Breath-holding spells (BHS) are the occurrence of episodic apnea in children, possibly associated with syncope (loss of consciousness and changes in postural tone). Breath-holding spells occur in approximately 5% of the population with equal distribution between males and females. They are most common in children between 6 and 18 months and usually not present after 5 years of age. They are unusual before 6 months of age. A positive family history can be elicited in 25% of cases. They may be confused with a seizure disorder. They are sometimes observed in response to frustration during or following disciplinary conflict.

Diagnosis

The diagnosis of a breath-holding spell is made clinically. A good history including the sequence of events, lack of incontinence and no postictal phase, help to make an accurate diagnosis. Some families are advised to make a video recording of the events to aid diagnosis. An electrocardiogram (ECG) may rule out cardiac arrhythmia as a cause. There is some evidence that children with anemia (especially iron deficiency) may be more prone to breath-holding spells.

Classification

There are four types of breath-holding spells.

Treatment

The most important approach is to reassure the family, because witnessing a breath-holding spell is a frightening experience for observers. There is no definitive treatment available or needed for breath-holding spells, as the child will eventually outgrow them. Some trials have demonstrated the efficacy of iron therapy, especially because although BHS can readily occur without anemia, BHS has been found to be aggravated by the presence of anemia. Other studies have supported the use of piracetam; a 1998 study indicating that over two months piracetam reduced BHS incidence by sixty percent, twice as much as a placebo. All of these studies agree with the established medical view that a pharmacological agent is not necessary, although it may be desirable for the comfort of the parent and child. Two articles on breath-holding spells strongly suggest that parents consider having their child be tested by electrocardiogram for the rare, but real possibility that the BHS episodes are actually a symptom of prolonged QT-syndrome, a serious but treatable form of cardiac arrhythmia.