotic and pallid BHS which indicates that both types of BHS share the same pathophysiologic mechanism, that is, pallid and cyanotic BHS are 1 and not 2 diseases.

• #8 Breath-holding spells – UpToDate

  https://www.uptodate.com/contents/breath-holding-spells

  Breath-holding spells (BHS) are frightening but innocuous episodic events that can affect infants and young children. The two clinical types are cyanotic and pallid. Both types are typically preceded or provoked by an injury or emotional upset. Brief unresponsiveness, loss of consciousness, or seizures may result. […] The pathogenesis of BHS events is not clear. Some studies support a primary role for dysfunction of the autonomic nervous system. Iron deficiency anemia is more prevalent in children with BHS compared with controls and might contribute to the occurrence of BHS and the underlying dysautonomia. An association between BHS and other types of anemia, including transient erythroblastopenia of childhood (TEC), has also been described. Other possible mechanisms include vagally mediated cardiac inhibition and delayed myelination of the brainstem. […] A family history of BHS is present in 20 to 35 percent of patients, and an autosomal dominant trait has been reported in some families.

• #9

  https://journals.lww.com/md-journal/fulltext/2015/07030/novel_findings_in_breath_holding_spells__a.25.aspx

  The mechanism of breath-holding spells (BHS) is not fully understood and most probably multifactorial; so, this study was designed to clarify the pathophysiology of BHS through assessing some laboratory parameters and electrocardiographic (ECG) changes which might be contributing to the occurrence of the attacks. […] Autonomic dysregulation evidenced by frequent RSA is considered to be an important cause of BHS in children and is correlated with the frequency of the attacks. Low serum ferritin is additional factor in the pathophysiology. Both pallid and cyanotic BHS are suggested to be types of the same disease sharing the same pathophysiology. […] The pathophysiologic mechanism of BHS remains controversial and no study had identified the exact etiology of the attacks. […] Our study revealed a significant correlation between the frequency of RSA in Holter monitoring and the frequency of BHS obtained from parental history, which is an important evidence indicating the basic role of cardiac rhythm abnormality in the pathophysiology of BHS and strengthen the results of other studies which concluded that autonomic dysregulation is the primary abnormality in children with BHS that leads to defective cerebral blood flow followed by the sequence of events observed. […] Last, among all clinical, laboratory, and ECG data obtained from the present study no significant difference was found between cyanotic and pallid BHS which indicates that both types of BHS share the same pathophysiologic mechanism, that is, pallid and cyanotic BHS are 1 and not 2 diseases.

• #10 Breath-holding in babies and children

  https://www.nhs.uk/conditions/breath-holding-in-babies-and-children/

  Breath-holding is when a baby or child stops breathing for up to 1 minute and may faint. It can happen when a child is frightened, upset, angry, or has a sudden shock or pain. It’s usually harmless but can be scary for parents, particularly when it happens for the first time. […] Breath-holding is usually harmless. […] Breath-holding is not something a child does deliberately. […] It’s usually triggered by a sudden shock or pain, or strong emotions like fear, upset or anger. […] There are 2 types of breath-holding: blue breath-holding spells this is the most common type of breath-holding and happens when a child’s breathing pattern changes; reflex anoxic seizures this type of breath-holding happens when a child’s heart rate slows down.

• #11 Breath-Holding Spells | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18619

  Breath-holding spells were once considered attention-seeking behavior, but studies have shown that these episodes are not intentional and result from an involuntary reflex. […] While cyanotic and pallid are the 2 predominant types of breath-holding spells, some children can have a mixed phenotype. […] The underlying cause of breath-holding spells is poorly understood. However, it has been shown that children with cyanotic breath-holding episodes may have some autonomic dysregulation, including higher diastolic blood pressure and a higher resting heart rate. […] Recent work has shown that these patients have differences in the development of the brainstem and medulla, as measured by MRI. […] Evidence suggests that respiratory sinus arrhythmia is more common in children with breath-holding spells compared to controls, giving credence to the dysregulation of autonomic function.

• #12

  https://journals.lww.com/md-journal/fulltext/2015/07030/novel_findings_in_breath_holding_spells__a.25.aspx

  The mechanism of breath-holding spells (BHS) is not fully understood and most probably multifactorial; so, this study was designed to clarify the pathophysiology of BHS through assessing some laboratory parameters and electrocardiographic (ECG) changes which might be contributing to the occurrence of the attacks. […] Autonomic dysregulation evidenced by frequent RSA is considered to be an important cause of BHS in children and is correlated with the frequency of the attacks. Low serum ferritin is additional factor in the pathophysiology. Both pallid and cyanotic BHS are suggested to be types of the same disease sharing the same pathophysiology. […] The pathophysiologic mechanism of BHS remains controversial and no study had identified the exact etiology of the attacks. […] Our study revealed a significant correlation between the frequency of RSA in Holter monitoring and the frequency of BHS obtained from parental history, which is an important evidence indicating the basic role of cardiac rhythm abnormality in the pathophysiology of BHS and strengthen the results of other studies which concluded that autonomic dysregulation is the primary abnormality in children with BHS that leads to defective cerebral blood flow followed by the sequence of events observed. […] Last, among all clinical, laboratory, and ECG data obtained from the present study no significant difference was found between cyanotic and pallid BHS which indicates that both types of BHS share the same pathophysiologic mechanism, that is, pallid and cyanotic BHS are 1 and not 2 diseases.

• #13 Breath-holding spells: Scary but not serious

  https://www.contemporarypediatrics.com/view/breath-holding-spells-scary-not-serious

  Breath-holding spells represent an interplay among the central nervous system respiratory control center, the autonomic nervous system, and cardiopulmonary mechanics. […] The pathophysiology of cyanotic spells is more difficult to explain, but a major feature appears to be hyperventilation followed by a valsalva maneuver that reduces blood return to the heart, decreasing cerebral blood flow. […] Although the exact physiologic mechanism of breath-holding spells is not well understood, it is clear that children with breath-holding spells respond differently to negative stimuli than other children.

• #14 Breath-holding spell – Wikipedia

  https://en.wikipedia.org/wiki/Breath-holding_spell

  Breath-holding spells (BHS) are the occurrence of episodic apnea in children, possibly associated with syncope (loss of consciousness and changes in postural tone). […] They may be confused with a seizure disorder. […] There is some evidence that children with anemia (especially iron deficiency) may be more prone to breath-holding spells. […] The usual precipitating event is frustration or injury. […] Physiologically, there is often hypocapnea (low levels of carbon dioxide) and usually hypoxia (low levels of oxygen). […] There is increased intrathoracic pressure and decreased cardiac output following the Valsalva maneuver. This eventually leads to a significant decrease in circulation to the brain and ultimately, loss of consciousness. […] There may be a relationship with adulthood syncope.

