Breath-holding spells

This article was written by dr. Aursulesei Ruxandra, pediatric neurologist with extensive experience in diagnosing and treating neurological conditions. Pediatric neurology plays an important role in the periodic neurological evaluation of children born prematurely, as well as of all newborns at risk of developing neurological sequelae, with the goal of early detection and treatment of any impairment of the nervous system.

What is a breath-holding spell (BHS)?

In short, BHS is an event in which the child cries/starts to cry, then holds their breath for a few seconds.

How long does a BHS episode last?

A BHS episode lasts anywhere from a few seconds to a maximum of one minute.

When can breath-holding spells occur?

BHS can occur from the first weeks of life and stops around the age of 8. Some authors also describe cases at the age of 14.

How often can these episodes occur?

They can occur anywhere from several episodes a day to a few episodes a year.

Are all BHS episodes the same?

No. There are 2 types of BHS:

• Cyanotic BHS (the child turns blue) is generally caused by fear, pain, being contradicted, frustration, or surprise. The child starts crying loudly, followed by a few increasingly short and shallow breaths that lead to the chest becoming fixed in exhalation. Some episodes are associated with loss of consciousness, followed by mild tonic contracture, or even a generalized tonic-clonic convulsion.
• Pallid BHS (the child turns pale), like the other form, is triggered by situations such as falling, being hit, or fear. The child cries briefly, or crying may even be absent ("starts to cry"). ("Pediatric Neurology", Assoc. Prof. Dr. Dana Craiu)

Can BHS be genetically inherited?

Yes. In children with BHS, there is a positive family history of similar episodes in 23-38% of cases.

Can BHS cause brain damage?

No, a BHS episode does not cause brain damage.

Is BHS epilepsy?

No, BHS does not mean epilepsy.

Is there a risk of developing epilepsy after BHS?

The risk of developing epilepsy is the same as in the general population.

Is there a risk of developing other conditions after BHS?

Yes. In adolescence, there is a risk of the occurrence of syncope, behavioral disorders, anger episodes, and conversion disorders.

What should parents do?

• An attempt is made to avoid triggering factors as much as possible or to ignore the episodes. During attacks, parents should position the child in a lateral decubitus position (on their side), or even position the child's head lower than the body, to increase cerebral perfusion.
• An attempt should be made to film the episode.
• In the case of pallid forms of BHS, if the episodes are too frequent, sedatives, belladonna chloride or atropine sulfate, carbamazepine, or iron supplementation may be used.

Centrokinetic is well prepared for this specialty, with a team of experienced doctors and the necessary equipment for diagnosis, monitoring, and treatment. Find out more about pediatric neurology and book an appointment at Centrokinetic here.