BREATH-HOLDING SPELLS

This common situational disorder, also known as infantile syncope, accounts for 4 to 13% of psychosomatic disorders in pediatric age group.


ETIOLOGY
Breath-holding spells result from frustration. A disciplinary conflict between parents and the child is basic underlying cause. The child uses the attack or its threat to "assert" himself and to express his anger or protest.
The role of iron deficiency anemia in the etiology is doubtful.

CLINICAL FEATURES
In a classical attack, the child cries, hyperventilates and holds his breath ( usually in expiration )
followed by cyanosis in a few seconds. There may occur momentary loss of consciousness and convulsive twitchings. Finally he becomes limp.
In second type, the child develops characteristic pallor rather than cyanosis.
The first type is called cyanotic and the second pallid.
The onset in both the types is between 6 and 18 months of age. The frequency is usually one to three attacks a day.

DIAGNOSIS
Clinical picture is usually so characteristic that little difficulty should be encountered in recognizing the condition. When "spells" are accompanied by tonic and clonic convulsions, differentiation from epilepsy becomes essential. In the former, an obvious precipitating factor
can invariably normal.
Breath-holding spells should also be differentiated from cyanotic attacks seen in congenital heart disease.

TREATMENT
It is directed at determination of the causative and precipitating factors and treating these by psychotherapy. Drug therapy is of insignificant value. Attention must be directed to coexisting iron deficiency anemia, if any,

PROGNOSIS
As the child grows, frequency of spells decreases. Finally, almost all such children are symptom- free by the age of 5 or 6 years.
Incidence of temper tantrum and other behavioral disorders in these children is high. There is no evidence that epilepsy occurs in greater proportion in them than in normal population.