• #15 Breath-holding spells | MedLink Neurology

  https://www.medlink.com/articles/breath-holding-spells

  Iron deficiency, anemia, also appears to be a factor to contributing breath-holding spells. […] Traditional concepts of breath-holding spells invoked clearly distinct mechanisms for cyanotic and for pallid spells. […] However, there appears to be evidence of parasympathetic reflex cardio-respiratory inhibition in both types, as well as subtle generalized autonomic dysregulation. […] Excessive vagal tone or vagal overactivity related to autonomic dysregulation is currently believed to be the primary biological basis of breath-holding spells. […] Studies in a small group of children with pallid breath-holding spells showed a significant decrease in mean arterial blood pressure and increase in pulse rate during the change from lying to standing. […] Findings further suggested greater sympathetic activity in children with cyanotic breath-holding spells.

• #16 Breath-Holding Spells – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK539782/

  Breath-holding spells were once considered attention-seeking behavior, but studies have shown that these episodes are not intentional and result from an involuntary reflex. […] The exact mechanism for cyanotic breath-holding spells is not clear. Pallid breath-holding is caused by an increased parasympathetic response, causing a reduced blood flow to the brain. This can be demonstrated by the fact that these spells can be incited by increasing the vagal tone via ocular compression. In both types of cases, the association of iron deficiency anemia indicates that if a child’s oxygen-carrying capacity is reduced from anemia (including iron deficiency anemia, sideroblastic anemia, or transient erythroblastopenia of childhood), the child may be more prone to these spells and loss of consciousness.

• #17 Breath-Holding Spells – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/behavioral-concerns-and-problems-in-children/breath-holding-spells

  During a pallid breath-holding spell, vagal stimulation severely slows the heart rate. The child stops breathing, rapidly loses consciousness, and becomes pale and limp. If the spell lasts more than a few seconds, muscle tone increases, and a seizure and incontinence may occur. After the spell, the heart speeds up again, breathing restarts, and consciousness returns without any treatment.

• #18 Breath-Holding Spells – Child Neurology Foundation

  https://www.childneurologyfoundation.org/disorder/breath-holding-spells/

  Breath-holding spells are short spells of time during which a child stops breathing. They are commonly mistaken for seizures. […] There are two types of breath-holding spells. Both types may occur in the same child at different times. They are defined based on the child’s color during the spell: […] The exact mechanism of these is not clearly understood. It is somewhat complex. […] Consciousness requires a steady flow of blood and oxygen to the brain. This gets interrupted when a child is holding their breath. As blood and oxygen stop flowing to the brain, a child can pass out and turn blue. […] These are believed to be a vasovagal response to pain caused by a relatively trivial trauma. The vagus nerve controls the heart rate. Sometimes it is overactivated. This is called a vasovagal response. This overactivation can result in a decrease in the heart rate. A decrease in heart rate can lead to a reduction in blood and oxygen supply to the brain. This reduction, in turn, can cause a child to lose color and pass out.

• #19 Breath-Holding Spells | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18619

  Some studies suggest that a dysfunctional autonomic nervous system may play a role in the cause of the spells, specifically with a maturation delay in parts of the brainstem. […] The exact mechanism for cyanotic breath-holding spells is not clear. Pallid breath-holding is caused by an increased parasympathetic response, causing a reduced blood flow to the brain. […] This can be demonstrated by the fact that these spells can be incited by increasing the vagal tone via ocular compression. […] In both types of cases, the association of iron deficiency anemia indicates that if a child’s oxygen-carrying capacity is reduced from anemia (including iron deficiency anemia, sideroblastic anemia, or transient erythroblastopenia of childhood), the child may be more prone to these spells and loss of consciousness.

• #20 Breath-holding spells – UpToDate

  https://www.uptodate.com/contents/breath-holding-spells

  Breath-holding spells (BHS) are frightening but innocuous episodic events that can affect infants and young children. The two clinical types are cyanotic and pallid. Both types are typically preceded or provoked by an injury or emotional upset. Brief unresponsiveness, loss of consciousness, or seizures may result. […] The pathogenesis of BHS events is not clear. Some studies support a primary role for dysfunction of the autonomic nervous system. Iron deficiency anemia is more prevalent in children with BHS compared with controls and might contribute to the occurrence of BHS and the underlying dysautonomia. An association between BHS and other types of anemia, including transient erythroblastopenia of childhood (TEC), has also been described. Other possible mechanisms include vagally mediated cardiac inhibition and delayed myelination of the brainstem. […] A family history of BHS is present in 20 to 35 percent of patients, and an autosomal dominant trait has been reported in some families.

• #21 Breath-holding spell – Wikipedia

  https://en.wikipedia.org/wiki/Breath-holding_spell

  Some trials have demonstrated the efficacy of iron therapy, especially because although BHS can readily occur without anemia, BHS has been found to be aggravated by the presence of anemia. […] Two articles on breath-holding spells strongly suggest that parents consider having their child be tested by electrocardiogram for the rare, but real possibility that the BHS episodes are actually a symptom of prolonged QT-syndrome, a serious but treatable form of cardiac arrhythmia.

• #22 Breath-Holding Spells – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK539782/

  Breath-holding spells were once considered attention-seeking behavior, but studies have shown that these episodes are not intentional and result from an involuntary reflex. […] The exact mechanism for cyanotic breath-holding spells is not clear. Pallid breath-holding is caused by an increased parasympathetic response, causing a reduced blood flow to the brain. This can be demonstrated by the fact that these spells can be incited by increasing the vagal tone via ocular compression. In both types of cases, the association of iron deficiency anemia indicates that if a child’s oxygen-carrying capacity is reduced from anemia (including iron deficiency anemia, sideroblastic anemia, or transient erythroblastopenia of childhood), the child may be more prone to these spells and loss of consciousness.

• #23

  https://europepmc.org/books/n/statpearls/article-18619/?extid=32965841&src=med

  Some studies suggest that a dysfunctional autonomic nervous system may play a role in the cause of the spells, specifically with a maturation delay in parts of the brainstem. […] The lower selenium levels found in patients with breath-holding spells may also explain the underlying pathophysiology, as oxidative stress is a culprit in other neurological disorders such as epilepsy. […] The association of iron deficiency anemia indicates that if a child’s oxygen-carrying capacity is reduced from anemia, the child may be more prone to these spells and loss of consciousness.

