Breath- holding Spell (BHS)

Autonomic immaturity – mainly manifested in children between 6 -18 months- causing vagal – cardiac reflex- leading to lowering of heart rate( might be asystole ) and expiratory apnoea.

breath holding spells video

Types

Two types-
Pallid– cry –> initial pallor –>then bradycardia and apnoea
Cyanotic (Blue BHS) – caused by prolonged expiratory apnoea. May manifest as seizure- like posturing due to anoxia, syncopal attack and also incontinence( both faecal and urinary)
Triggered by anger, injury and any type of surprise.
It very close to cyanotic spell ( In congenital cyanotic heart disease ) ignoring this condition may be fatal.

Essentially self-limiting, the child outgrows this condition.

Treatment is multimodal- includes parental counselling (might also include teaching basic cardio-pulmonary resuscitation), Iron therapy (oral) – and rarely anti-cholinergic drugs in severe cases.

Written by

Dr. Subhodeep Sarkar ( MBBS , DCH )