Breath Holding Attacks

Breath-holding spells

Breath-holding spells are the occurrence of episodic apnea in children, possibly associated with 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 disciplinary conflict.

Classification

There are four types of breath-holding spells.

1.    The most common is termed simple breath-holding spell, in which the manifestation is the holding of breath in and expiration. The usual precipitating event is a frustration or injury leading to the temporary cessation of breathing in and expiration. There is no major alteration of circulation or oxygenation and the recovery is spontaneous.

2.    The second type are the Cyanotic breath-holding spells. They are usually precipitated by anger or frustration although they may occur after a painful experience. The child cries and has forced expiration sometimes leading to cyanosis (blue in color), loss of muscle tone, and loss of consciousness. The majority of children will regain consciousness. The child usually recovers within a minute or two, but some fall asleep for an hour or so. Physiologically, there is often hypocapnea (low levels of carbon dioxide) and usually hypoxia (low levels of oxygen). The events are thought to occur due to a variety of factors, including the fact that the child is not breathing, there is increased intrathoracic pressure secondary to the Valsalva maneuver, and decreased cardiac output. This eventually leads to a significant decrease of circulation to the brain and ultimately, loss of consciousness. There is no postictal phase (as is seen withseizures), no incontinence, and the child is fine in between spells. EEGs are normal in these children. There is no relationship to the subsequent development of seizures or cerebral injury as a consequence of breath holding spells.

3.    In the third type, known as Pallid breath-holding spells, the most common stimulus is a painful event. The child turns pale (as opposed to blue) and loses consciousness with little if any crying. The EEG is also normal, and again there is no post ictal phase, nor incontinence. The child is usually alert within a minute or so. There may be some relationship with adulthoodsyncope in children with this type of spell.

4.    A fourth type, known as Complicated breath-holding spells, may simply be a more severe form of the two most common types. This type generally begins as either a cyanotic or pallid spell that then is associated with seizure like activity. An EEG taken while the child is not having a spell is still generally normal.

The diagnosis of a breath-holding spell is made clinically. A good history including the sequence of events, lack of incontinence and no post ictal 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.

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 exaggerated 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.

****Info dari Wikipedia****

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Apa motif saya buat post ni? Sebab anak saya ada ni... Huhu... So saya nak share kalau-kalau ada parents yang ada anak yang mengalami ni jugak...

First time kena, 6 Julai 2013... Tengok, saya siap tulis tarikh tu... Sebab haritu, saya ingat saya dah kehilangan dah anak saya ni... Masa tu, umur anak saya 5 bulan 15 hari... Masa tu kami balik kampung rumah mak mertua di Kelantan... Kami tengah beramai-ramai packing kurma, sebab mak mertua nak agih-agihkan pada kawan-kawan masjid dia... Fateh kami letak kat atas toto sebelah kami bekerja tu...

Time tu die tengah lasak pusing-pusing, merangkak belum pandai lagi... So tengah dia pusing-pusing tu, die terpusing belah sana, membelakangi kami.. So dia tak nampak la kami kat belakang die ni... So dia ingat kami semua dah tinggalkan die, dia tinggal sorang-sorang... Dia pun nangis la minta diambil...

Suami saya pun angkat la dia dari belakang.... Dia punya terkejut, terus jadi kejang... Sampai biru, tak bernafas... Semua orang panik... Saya terfikir, macam ni ke kes bayi yang mati tanpa sebab tu.... Kan kita selalu dengar baby mati tiba-tiba tak tau sebab apa... Suami saya pun buat CPR... Family yang lain semua pun panik... Ada yang mengaji, ada yang selawat... Mak mertua tengah solat pun smpi berhenti solat.... Saya? Tergamam xtau nak buat apa... Huhu...

Tapi, after a few minutes (saya rasa macam berjam-jam!!), dia OK dengan sendiri... Lepas tu terus tinggal kurma, terus peluk die, n susukan die, sampai tertdo...

Balik KL, terus buat appointment dengan doc jantung... Doc cek, doc buat EEG, semua normal... Doc ckp la, maybe it's just Breath Holding Attacks... Tapi this thing keeps happening... Cuba you all bayangkan, as parents, anak kita macam 'mati' kejap tau... Sape tak panik.... Saya pun buat research, tu yg jumpe artikel ni... Semua orang, semua sumber kata tak bahaya... Ada yang siap cakap, jangan treat them differently... Tapi saya tetap panik setiap kali terjadi.... Tetap melompat setiap kali dia jadi macam tu... Huhu

Kebiasaanya, dia akan jadi macam ni bila 
#Kalau saya lalu, die hulur tangan, saya tak ambil die
#Tiba-tiba terhantuk kepala kat dinding, lantai
#Dia tak dapat apa yang dia nak (mainan, orang-selalunya mama die la)

Now, setelah berkali-kali mengalaminya, kami semakin tenang menghadapinya. Tetapi, setiap kali terjadi, memang ada rasa takut kali ini adalah yang terakhir... 

Senang nak kata, anak saya ni tak pandai nangis tau... Die tarik nafas dalam2, tapi tak tau macam mana nak lepaskan... So dia tersekat di situ, sampai la biru muka dia, kejang kaki tangan... Tapi after a few seconds, dia OK dengan sendiri... Yang saya risaunya, oksigen tak masuk cukup lama dan jadi efek-efek yang tidak diingini... Tapi so far review semua kata tak bahaya.... Semua dok kata observe je... Tapi tula, masalahnya dengan kita yang takde medical background ni, sampai bila nak observe? Apa yang perlu diperhatikan? Apa yang boleh saya buat sekarang ialah berdoa dan sentiasa pastikan ada orang bersama-sama Fateh pada setiap masa...

Tolong doakan sama ye anak saya umur panjang :)