• #24 Children with breath-holding spells undergo unnecessary diagnostic interventions | Faculty of Medicine, Lund University

  https://www.medicine.lu.se/article/children-breath-holding-spells-undergo-unnecessary-diagnostic-interventions

  If the child is treated with iron supplements, the number of episodes may be reduced or stop altogether. […] We expect the number of ECG investigations to decrease significantly with our guidelines, and the use of EEG is not suggested at all. […] It is also important to note that anemia and iron deficiency are more commonly observed in children in many of these low-income countries, and for these children it is an advantage that our guidelines propose more liberal blood sampling.

• #25 Breath-holding spells – UpToDate

  https://www.uptodate.com/contents/breath-holding-spells

  Breath-holding spells (BHS) are frightening but innocuous episodic events that can affect infants and young children. The two clinical types are cyanotic and pallid. Both types are typically preceded or provoked by an injury or emotional upset. Brief unresponsiveness, loss of consciousness, or seizures may result. […] The pathogenesis of BHS events is not clear. Some studies support a primary role for dysfunction of the autonomic nervous system. Iron deficiency anemia is more prevalent in children with BHS compared with controls and might contribute to the occurrence of BHS and the underlying dysautonomia. An association between BHS and other types of anemia, including transient erythroblastopenia of childhood (TEC), has also been described. Other possible mechanisms include vagally mediated cardiac inhibition and delayed myelination of the brainstem. […] A family history of BHS is present in 20 to 35 percent of patients, and an autosomal dominant trait has been reported in some families.

• #26

  https://omim.org/entry/607578

  The diagnosis of severe breath-holding spells (BHS) in childhood is based on a distinctive and stereotyped sequence of clinical events beginning with a provocation resulting in crying or emotional upset that leads to a noiseless state of expiration accompanied by color change and ultimately loss of consciousness and postural tone (Lombroso and Lerman, 1967; DiMario, 1992). […] Autonomic dysregulation has been hypothesized as an underlying mechanism that results in loss of consciousness (Hunt, 1990; DiMario and Burleson, 1993; Dimario et al., 1998). […] The data suggested that the most likely underlying genetic inheritance pattern in severe BHS is an autosomal dominant trait with reduced penetrance. […] They concluded that treating iron deficiency anemia is effective in reducing the frequency of BHS.

• #27 Breath-Holding Spells | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18619

  Breath-holding spells were once considered attention-seeking behavior, but studies have shown that these episodes are not intentional and result from an involuntary reflex. […] While cyanotic and pallid are the 2 predominant types of breath-holding spells, some children can have a mixed phenotype. […] The underlying cause of breath-holding spells is poorly understood. However, it has been shown that children with cyanotic breath-holding episodes may have some autonomic dysregulation, including higher diastolic blood pressure and a higher resting heart rate. […] Recent work has shown that these patients have differences in the development of the brainstem and medulla, as measured by MRI. […] Evidence suggests that respiratory sinus arrhythmia is more common in children with breath-holding spells compared to controls, giving credence to the dysregulation of autonomic function.

• #28 Breath-Holding Spells | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18619

  Some studies suggest that a dysfunctional autonomic nervous system may play a role in the cause of the spells, specifically with a maturation delay in parts of the brainstem. […] The exact mechanism for cyanotic breath-holding spells is not clear. Pallid breath-holding is caused by an increased parasympathetic response, causing a reduced blood flow to the brain. […] This can be demonstrated by the fact that these spells can be incited by increasing the vagal tone via ocular compression. […] In both types of cases, the association of iron deficiency anemia indicates that if a child’s oxygen-carrying capacity is reduced from anemia (including iron deficiency anemia, sideroblastic anemia, or transient erythroblastopenia of childhood), the child may be more prone to these spells and loss of consciousness.

• #29 Breath-holding spells – UpToDate

  https://www.uptodate.com/contents/breath-holding-spells

  Breath-holding spells (BHS) are frightening but innocuous episodic events that can affect infants and young children. The two clinical types are cyanotic and pallid. Both types are typically preceded or provoked by an injury or emotional upset. Brief unresponsiveness, loss of consciousness, or seizures may result. […] The pathogenesis of BHS events is not clear. Some studies support a primary role for dysfunction of the autonomic nervous system. Iron deficiency anemia is more prevalent in children with BHS compared with controls and might contribute to the occurrence of BHS and the underlying dysautonomia. An association between BHS and other types of anemia, including transient erythroblastopenia of childhood (TEC), has also been described. Other possible mechanisms include vagally mediated cardiac inhibition and delayed myelination of the brainstem. […] A family history of BHS is present in 20 to 35 percent of patients, and an autosomal dominant trait has been reported in some families.

• #30 Breath-Holding Spells – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK539782/

  The lower selenium levels found in patients with breath-holding spells may also explain the underlying pathophysiology, as oxidative stress is a culprit in other neurological disorders such as epilepsy. Selenium is responsible for removing free oxygen radicals, and the lower levels in these patients can indicate that this system is not in balance.

• #31

  https://europepmc.org/books/n/statpearls/article-18619/?extid=32965841&src=med

  Some studies suggest that a dysfunctional autonomic nervous system may play a role in the cause of the spells, specifically with a maturation delay in parts of the brainstem. […] The lower selenium levels found in patients with breath-holding spells may also explain the underlying pathophysiology, as oxidative stress is a culprit in other neurological disorders such as epilepsy. […] The association of iron deficiency anemia indicates that if a child’s oxygen-carrying capacity is reduced from anemia, the child may be more prone to these spells and loss of consciousness.

• #32 Breath-Holding Spells | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18619

  The lower selenium levels found in patients with breath-holding spells may also explain the underlying pathophysiology, as oxidative stress is a culprit in other neurological disorders such as epilepsy. […] Selenium is responsible for removing free oxygen radicals, and the lower levels in these patients can indicate that this system is not in balance.

• #33 Breath-Holding Spells – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK539782/

  Breath-holding spells commonly affect up to 5% of all infants. While they are benign, they might be a frightening experience for children and, consequently, for their caregivers. Breath-holding spells occur in children with benign neurological examination findings and children who meet age-appropriate developmental milestones. Typically breath-holding spells do not affect the subsequent neurological development of a child. […] Breath-holding episodes usually follow an inciting event in which the patient is disciplined, angry, or irritated, followed by crying and breath-holding, resulting in the loss of consciousness. These episodes can be reduced by distracting the child and avoiding the triggers. While benign, knowing these spells’ pathophysiology and differential diagnosis is essential so other pathological conditions may be ruled out.

