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After being startled or becoming upset, the child may make a short gasp and then exhale and stop breathing. Then the child quickly becomes blue (cyanotic) and may have many jerky movements that look like a small seizure.
The event ends with a brief period of unconsciousness, at which time normal breathing restarts. The child's color improves with the first breath and the event ends. The child may repeat this behavior several times per day, or do it only on rare occasions.
Breath holding can be a frightening experience for parents, who may think it is a seizure or even cardiac arrest. After a doctor has diagnosed the child with breath holding spells, the parent can simply wait for the event's natural end.
The doctor will take a history and do a thorough physical exam to rule out a physical cause of the breath holding. Because of a known association with iron deficiency, a blood test may be done.
Sometimes patients will have a cardiac test (such as an EKG) to be sure the heart is not involved in the spells. Sometimes an EEG may be done, especially if it is difficult to tell the seizure-like movements of the breath holding spell from an actual seizure.
Dalton R, Boris NW. Disruptive behavioral disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 28.
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