Age affected: most often when 2 years old, but may occur from the neonatal period to 3 years of age
Risk factors:
(1) family history of breath-holding spells
(2) autonomic system dysfunction
(3) iron-deficiency anemia
Features of a breath-holding spell:
(1) The child is typically healthy and asymptomatic between episodes.
(2) The episode may be triggered by pain, frustration, crying or illness.
(3) The child is usually cyanotic but may be pale.
(4) Transient cerebral anoxia can result in a loss of consciousness and sometimes a reflex seizure.
(5) The child may suddenly collapse and fall to the floor.
(6) The patient may show opisthotonic posturing.
(7) After the episode the child is normal.
Differential diagnosis:
(1) syncope from other cause (vasovagal, other)
(2) epilepsy
(3) brainstem or other neurologic malformations
(4) prolonged QT syndrome