• #34 Breath-Holding Spells – Child Neurology Foundation

  https://www.childneurologyfoundation.org/disorder/breath-holding-spells/

  Breath-holding spells are short spells of time during which a child stops breathing. They are commonly mistaken for seizures. […] There are two types of breath-holding spells. Both types may occur in the same child at different times. They are defined based on the child’s color during the spell: […] The exact mechanism of these is not clearly understood. It is somewhat complex. […] Consciousness requires a steady flow of blood and oxygen to the brain. This gets interrupted when a child is holding their breath. As blood and oxygen stop flowing to the brain, a child can pass out and turn blue. […] These are believed to be a vasovagal response to pain caused by a relatively trivial trauma. The vagus nerve controls the heart rate. Sometimes it is overactivated. This is called a vasovagal response. This overactivation can result in a decrease in the heart rate. A decrease in heart rate can lead to a reduction in blood and oxygen supply to the brain. This reduction, in turn, can cause a child to lose color and pass out.

• #35 Breath-Holding Spells – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/behavioral-concerns-and-problems-in-children/breath-holding-spells

  A breath-holding spell is an episode in which the child stops breathing involuntarily and loses consciousness for a short period immediately after a frightening or emotionally upsetting event or after a painful experience. […] Breath-holding spells occur in 0.1% to 5% of otherwise healthy children. They usually begin in the first year of life and peak at age 2. They disappear by age 4 in 50% of children and by age 8 in about 83% of children. The remainder may continue to have spells into adulthood. […] Breath-holding spells do not appear to be risk factors for true epilepsy but may be associated with an increased risk of fainting spells in adulthood. […] During a cyanotic breath-holding spell, children hold their breath (without necessarily being aware they are doing so) until they lose consciousness.

• #36 Breath-Holding Spells – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/behavioral-concerns-and-problems-in-children/breath-holding-spells

  During a pallid breath-holding spell, vagal stimulation severely slows the heart rate. The child stops breathing, rapidly loses consciousness, and becomes pale and limp. If the spell lasts more than a few seconds, muscle tone increases, and a seizure and incontinence may occur. After the spell, the heart speeds up again, breathing restarts, and consciousness returns without any treatment.

• #37 Breath-Holding Spells – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/behavioral-concerns-and-problems-in-children/breath-holding-spells

  During a pallid breath-holding spell, vagal stimulation severely slows the heart rate. The child stops breathing, rapidly loses consciousness, and becomes pale and limp. If the spell lasts more than a few seconds, muscle tone increases, and a seizure and incontinence may occur. After the spell, the heart speeds up again, breathing restarts, and consciousness returns without any treatment.

• #38 Breath-Holding Spells – Child Neurology Foundation

  https://www.childneurologyfoundation.org/disorder/breath-holding-spells/

  Breath-holding spells are short spells of time during which a child stops breathing. They are commonly mistaken for seizures. […] There are two types of breath-holding spells. Both types may occur in the same child at different times. They are defined based on the child’s color during the spell: […] The exact mechanism of these is not clearly understood. It is somewhat complex. […] Consciousness requires a steady flow of blood and oxygen to the brain. This gets interrupted when a child is holding their breath. As blood and oxygen stop flowing to the brain, a child can pass out and turn blue. […] These are believed to be a vasovagal response to pain caused by a relatively trivial trauma. The vagus nerve controls the heart rate. Sometimes it is overactivated. This is called a vasovagal response. This overactivation can result in a decrease in the heart rate. A decrease in heart rate can lead to a reduction in blood and oxygen supply to the brain. This reduction, in turn, can cause a child to lose color and pass out.

• #39 Breath-Holding Spells – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/behavioral-concerns-and-problems-in-children/breath-holding-spells

  During a pallid breath-holding spell, vagal stimulation severely slows the heart rate. The child stops breathing, rapidly loses consciousness, and becomes pale and limp. If the spell lasts more than a few seconds, muscle tone increases, and a seizure and incontinence may occur. After the spell, the heart speeds up again, breathing restarts, and consciousness returns without any treatment.

• #40 Breath-holding spells | MedLink Neurology

  https://www.medlink.com/articles/breath-holding-spells

  DiMario and colleagues demonstrated a marked difference in respiratory sinus arrhythmia in children with pallid breath-holding spells when compared to controls or subjects with cyanotic breath-holding spells. […] An abnormal oculocardiac reflex, manifested by significant slowing of the heart rate and lengthening of the beat-to-beat interval, is present in most children with pallid breath-holding spells and in many with cyanotic spells. […] The presence of lower hemoglobin values in children with breath-holding spells and improvement in or amelioration of spells with oral iron therapy suggests that anemia may be a contributing factor.

• #41

  https://journals.lww.com/rcvm/fulltext/2019/08040/paraclinical_cardiac_findings_of_children_with.2.aspx

  Breath-holding spells (BHSs) are episodes of brief, involuntary cessation of breathing that occur in children in response to stimuli such as anger, frustration, fear, or injury. […] Although the etiology is not known, autonomic dysfunction and increased vagal tonus leading to cardiac arrest and cerebral anoxia are considered to play a role. […] While the etiology of BHS is still unknown, autonomic dysfunction and increased vagal tone, which lead to cardiac arrest and anoxia, can be considered as major factors in this regard. […] This cardiac arrest and anoxia may ultimately lead to the emergence of bradycardia and asystole that last longer than 2 s, leading to cerebral hypoperfusion. […] The possibility of an increase in QT is another dangerous complication of the disease that can lead to early neonatal mortality.

• #42

  https://journals.lww.com/rcvm/fulltext/2019/08040/paraclinical_cardiac_findings_of_children_with.2.aspx

  However, due to contradictions between limited studies and evaluation of the possibility of the long QT, detection of QT syndrome and its risks should be considered in these children. […] Some studies have indicated that implantation of a pacemaker can effectively reduce or improve the severity of symptoms in BHS. […] Therefore, with regard to the cardiac complications and problems of these infants, this study aimed to evaluate Long QT and echocardiography finding of Children with Breath-holding Spells in Taleghani Hospital of Gorgan, Iran. […] In the present study, ECG showed long QT in 5.6% of children. […] In addition, echocardiography indicated PDA, PFO, ASD, and tricuspid regurgitation (TR) in 1.9%, 0.9%, 2.8%, and 1.9% of the participants, respectively. […] According to ECG and echocardiography findings, long QT and PDA, patent foramen ovale, TR, and atrial septal defect were observed in neonates with BHS.

