Hi, this is Tom, and in this episode I'm going to be going through breath holding spells.

And you can find notes at zero to finals.com slash breath holding spells and in the zero to finals

pediatrics book. And if you're preparing for medical school exams, particularly medical school finals,

check out the zero to finals finals revision book, which is fully illustrated in colour,

and you can find it at zero to finals shop.com. So let's jump straight in.

Breathholding spells, also known as breath holding attacks, are involuntary episodes

during which a child holds their breath and loses consciousness, usually triggered by something

upsetting or scaring them. They most commonly occur between six months and two years of age, but they can occur up to

four to five years. They're not harmful in the long term and they do not lead to epilepsy.

Let's talk about cyanotic breath holding spells. Cyanotic breath holding spells occur when the child is really upset, they're worked up and they're crying.

After letting out a long cry, they stop breathing, become cyanotic and lose consciousness.

They regain consciousness and breathing restarts within a minute.

They may be tired and lethargic after an episode.

Next let's talk about reflex anoxic seizures.

Reflex anoxic seizures, which are also known as pallid breath-holding spells,

occur when the child is startled.

The vagus nerve sends strong signals to the heart, which causes temporary bradicardia or acystole,

with the heart stopping. The child will suddenly go pale, lose consciousness, and there may be seizure-like muscle twitching.

Within seconds, the heart restarts and the child regains consciousness.

Episodes can last up to 30 seconds or rarely longer.

An episode may be isolated or occur in clusters

with several episodes over days or weeks.

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