Presentation
Obstruction of airway by blood Obstruction of airway by food On examination - abdominal breathing On examination - adventitious sounds present On examination - chest expansion unequal On examination - chest PN hyperresonant On examination - chest PN [icd9data.com]
To the best our knowledge, this study presents the first data on QOL before and after PM implantation in this group of patients. [annalspc.com]
Note, that the use of anti-epileptic medications will not address the symptoms of breath holding spells.[5] Breath holding spells occur when children hold their breath as they are crying excessively.[1] In pediatrics, it is a common presentation and is [aaemrsa.blogspot.com]
Cyanotic breath-holding has been found to respond to iron therapy (1), even in the absence of anemia, and to treatment for obstructive sleep apnea (when present). During a pallid breath-holding spell, vagal stimulation severely slows the heart rate. [msdmanuals.com]
Entire Body System
- Crying
The child may gasp and give a very brief cry. Sometimes the child does not even give a cry, but only opens his mouth like he is going to cry but makes no sound. [childneurologyfoundation.org]
About breath-holding spells Breath-holding usually happens when babies or children: are crying are frightened or upset have had a minor accident and have gone into shock. [raisingchildren.net.au]
The spell begins with the child crying, usually out of frustration, but occasionally when upset after an injury. This crying causes hyperventilation. [drhull.com]
The typical spell goes as follows – baby starts crying, continues exhaling as he cries, cannot stop the exhaling cry in order to take a breath, starts to turn blue on the lips and face, passes out, finally takes a deep breath and wakes up. [askdrsears.com]
The child will often open their mouth as if they're going to cry, but make no sound before turning a deathly pale grey colour and losing consciousness. [nhs.uk]
- Pain
Breath-holding spells usually are triggered by physically painful or emotionally upsetting events. Typical symptoms include paleness, stoppage of breathing, loss of consciousness, and seizures. [msdmanuals.com]
Reflex anoxic seizures Reflex anoxic seizures are often triggered by a sudden unexpected fright or pain, such as a fall with a minor head injury. The seizure isn't caused by the injury itself, but by the sudden fright or pain. [nhs.uk]
- Falling
"But if they're in a safe place and not going to fall off a table or chair, then you really just have to ignore it." [abcnews.go.com]
These spells can be triggered by frustration, a fall, or something frightening. Holding the breath (when frustrated) and becoming bluish without passing out is such a common reaction in young infants that it is not considered abnormal. [kpjampang.com]
Thankfully, breath-holding spells resolve spontaneously soon after the child passes out, and unless the fall hurts the child, she will be fine afterwards. [drgreene.com]
During a spell, they may fall to the ground, go limp, arch their back or become stiff. Only in rare circumstances will they have a seizure. [healthand.com]
- Anemia
Both patients had signs, symptoms, and laboratory findings of severe anemia. With correction of anemia the breath-holding spells promptly and completely resolved in each case. [ncbi.nlm.nih.gov]
In a study of 165 children with breath holding spells, 47.9% of children were found to have iron deficiency anemia.[4] Iron deficiency anemia is not the reason for breath holding spells and it is unclear the correlation. [aaemrsa.blogspot.com]
Some trials have demonstrated the efficacy of iron therapy, especially because although BHS can readily occur without anemia, BHS has been found to be exaggerated by the presence of anemia. [en.wikipedia.org]
Sometimes, iron deficiency anemia might cause kids to have breath-holding spells. So a doctor might do a blood test to check for anemia. Treating the anemia may help reduce the number of the spells. [kidshealth.org]
Anemia, or a low blood count, may cause a child who has breath-holding spells to have more frequent episodes, but anemia is not the cause for the episodes. Most children with breath-holding spells are otherwise healthy. [childneurologyfoundation.org]
- Unconsciousness
Once the child is unconscious, normal respiration will resume immediately, the CO 2 level will rise to normal, and she will awaken. [drhull.com]
Symptoms can include: Blue or pale skin Crying, then no breathing Fainting or loss of alertness (unconsciousness) Jerky movements (short, seizure-like movements) Normal breathing starts again after a brief period of unconsciousness. [nicklauschildrens.org]
Gastrointestinal
- Choking
Choking – while choking can be a life-threatening emergency, most episodes of choking aren’t. [keepkidshealthy.com]
Was she choking?! I flipped her over and hit her several times with my palm in between her shoulder blades (thank goodness I had remembered what to do in case a baby was choking). But still nothing. She was even more blue. [modernlymorgan.com]
What to do during a breath-holding spell Keep your child safe by rolling her onto her side and checking her mouth for food or objects she could choke on. [allparenting.com]
Also, don't put anything in your child's mouth because it could make him choke or vomit. Treatment after attacks of breath-holding Give your child a brief hug and go about your business. A relaxed attitude is best. [kpjampang.com]
If your child passes out for a brief time, stay calm and: check your child's mouth for food or any object that could pose a choking hazard once your child regains consciousness remove all objects or furniture within reach in case your child has a seizure [kidshealth.org]
