Breath-holding spells in infants.

QUESTION: I have children in my clinic who experience seizurelike episodes in which they cry and hold their breath to the point of cyanosis and loss of consciousness. Their examination or investigation findings are normal and referral to a pediatric specialist results in no further investigation. Are breath-holding spells common, and what type of investigation is needed?

ANSWER: A breath-holding spell is a benign paroxysmal nonepileptic disorder occurring in healthy children 6 to 48 months of age. The episodes start with a provocation such as emotional upset or minor injury, and might progress to breath holding, cyanosis, and syncope. The episodes are extremely frightening to watch but have benign consequences. Once a clinical diagnosis is made, it is recommended to conduct an electrocardiogram and to rule out anemia, but no further investigation or referral is warranted.