Breath holding spells
Breath holding spasms usually occur between the ages of six months and five years. These may either be cyanotic or pallid. Cyanotic spells (where baby turns blue) are precipitated by anger, frustration, while pallid spells are associated with fear or minor injury. The usual story is that the child starts crying after he is hurt, admonished, frustrated or frightened. After a bout of crying most of the air in the lungs is exhaled, vocal cords which are narrowed during crying close, breath is held in expiration for a few seconds, and the child becomes blue. There is rigidity and opisthotonos followed by limpness. Thereafter the child becomes less active for a short period. In 20% of the children, the child suddenly becomes unconscious and apnoeic following an unexpected painful stimulus.
The sequence of events helps to distinguish it from epilepsy. Epileptic seizure does not follow anger or fright. In epilepsy the child becomes blue in the late stages only, not in the beginning.
Antiepileptic therapy (treatment for convulsions) is not warranted. Measure should be taken to avoid precipitating factors. A kind and understanding attitude towards the infant or child is helpful. Over anxiety on part of parents may lead to an over protective attitude leading to spoiling of the child. Hence unreasonable demands of a child need not be entertained. These attacks can be aborted by strong physical stimulus like a pinch applied at the onset of the spell.