Cardiovascular
- Cyanosis
The child initially provoked, cries vigorously for a few seconds and then holds his or her breath in expiration and cyanosis develops. Consciousness is lost because of cerebral hypoxia. [indianpediatrics.net]
This brief period of blueness (cyanosis) unconsciousness in no way harms your child's brain. Breathholding is more than just an irritating and indeed frightening tantrum behavior, though. [drhull.com]
Clinically, these patients demonstrate a prolonged QT period on electrocardiogram, which may be associated with cyanosis and pallor.[3] Breath holding spells may be confused with a Brief Resolved Unexplained Event; however, they have benign consequences [aaemrsa.blogspot.com]
The child cries and has forced expiration sometimes leading to cyanosis (blue in color), loss of muscle tone, and loss of consciousness. The child usually recovers within a minute or two, but some fall asleep for an hour or so. [en.wikipedia.org]
Child cries and has forced expiration leading to cyanosis, limpness, and loss of consciousness. The majority of children will regain consciousness and be fine within 1 minute, but some will fall asleep for an hour. [pedclerk.bsd.uchicago.edu]
Psychiatrical
- Fear
Sometimes breath-holding spells are brought on by strong emotions such as anger, fear, pain or frustration. In around a third of children who breath hold, there is a family history of breath holding. [rch.org.au]
At the same time, parents should not avoid providing appropriate structure for children out of fear of causing spells. Distracting children and avoiding situations that lead to tantrums are the best ways of preventing and treating these spells. [msdmanuals.com]
They can be triggered by pain, fear, or the child becoming upset. The episodes usually last less than one minute. [childneurologyfoundation.org]
Children can have breath holding spells when they are responding to: Fear Pain Traumatic event Being startled or confronted Breath holding spells are more common in children with: Genetic conditions, such as Riley-Day syndrome or Rett syndrome Iron deficiency [coordinatedhealth.com]
- Anger
Some healthcare professionals view breath-holding spells as a way to communicate anger. Because the condition often runs in families, genetics may play a role. Usually the episodes stop between the ages of 4 and 8 years. [mhealth.org]
Sometimes breath-holding spells are brought on by strong emotions such as anger, fear, pain or frustration. In around a third of children who breath hold, there is a family history of breath holding. [rch.org.au]
Definition Breath holding spells are episodes of brief, involuntary cessations of breathing that occur in children in response to stimuli such as anger, frustration, fear, or injury. [healthofchildren.com]
In cyanotic breath-holding spells, loss of consciousness is triggered by a sudden injury or fright, anger or frustration. [indianpediatrics.net]
This may lead to a patient becoming unconscious; however, these routine episodes are far from life-threatening.[1] Breath holding spells can be a result of various situations, such as a frightening or painful event, or can be linked to excessive anger [aaemrsa.blogspot.com]
- Aggressive Behavior
However, because of the side-effects (hyperreactivity, aggressive behavior, and loss of appetite) the drug was eventually discontinued. As the symptoms were severe, implantation of permanent pacemaker was warranted. [circ.ahajournals.org]
Neurologic
- Seizure
Reflex anoxic seizures Reflex anoxic seizures are often triggered by a sudden unexpected fright or pain, such as a fall with a minor head injury. The seizure isn't caused by the injury itself, but by the sudden fright or pain. [nhs.uk]
Unprovoked seizures, seizures lasting longer then two or three minutes, and multiple seizures in one day should give cause for concern. [gringoslocos6.com]
Children who have a seizure during a breath holding spell are not at higher risk of having seizures otherwise. [medlineplus.gov]
- Tantrums
Distracting children and avoiding situations that lead to tantrums are the best ways of preventing and treating these spells. [msdmanuals.com]
Home care If your child has a temper tantrum, make reasonable efforts to calm him or her. If this doesn't work, let the tantrum happen but prevent your child from injuring him- or herself. [fairview.org]
Learn more about managing tantrums. You might be tempted to give in to your child during a tantrum, because you’re worried the tantrum will cause breath-holding. But giving in to tantrums often causes more tantrums. [raisingchildren.net.au]
- Screaming
"His mouth was wide open like the wires got crossed and he didn't start screaming because his mouth was open and stuck," she said. [abcnews.go.com]
The child may then gasp and start crying or screaming. Or, he or she may even lose consciousness and start breathing again. Some healthcare professionals view breath-holding spells as a way to communicate anger. [mhealth.org]
Typically, the child cries or screams and then stops breathing. The skin then begins to turn blue, particularly around the lips, which is caused by a shortage of oxygen. The child then becomes unconscious. [news-medical.net]
Some attacks result from hyperactive normal reflexes, such as slowing of the heart rate when the eyes are rubbed, or when the child tries to breathe or scream against a closed throat (the Valsalva response). [epilepsy.com]
Night terrors – often confused for nightmares, a child having a night terror will wake up in the early part of the night yelling and screaming, which is why parents think their child is having a nightmare. [keepkidshealthy.com]
- Confusion
