Breath holding spells are common events in infants and young children age 6 months to 6 years. The attacks are precipitated by minor injury, frustration, or anger. The events are heralded by crying followed by apnea that typically occurs in expiration. The child then develops significant cyanosis. If the attacks are prolonged, the child loses consciousness and becomes limp. If significant hypoxia occurs, the child may develop tonic posturing or even a few extremity jerks that may be mistaken for seizure activity. The key to the diagnosis is the preceding crying and cyanosis prior to each event. Difficulty in correct diagnosis occurs if the onset of the attacks is not witnessed. Cyanotic syncope is presumed to be a benign involuntary development response to the injury and crying that the child will ultimately outgrow (22,23).
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