• #43

  https://journals.lww.com/rcvm/fulltext/2019/08040/paraclinical_cardiac_findings_of_children_with.2.aspx

  However, due to contradictions between limited studies and evaluation of the possibility of the long QT, detection of QT syndrome and its risks should be considered in these children. […] Some studies have indicated that implantation of a pacemaker can effectively reduce or improve the severity of symptoms in BHS. […] Therefore, with regard to the cardiac complications and problems of these infants, this study aimed to evaluate Long QT and echocardiography finding of Children with Breath-holding Spells in Taleghani Hospital of Gorgan, Iran. […] In the present study, ECG showed long QT in 5.6% of children. […] In addition, echocardiography indicated PDA, PFO, ASD, and tricuspid regurgitation (TR) in 1.9%, 0.9%, 2.8%, and 1.9% of the participants, respectively. […] According to ECG and echocardiography findings, long QT and PDA, patent foramen ovale, TR, and atrial septal defect were observed in neonates with BHS.

• #44 Breath-Holding Spells – Child Neurology Foundation

  https://www.childneurologyfoundation.org/disorder/breath-holding-spells/

  Breath-holding spells are short spells of time during which a child stops breathing. They are commonly mistaken for seizures. […] There are two types of breath-holding spells. Both types may occur in the same child at different times. They are defined based on the child’s color during the spell: […] The exact mechanism of these is not clearly understood. It is somewhat complex. […] Consciousness requires a steady flow of blood and oxygen to the brain. This gets interrupted when a child is holding their breath. As blood and oxygen stop flowing to the brain, a child can pass out and turn blue. […] These are believed to be a vasovagal response to pain caused by a relatively trivial trauma. The vagus nerve controls the heart rate. Sometimes it is overactivated. This is called a vasovagal response. This overactivation can result in a decrease in the heart rate. A decrease in heart rate can lead to a reduction in blood and oxygen supply to the brain. This reduction, in turn, can cause a child to lose color and pass out.

• #45 Breath-holding spell – Wikipedia

  https://en.wikipedia.org/wiki/Breath-holding_spell

  Breath-holding spells (BHS) are the occurrence of episodic apnea in children, possibly associated with syncope (loss of consciousness and changes in postural tone). […] They may be confused with a seizure disorder. […] There is some evidence that children with anemia (especially iron deficiency) may be more prone to breath-holding spells. […] The usual precipitating event is frustration or injury. […] Physiologically, there is often hypocapnea (low levels of carbon dioxide) and usually hypoxia (low levels of oxygen). […] There is increased intrathoracic pressure and decreased cardiac output following the Valsalva maneuver. This eventually leads to a significant decrease in circulation to the brain and ultimately, loss of consciousness. […] There may be a relationship with adulthood syncope.

• #46 Breath-holding in babies and children

  https://www.nhs.uk/conditions/breath-holding-in-babies-and-children/

  Breath-holding is when a baby or child stops breathing for up to 1 minute and may faint. It can happen when a child is frightened, upset, angry, or has a sudden shock or pain. It’s usually harmless but can be scary for parents, particularly when it happens for the first time. […] Breath-holding is usually harmless. […] Breath-holding is not something a child does deliberately. […] It’s usually triggered by a sudden shock or pain, or strong emotions like fear, upset or anger. […] There are 2 types of breath-holding: blue breath-holding spells this is the most common type of breath-holding and happens when a child’s breathing pattern changes; reflex anoxic seizures this type of breath-holding happens when a child’s heart rate slows down.

• #47 Breath Holding Spell — Pediatric EM Morsels

  https://pedemmorsels.com/breath-holding-spell/

  Breath holding spells (BHS) are common involuntary reflexes in infancy and early childhood. […] Breath holding spells are defined by their benign course; however, […] The breath holding episode may lead to syncopal event / loss of consciousness. […] May even demonstrate seizure-like activity immediately upon loss of consciousness. […] There is no post-ictal period. […] Mostly occurs in children 6 months to 18 months, but can occur up to 6 years of age. […] May be associated with Cyanosis. […] May be associated with Pallor. […] Iron deficiency anemia is commonly found in these patients. […] Breath holding spells are a common and dramatic form of syncope and anoxic seizure in infancy. […] They are usually triggered by an emotional stimuli or minor trauma. […] Pallid breath holding spells result from exaggerated, vagally-mediated cardiac inhibition, whereas the more common, cyanotic breath holding spells are of more complex pathogenesis which is not complete.

• #48

  https://omim.org/entry/607578

  The diagnosis of severe breath-holding spells (BHS) in childhood is based on a distinctive and stereotyped sequence of clinical events beginning with a provocation resulting in crying or emotional upset that leads to a noiseless state of expiration accompanied by color change and ultimately loss of consciousness and postural tone (Lombroso and Lerman, 1967; DiMario, 1992). […] Autonomic dysregulation has been hypothesized as an underlying mechanism that results in loss of consciousness (Hunt, 1990; DiMario and Burleson, 1993; Dimario et al., 1998). […] The data suggested that the most likely underlying genetic inheritance pattern in severe BHS is an autosomal dominant trait with reduced penetrance. […] They concluded that treating iron deficiency anemia is effective in reducing the frequency of BHS.

• #49

  https://www.ijpediatrics.com/index.php/ijcp/article/view/4826

  Breath holding spells are a common form of a benign sudden non-epileptic condition commonly seen in healthy children 6 to 48 months of age. They are usually triggered by an emotional stimuli or minor trauma. Based on the color change, they are classified into 3 types, cyanotic, pallid, and mixed. Pallid breath holding spells result from exaggerated, vagally-mediated cardiac inhibition, whereas the more common, cyanotic breath holding spells are of more complex pathogenesis which is not completely understood. […] A detailed and accurate history is the mainstay of diagnosis. An EKG should be strongly considered to rule out long QT syndrome. […] Rare cases of status epilepticus, prolonged asystole, and sudden death have been reported. […] Occasionally, pharmacologic intervention with iron, piracetam; atropine may be of benefit.