Night terrors – often confused for nightmares, a child having a night terror will wake up in the early part of the night yelling and screaming, which is why parents think their child is having a nightmare. [keepkidshealthy.com]
As breath-holding spells may look like epileptic seizures, the 2 are often confused. Breath-holding spells happen after your child has been frustrated, startled or hurt. [kidshealth.org.nz]
Afterwards the child will regain consciousness, but may appear sleepy and confused for a few hours. [nhs.uk]
Clinically, these patients demonstrate a prolonged QT period on electrocardiogram, which may be associated with cyanosis and pallor.[3] Breath holding spells may be confused with a Brief Resolved Unexplained Event; however, they have benign consequences [aaemrsa.blogspot.com]
They may be confused with a seizure disorder. They are sometimes observed in response to frustration during disciplinary conflict. There are four types of breath-holding spells. [en.wikipedia.org]
- Convulsions
Louis Children's Hospital from 1934 to 1961 (51) and all registered in the convulsive outpatient clinic from 1951 to 1961. .. Funding and Disclosures * From the Department of Pediatrics, Washington University School of Medicine, and the St. [nejm.org]
During further follow up, febrile convulsions occurred in 10 children (six were on iron treatment initially). [adc.bmj.com]
Even after he stopped convulsing, he was not acting normal. Brad said we could see a doctor in Mexico. I said, “No. We are going to Kosair now!” I contacted our family doctor and talked with the nurse practitioner on call. [gringoslocos6.com]
Various associations have been made between breath holding spells such as convulsions, cardiac abnormalities, and iron deficiency anemia.[1] Convulsions are associated with breath holding spells due to extreme anoxia. [aaemrsa.blogspot.com]
"I noticed the signs of an impending pass out, except this time, she started convulsing. Her arms were out straight, stiff and wouldn't go down." The restaurant staff called 911 and by the time paramedics arrived, the toddler was convulsing. [abcnews.go.com]
Treatment
Piracetam is an effective prophylactic treatment for severe BHS. [ncbi.nlm.nih.gov]
[…] is effective in the treatment of BHS and that iron deficient children are more likely to benefit from such treatment. 8 Our data suggest that iron may be crucial in the treatment of BHS because IDA may be the main underlying defect. [adc.bmj.com]
After the spell, the heart speeds up again, breathing restarts, and consciousness returns without any treatment. Because this form is rare, further diagnostic evaluation and treatment may be needed if the spells occur often. [msdmanuals.com]
Breath-holding spells is a relatively common disorder in young children that usually spontaneously resolves and needs no treatment. [circ.ahajournals.org]
Prognosis
Outlook (Prognosis) Most children outgrow breath holding spells by the time they are 4 – 8 years old. Children who have a seizure during a breath holding spell are not at more risk of getting a seizure disorder. [coordinatedhealth.com]
Outlook (Prognosis) 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 more risk of getting a seizure disorder. [nicklauschildrens.org]
Outlook (Prognosis) 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 of having seizures otherwise. [m.ufhealth.org]
See also: Temper tantrums Support Groups Expectations (prognosis) Most children outgrow breath holding spells by ages 4 - 8. [mostellarmedical.org]
Etiology
The book is designed to supplement standard textbooks that provide detailed information on etiology, pathogenesis and therapeutic controversies in pediatric clinical neuroscience. [books.google.com]
Practically all categories in the chapter could be designated 'not otherwise specified', 'unknown etiology' or 'transient'. [icd10data.com]
Epidemiology
The clinical and epidemiologic aspects of breath-holding spells are herein summarized. The pertinent respiratory and neural physiologic interactions involved are delineated, as well as practical treatment approaches. [ncbi.nlm.nih.gov]
The clinical and epidemiologic aspects of breath-holding spells are herein summarized. The pertinent respiratory and neural physiologic interactions involved are delineated, as well as practical treatment approaches. ( AJDC. 1992;146:125-131) [doi.org]
[…] v=oknV2XZt9Uw Epidemiology Occurs in approximately 5% of the population with equal distribution between males and females. Most common between 6-18 months and usually not present after 5 years of age. [pedclerk.bsd.uchicago.edu]
Pathophysiology
Prior research concerning the underlying pathophysiologic mechanisms involved in breath-holding spells has implicated an autonomic nervous system dysregulation. [ncbi.nlm.nih.gov]
These events are unique to childhood, though they may have the same pathophysiology as similar events that occur in adults. It is important to understand that these episodes are not temper tantrums. [journals.lww.com]
Prevention
Often, the spells can be predicted and even prevented from occurring once the factors that trigger them have been identified. [news-medical.net]
What can I do to help prevent breath-holding spells? Most attacks from falling down or a sudden fright can't be prevented. Neither can most attacks that are triggered by anger. [kpjampang.com]
Preventing breath-holding You can’t prevent breath-holding, but you might be able to prevent the events leading up to it: Before children start to get upset, try to distract them. Reassure children after they’ve had a fright or a shock. [raisingchildren.net.au]
Distracting children and avoiding situations that lead to tantrums are the best ways of preventing and treating these spells. [msdmanuals.com]