BREATH

HOLDING
SPELL

INTRODUCTION
BREATH HOLDING SPELL
BREATH HOLDING SPASMS
BREATH HOLDING ATTACKS

INTRODUCTION
The needs of a child for complete emotional
and behavioural development are called
emotional needs of a child.
Very few parents are aware that they can
play
a
significant
role
in
emotional
development of a child.
The first five years of life
important
for
mental
and
development of a child.

are very
emotional

INTRODUCTION
Breath holding spasms are a
common phenomenon in children
below 2 years of age.
Nothing terrifies a parent more
than
seeing
the
child
stop
breathing and turn blue and if a
generalized seizure follows, the
parent
may
completely
decompensate.

DEFINITION
It is a conduct disorder due
to some cause (being hurt or
thwarted) when the child
holds breath in expiration,
which may lead to cyanosis
(with or without hypoxia,
limpness and convulsion).
These spells

arent intentional-

INCIDENCE
AGE:- 6 months to 5 years
SEX- It is equally common in both sexes.
FAMILY HISTORY may be positive in up to
33% cases.
FREQUENCY- extremely variable, once a

month to ten times a day

CLINICAL TYPES
1. Cyanotic Breath Holding Spell (More
Common)
2. Pallid Type Of Breath Holding Spell

CYANOTIC BREATH HOLDING SPELL

PRECIPITATING FACTORS
1.ANGER
2.FRUSTRATION
3.WHEN CHILD IS HURT

CYANOTIC BREATH HOLDING SPELL

1)Anger
or
frustration
is
followed by crying that lasts
briefly, often less than 15
seconds. Following this, the
child holds his breath in
expiration and a progressively
deepening cyanosis develops.

CYANOTIC BREATH HOLDING SPELL

(2) During the first 10-15 seconds of
apnoea, the child may be aware of
surroundings [this brief period is
the only time when a counter
stimulus like sprinkling cold water
on the face or application of wet
cloth on the face is effective]. If
the sequence continues, the child
loses
his
consciousness
and
collapses limply. A generalized
seizure may follow. At times there
is
vomiting
and
involuntary

CYANOTIC BREATH HOLDING SPELL

(3) The child may end the

apnoeic phase with a gasp and
the cyanosis abates promptly.
A drowsy, stuporous state may
last for few minutes or few
hours.
Usually the normal activity is
resumed immediately.

PALLID TYPE OF
BREATH HOLDING SPELL
PRECIPITATING FACTORS
1. MINOR INJURY
2. SUDDEN FRIGHT
3. PAINFUL
STIMULATION
(FALLING, STRIKING)

PALLID TYPE OF BREATH HOLDING SPELL

Usually it is precipitated by
minor injuries or sudden fright
(unexpected
or
painful
stimulation).
Occipital
blows,
particularly common when a
child begins walking, tripping
and falling seem very potent
stimuli.
The

stimulus

is

followed

by

PATHOPHYSIOLOGY
Child Thwarted/ Hurt/ Frightened/ Frustrated

Most of the AIR in lungs is EXHALED

VOCAL CORDS which were NARROWED during CRYING

CLOSE COMPLETELY

BREATH is HELD in EXPIRATION for a FEW SECONDS

CYANOSIS

RIGIDITY, OPISTHOTONUS, LIMPNESS

if HYPOXIA for more than 10-15 sec.

CONVULSION

PATHOPHYSIOLOGY
BREATH HOLDING IS ASSOCIATED WITH AN
INCREASE IN INTRATHORACIC PRESSURE

DECREASED VENOUS RETURN

DECREASED CARDIAC OUTPUT

CEREBRAL ISCHAEMIA
[LOSS OF CONSIOUSNESS, RIGIDITY,
OPISTHOTONUS, CONVULSION]

MANAGEMENT
1)REASSURANCE AND COUNSELLING
TO PARENTS
)Tell the parents that everything is fine.
)Explain what has happened and reassure about the
benign nature of breath holding.
)Discipline is required
without conflicts.

with

consistency

and

)The child should never derive any benefit from a

breath holding episode. If he derives any benefit the
attacks will recur.

a child asks for a particular demand to

be satisfied, it should be satisfied only if it is
reasonable, but if not; the demand must
)If

MANAGEMENT
2)

DEALING WITH
BREATH HOLDING

AN

EPISODE

OF

If the parent is confronted in future by

the sequence of negative emotion, crying,
apnea, cyanosis and collapse; the parents
should place the child in a horizontal
position to prevent injury from
falling.
As he recovers, the child should be left
to himself, thereby ensuring that be
receives no satisfaction from the episode.
This is called PURPOSEFUL NEGLECT.

MANAGEMENT
3) MISCELLANEOUS ASPECTS
HYPOCHROMIC ANAEMIA IS KNOWN TO
BE ASSOCIATED WITH BREATH HOLDING &
SHOULD BE TREATED.

Counter stimulus like sprinkling cold

water on the face or application of wet
cloth on the face is effective.

MANAGEMENT
4) DRUGS
ATROPINE 0.01 ml/kg/dose
(prevents bradycardia)
SODIUM VALPROATE 15 mg/kg/day
is helpful if attacks are very
frequent
RARELY, IF THE BREATH HOLDING ATTACKS
PERSIST, INCREASE IN FREQUENCY, OR CAUSE A
GREAT APPREHENSION FOR PARENTS, A BRIEF