• #50 Children with breath-holding spells undergo unnecessary diagnostic interventions | Faculty of Medicine, Lund University

  https://www.medicine.lu.se/article/children-breath-holding-spells-undergo-unnecessary-diagnostic-interventions

  Breath-holding spells are episodes during which a child temporarily stops breathing and are triggered by an emotional reaction, such as anger, fear or pain. […] The pattern is quite clear. The spell is always caused by an emotion. […] Breath-holding spells can also be frightening for family members and often results in urgent but unnecessary medical visits even after the child has been diagnosed. […] This is why we need clear diagnostic criteria, to standardise assessment and treatment. […] None of these ECG and EEG investigations in the study showed abnormal test results which could explain the spells in these children. […] These unjustified diagnostic interventions are stressful for both children and their parents and can cause unnecessary worry. […] It may seem a bit controversial to suggest fewer diagnostic tests, but with an accurate and detailed patient medical history and background information on what happened to the child, the doctor can easily diagnose breath-holding spells without these tests, argues Sanna Hellstrm Schmidt.

• #51 Breath-holding spell – Wikipedia

  https://en.wikipedia.org/wiki/Breath-holding_spell

  Some trials have demonstrated the efficacy of iron therapy, especially because although BHS can readily occur without anemia, BHS has been found to be aggravated by the presence of anemia. […] Two articles on breath-holding spells strongly suggest that parents consider having their child be tested by electrocardiogram for the rare, but real possibility that the BHS episodes are actually a symptom of prolonged QT-syndrome, a serious but treatable form of cardiac arrhythmia.

• #52 Breath-Holding Spells | Pediatric Neurology Briefs

  https://pediatricneurologybriefs.com/articles/10.15844/pedneurbriefs-10-5-4

  The clinical characteristics, types, diagnosis, and management of breath-holding spells are reviewed from The Department of Pediatrics (Neurology), Park Nicollet Medical Center, Minneapolis, MN. […] Pallid breath-holding spells (BHS) result from vagal hyperresponsiveness, following a sudden, unexpected, unpleasant stimulus, usually a mild head injury. Vagal cardiac inhibition with cerebral anoxia is the pathophysiology of pallid BHS. […] Cyanotic breath-holding spells result from a complex interplay of hyperventilation followed by apnea in expiration, and increased intrathoracic pressure. […] Diagnosis may be confirmed by EEG with ocular compression and cardiac monitoring. […] Prolonged QT syndrome is a rare but serious cause of anoxic seizure, induced by exercise, injury, or fright. […] A more protracted seizure following a BHS may represent an anoxic-epilepsy, requiring anticonvulsant therapy. […] An iron deficiency anemia may be an underlying causative factor in about 20% of cases of breath-holding.

• #53 Breath-Holding Spells – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK539782/

  Breath-holding spells commonly affect up to 5% of all infants. While they are benign, they might be a frightening experience for children and, consequently, for their caregivers. Breath-holding spells occur in children with benign neurological examination findings and children who meet age-appropriate developmental milestones. Typically breath-holding spells do not affect the subsequent neurological development of a child. […] Breath-holding episodes usually follow an inciting event in which the patient is disciplined, angry, or irritated, followed by crying and breath-holding, resulting in the loss of consciousness. These episodes can be reduced by distracting the child and avoiding the triggers. While benign, knowing these spells’ pathophysiology and differential diagnosis is essential so other pathological conditions may be ruled out.

• #54 Breath-Holding Spells – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/behavioral-concerns-and-problems-in-children/breath-holding-spells

  A breath-holding spell is an episode in which the child stops breathing involuntarily and loses consciousness for a short period immediately after a frightening or emotionally upsetting event or after a painful experience. […] Breath-holding spells occur in 0.1% to 5% of otherwise healthy children. They usually begin in the first year of life and peak at age 2. They disappear by age 4 in 50% of children and by age 8 in about 83% of children. The remainder may continue to have spells into adulthood. […] Breath-holding spells do not appear to be risk factors for true epilepsy but may be associated with an increased risk of fainting spells in adulthood. […] During a cyanotic breath-holding spell, children hold their breath (without necessarily being aware they are doing so) until they lose consciousness.

• #55 Brain metabolite values in children with breath-holding spells | NDT

  https://www.dovepress.com/brain-metabolite-values-in-children-with-breath-holding-spells-peer-reviewed-fulltext-article-NDT

  Breath-holding spells are benign, paroxysmal events with apnea and postural tone changes after a crying episode in infants. […] Our study suggested that there is no permanent neuronal damage in patients with breath-holding spells. This result confirms the previous studies, which reported no permanent neuronal damage in patients with breath-holding spells. […] The etiology of breath-holding spells is not fully understood. […] The aim of the present study was not to address the etiology of brain metabolite and neurological disorders associated with breath-holding spells. It was attempted to reveal the presence of neuronal damage associated with hypoxia, which may occur secondary to breath-holding spells. […] In conclusion, according to these findings, no permanent neuronal damage was found in the patients with breath-holding spells, indicating that it is a benign event indeed.

• #56

  https://ugeskriftet.dk/dmj/long-term-prognosis-children-breath-holding-spells

  Breath-holding spells (BHS) is a clinical entity that is easy to diagnose in its typical form. There are two clinical subtypes of breath-holding spells, which are based on the childs colour the cyanotic (blue) and the pallid type. Severe BHS causes unconsciousness. About 4% of all children under the age of five years are affected. […] It has been suggested, that iron deficiency may play a role in the pathogenesis of BHS but in this study 25 children were examined, 23 of whom had a normal haemoglobin level. […] Our results confirm the previously established familial tendency to BHS. We also found a familial tendency to epilepsy, which has not been described in previous follow-up studies. […] The long-term outcome in this study confirms the predisposition to fainting spells; there were 26 children (30.6% in the BHS group versus 6.3% of the controls, p 0.001) who later developed fainting spells. […] We found that 29.4% of the children had concentration problems. We did not reveal considerable differences when comparing the types of BHS found in this group to those found in the group without concentration problems.

• #57 Breath-Holding Spells – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/behavioral-concerns-and-problems-in-children/breath-holding-spells

  A breath-holding spell is an episode in which the child stops breathing involuntarily and loses consciousness for a short period immediately after a frightening or emotionally upsetting event or after a painful experience. […] Breath-holding spells occur in 0.1% to 5% of otherwise healthy children. They usually begin in the first year of life and peak at age 2. They disappear by age 4 in 50% of children and by age 8 in about 83% of children. The remainder may continue to have spells into adulthood. […] Breath-holding spells do not appear to be risk factors for true epilepsy but may be associated with an increased risk of fainting spells in adulthood. […] During a cyanotic breath-holding spell, children hold their breath (without necessarily being aware they are doing so) until they lose consciousness.

