Paediatrics Q6

Breath-Holding Spells


Breath-Holding Spells occur mainly in toddlers between 6 months to 2 years old. They are often triggered by minor injuries or emotional upset.

Clinical Presentation

1. Blue Breath-Holding Spells: The child turns blue and stops breathing, usually after vigorous crying. Rapid recovery typically occurs.

2. Reflex Anoxic Seizures: Also known as reflex asystolic syncope or white breath-holding attacks. The child becomes pale and stops breathing. They may exhibit rigid posture, jerky movements, and upward eye deviation. Rapid recovery is common. An important distinguishing feature is that there is no tongue biting, which sets it apart from epilepsy.

Common Management

Management for both conditions includes the following:

1. Reassure parents.

2. Advise to place the child in the recovery position until the episode ends (usually in less than 1-2 minutes).

3. Check Ferritin levels and treat iron deficiency anaemia if present.

Both conditions have similar management strategies, and distinguishing between the two is generally not necessary for management purposes. It’s crucial to reassure parents and educate them on how to manage these episodes.


Further Reading: Breath-Holding Spells

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