EPISODES OFTEN MISTAKEN FOR SEIZURES: “PALLID BREATHHOLDING SPELLS”
Sometimes these breathholding spells can be aborted or prevented by diverting the child’s attention. Also, since the crying and frustration that cause these spells are reinforced by parental overprotection in fear that a spell will reoccur, behavioral modification should be taught to the family by the physician or by a behavioral psychologist. Parents should learn to ignore the crying and reward the child’s good behavior, and not reward the tantrum and breathholding with attention and concern. The spells will probably then decrease in frequency and the child will outgrow them without long-term consequences as the central nervous system matures.
There is a second form of these spells that is misnamed “pallid breathholding spells,” usually occurring after trauma such as a bump on the head. The child suddenly stops what he has been doing, turns pale, and may fall down. Occasionally the child will then arch his back and rarely experience jerking movements. Such spells are not preceded by crying, breathholding, or turning blue. They are caused by “vasovagal syncope,” that is, fainting because of overactivity of the normal reflex that slows the heart rate. If the heart beat slows sufficiently, not enough blood is pumped to the brain and the child loses consciousness and stiffens. These “pallid breathholding spells” are the infancy and childhood counterpart of fainting when blood is drawn. The slowing of the heart rate can often be reproduced in the physician’s office by pressing on the child’s closed eye. If a child has an overactive vagal nerve reflex, the physician will hear a dramatic slowing of the heart rate, at times even a brief pause between heart beats. If an EKG (electrocardiogram) is running at the time, the increasingly longer interval between heart beats can be documented.
Although they are frightening, pallid spells are usually benign and will be outgrown. Only rarely, when the spells are quite frequent, is it necessary to consider treatment, but not with anticonvulsants since these spells are not seizures. The appropriate medications are those that block the action of the vagus nerve and prevent the slowing of the heart.
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