Breath Holding

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Breath-Holding Spells

Your baby is crying. Between sobs, he or she appears to be holding his or her breath for what seems like an eternity. You’re not sure what might be causing this, or what exactly you should do. You only know that it scares you, and you’re concerned about your child.

Your child may be suffering from Breath-Holding Spells (BHS), also known as Expiratory Apnea. BHS can affect healthy, otherwise normal infants and young children, and often occurs when they cry. We want you, as a parent, to know what this phenomenon is, how frequently it occurs, and its causes, assessment, treatment, and prognosis.

Breath-Holding Spells have a dramatic presentation, and they are often terrifying for parents to observe. Although the label “BHS” suggests a voluntary action, such spells are actually involuntarily and reflexive. BHS occur while the child is awake and engaging in active breathing. The duration of the spells is typically from 2 to 20 seconds, but can last as long as a minute or more.

There are two categories of BHS: simple and severe. Simple BHS are ones that develop from pain, suffering, or misery; they typically are indicated by crying, the appearance of breath- holding, and a change in skin color. Severe spells progress further and can result in a child losing consciousness and/or having a seizure.

A change in skin color during a spell is described as either cyanotic BHS or pallid BHS. Cyanotic BHS, the most common type, is characterized by rapidly occurring bluish or purplish discoloration of the skin. Pallid BHS is characterized by paleness or deficiency in skin color. Although crying occurs in both types, it is more common in cyanotic BHS than pallid BHS.

A typical BHS episode involves an event in the environment that distresses the child. This is followed by the child crying, which diminishes to quietness accompanied by a change in skin color (cyanotic or pallid), and ends with the child disoriented and either conscious (simple) or unconscious (severe).

What We Know About BHS
Here are some research findings about age of onset, frequency, and numbers of children affected (approximations):

  • Age of onset is generally between 3 and 18 months of age, although as many as 10% of cases begin before 3 months and a similar percentage begin after 18 months.
  • Frequency ranges from several times a day to as low as once a year, with the majority of children exhibiting several episodes per week.
  • Peak frequency is in a child’s second year; spells gradually but continuously diminish after that.
  • The average age at which BHS end is 3 years; BHS are rare after age 8.
  • 4.6% of young children suffer from severe BHS (loss of consciousness and/or seizures).
  • 27% of young children suffer from simple BHS (distress and silent respiration, to a change in skin color).
  • 54% to 62% of afflicted children exhibit cyanotic BHS (bluish or purplish discoloration of skin).
  • 19% to 22% of afflicted children exhibit pallid BHS (paleness or deficiency in skin color).
  • 12% of afflicted children exhibit both cyanotic and pallid types.
  • 12% of afflicted children exhibit an indeterminate type.

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