• #58

  https://ugeskriftet.dk/dmj/long-term-prognosis-children-breath-holding-spells

  Breath-holding spells (BHS) is a clinical entity that is easy to diagnose in its typical form. There are two clinical subtypes of breath-holding spells, which are based on the childs colour the cyanotic (blue) and the pallid type. Severe BHS causes unconsciousness. About 4% of all children under the age of five years are affected. […] It has been suggested, that iron deficiency may play a role in the pathogenesis of BHS but in this study 25 children were examined, 23 of whom had a normal haemoglobin level. […] Our results confirm the previously established familial tendency to BHS. We also found a familial tendency to epilepsy, which has not been described in previous follow-up studies. […] The long-term outcome in this study confirms the predisposition to fainting spells; there were 26 children (30.6% in the BHS group versus 6.3% of the controls, p 0.001) who later developed fainting spells. […] We found that 29.4% of the children had concentration problems. We did not reveal considerable differences when comparing the types of BHS found in this group to those found in the group without concentration problems.

• #59 Breath-Holding Spells – Child Neurology Foundation

  https://www.childneurologyfoundation.org/disorder/breath-holding-spells/

  No long-term neurological or health issues occur as a consequence of having breath-holding spells in childhood. […] There is not an increased risk of having epileptic seizures associated with breath-holding spells. This is true even if the child shows convulsive movements during the spell. […] Overall, outlook is excellent for both types of breath-holding spells.

• #60 Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence

  https://www.benthamscience.com/article/94468

  Breath-holding spells affect 0.1 to 4.6% of otherwise healthy young children. The onset is usually between 6 and 18 months of age. The etiopathogenesis is likely multifactorial and includes autonomic nervous system dysregulation, vagally-mediated cardiac inhibition, delayed myelination of the brain stem, and iron deficiency anemia. […] Although breath-holding spells are benign, they can be quite distressing to the parents. Confident reassurance and frank explanation are the cornerstones of treatment. Underlying cause, if present, should be treated. Interventions beyond iron supplementation may be considered for children with severe and frequent breath-holding spells which have a strong impact on the lifestyle of both the child and family.

• #61 Breath-holding spell: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000967.htm

  Normal breathing starts again after a brief period of unconsciousness. […] No treatment is usually needed. But iron drops or pills may be given if your child has an iron deficiency. […] Most children outgrow breath-holding spells by the time they are 4 to 8 years old. […] Children who have a seizure during a breath-holding spell are not at higher risk for having seizures otherwise.

• #62

  https://drnozebest.com/blogs/the-doctor-is-in/what-parents-need-to-know-about-breath-holding-spells?srsltid=AfmBOooqOYAnyZB5ubHhrvaceR2NFNrrMCwAqBEeSCJ9NONHpf0oSRpS

  Pallid breath-holding spells are less common and usually occur after a sudden painful or frightening experience. […] If this is your child’s first incident or if the spells change, notify your provider or call 911 to rule out any underlying complications. […] It is important to identify triggers to manage distress with positive coping skills. […] The most effective action you can take is partnering with your child to develop healthy coping skills when facing disappointments. […] One of the most powerful interventions is to immediately acknowledge the strong feeling and tell the child the feeling is okay. […] Your repetition, patience and love will pay off while working through the breath-holding spells phase.

• #63

  https://drnozebest.com/blogs/the-doctor-is-in/what-parents-need-to-know-about-breath-holding-spells?srsltid=AfmBOooqOYAnyZB5ubHhrvaceR2NFNrrMCwAqBEeSCJ9NONHpf0oSRpS

  Pallid breath-holding spells are less common and usually occur after a sudden painful or frightening experience. […] If this is your child’s first incident or if the spells change, notify your provider or call 911 to rule out any underlying complications. […] It is important to identify triggers to manage distress with positive coping skills. […] The most effective action you can take is partnering with your child to develop healthy coping skills when facing disappointments. […] One of the most powerful interventions is to immediately acknowledge the strong feeling and tell the child the feeling is okay. […] Your repetition, patience and love will pay off while working through the breath-holding spells phase.

• #64 Breath-holding spells | MedLink Neurology

  https://www.medlink.com/articles/breath-holding-spells

  Iron deficiency, anemia, also appears to be a factor to contributing breath-holding spells. […] Traditional concepts of breath-holding spells invoked clearly distinct mechanisms for cyanotic and for pallid spells. […] However, there appears to be evidence of parasympathetic reflex cardio-respiratory inhibition in both types, as well as subtle generalized autonomic dysregulation. […] Excessive vagal tone or vagal overactivity related to autonomic dysregulation is currently believed to be the primary biological basis of breath-holding spells. […] Studies in a small group of children with pallid breath-holding spells showed a significant decrease in mean arterial blood pressure and increase in pulse rate during the change from lying to standing. […] Findings further suggested greater sympathetic activity in children with cyanotic breath-holding spells.

• #65

  https://www.indianpediatrics.net/aug2015/aug-695-696.htm

  Breath Holding Spells A Tale of 50 Years […] BHS is a common behavioral disorder of early childhood associated with a lot of parental anxiety, besides carrying a potential for misdiagnosis. […] Multiple factors like disturbed parent-child relationship, hereditary autonomic instability, self asphyxiation, decreased cerebral blood flow secondary to increased intrathoracic pressure due to spontaneous valsalva manoeuvre and altered cerebral mechanism secondary to various stimuli were implicated for cyanotic BHS. […] Dysregulation of the autonomic nervous system is hypothesized as the most plausible mechanism responsible for its occurrence. […] The more common cyanotic form is considered to be due to inhibition of respiratory effort due to autonomic instability, or intra-pulmonary shunting as a result of abnormal pulmonary reflexes. Pallid spells are considered to be caused by an exaggerated vagal response to noxious stimuli leading to bradycardia or a brief asystole which in turn produces cerebral hypoperfusion. […] It is now well established that a trial of iron therapy is beneficial in reducing the frequency of BHS, especially in children with laboratory evidence of anemia. […] To summarize, pathophysiology of breath holding spells is clearer since the publication of this article. The role of iron in its treatment has got well established and newer drugs have found a role in management of severe and refractory cases.

• #66

  https://www.ijpediatrics.com/index.php/ijcp/article/view/4826

  Breath holding spells are a common form of a benign sudden non-epileptic condition commonly seen in healthy children 6 to 48 months of age. They are usually triggered by an emotional stimuli or minor trauma. Based on the color change, they are classified into 3 types, cyanotic, pallid, and mixed. Pallid breath holding spells result from exaggerated, vagally-mediated cardiac inhibition, whereas the more common, cyanotic breath holding spells are of more complex pathogenesis which is not completely understood. […] A detailed and accurate history is the mainstay of diagnosis. An EKG should be strongly considered to rule out long QT syndrome. […] Rare cases of status epilepticus, prolonged asystole, and sudden death have been reported. […] Occasionally, pharmacologic intervention with iron, piracetam; atropine may be of benefit.

• #67

  https://journals.lww.com/rcvm/fulltext/2019/08040/paraclinical_cardiac_findings_of_children_with.2.aspx

  However, due to contradictions between limited studies and evaluation of the possibility of the long QT, detection of QT syndrome and its risks should be considered in these children. […] Some studies have indicated that implantation of a pacemaker can effectively reduce or improve the severity of symptoms in BHS. […] Therefore, with regard to the cardiac complications and problems of these infants, this study aimed to evaluate Long QT and echocardiography finding of Children with Breath-holding Spells in Taleghani Hospital of Gorgan, Iran. […] In the present study, ECG showed long QT in 5.6% of children. […] In addition, echocardiography indicated PDA, PFO, ASD, and tricuspid regurgitation (TR) in 1.9%, 0.9%, 2.8%, and 1.9% of the participants, respectively. […] According to ECG and echocardiography findings, long QT and PDA, patent foramen ovale, TR, and atrial septal defect were observed in neonates with BHS.

• #68 Breath holding spells

  https://www.netmums.com/coffeehouse/drop-clinic-984/baby-child-health-989/1575110-breath-holding-spells.html

  They do say a shock of an accident can cause the breath holding spells which is hard to prevent in children, he is fine now was very sleepy for a day after which is normal. […] I have heard of older babies and toddlers having these breath holding episodes and have seen it happen once before to a friends child. Sometimes it can be triggered by your LO hurting them self or maybe not getting their own way.

• #69 Breath-holding in babies and children

  https://www.nhs.uk/conditions/breath-holding-in-babies-and-children/

  Breath-holding is when a baby or child stops breathing for up to 1 minute and may faint. It can happen when a child is frightened, upset, angry, or has a sudden shock or pain. It’s usually harmless but can be scary for parents, particularly when it happens for the first time. […] Breath-holding is usually harmless. […] Breath-holding is not something a child does deliberately. […] It’s usually triggered by a sudden shock or pain, or strong emotions like fear, upset or anger. […] There are 2 types of breath-holding: blue breath-holding spells this is the most common type of breath-holding and happens when a child’s breathing pattern changes; reflex anoxic seizures this type of breath-holding happens when a child’s heart rate slows down.

• #70

  https://abcnews.go.com/Health/toddler-breath-holding-terrifies-parents-hold-hostage/story?id=17556685

  Sometimes trauma can trigger an attack. […] „While these spells sometimes occur with tantrums, they’re not willful,” according to Baby Center. „Your child is not holding her breath on purpose.” […] The only time these attacks deserve a medical evaluation is if they occur on a regular basis or happen more frequently.

• #71 Breath-holding spells in children

  https://health-shared.com/topics/breathholding-spells-in-children-1531991256637

  ’Breath-holding spells’ refers to two distinct conditions that can occur when a child is frightened, upset or angry, or experiences a sudden shock or pain. […] Blue breath-holding spells are caused by an involuntary reflex that’s part of the crying mechanism. […] Reflex anoxic seizures are caused by an involuntary slowing of the heart rate, to the extent that the heart actually stops beating for 5 to 30 seconds. This is why the child looks so deathly pale. […] Reflex anoxic seizures are involuntary, aren’t dangerous and don’t cause brain damage or death. They’re not a sign of a difficult child or poor parenting. They’re not epileptic seizures. […] In some cases, blue breath-holding spells and reflex anoxic seizures may be linked to iron deficiency anaemia. […] There’s no specific treatment for blue breath-holding spells, but your child should have a thorough examination to check for any underlying problems, and an ECG to check for an irregular heartbeat. […] Reflex anoxic seizures can respond to some specific medicines, but these are usually only offered in cases where the seizures occur very frequently and have a significant impact on family life.

• #72 Breath-holding spell: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000967.htm

  Normal breathing starts again after a brief period of unconsciousness. […] No treatment is usually needed. But iron drops or pills may be given if your child has an iron deficiency. […] Most children outgrow breath-holding spells by the time they are 4 to 8 years old. […] Children who have a seizure during a breath-holding spell are not at higher risk for having seizures otherwise.

• #73 Breath holding spells

  https://www.netmums.com/coffeehouse/drop-clinic-984/baby-child-health-989/1575110-breath-holding-spells.html

  They do say a shock of an accident can cause the breath holding spells which is hard to prevent in children, he is fine now was very sleepy for a day after which is normal. […] I have heard of older babies and toddlers having these breath holding episodes and have seen it happen once before to a friends child. Sometimes it can be triggered by your LO hurting them self or maybe not getting their own way.

• #74 What Are Breath-Holding Spells in Kids? | Children’s Hospital Colorado

  https://www.childrenscolorado.org/just-ask-childrens/articles/breath-holding-spells/

  Everything You Need to Know About Breath-Holding Spells […] A breath-holding spell is when your child or baby holds their breath for long enough that they temporarily stop breathing, which sometimes causes them to pass out. […] It is important to know that this is something a child cant control, and you cant prevent them from occurring. […] Research has suggested that breath-holding spells are an abnormal reflex of the nervous system in young children that allows them to hold their breath long enough to stop breathing momentarily. Children do not do this on purpose, and they dont have control over it.

• #75

  https://drnozebest.com/blogs/the-doctor-is-in/what-parents-need-to-know-about-breath-holding-spells?srsltid=AfmBOooqOYAnyZB5ubHhrvaceR2NFNrrMCwAqBEeSCJ9NONHpf0oSRpS

  Pallid breath-holding spells are less common and usually occur after a sudden painful or frightening experience. […] If this is your child’s first incident or if the spells change, notify your provider or call 911 to rule out any underlying complications. […] It is important to identify triggers to manage distress with positive coping skills. […] The most effective action you can take is partnering with your child to develop healthy coping skills when facing disappointments. […] One of the most powerful interventions is to immediately acknowledge the strong feeling and tell the child the feeling is okay. […] Your repetition, patience and love will pay off while working through the breath-holding spells phase.

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