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correspondence

Indian Pediatr 2010;47: 196

Recurrent Breath-Holding Spells With Infantile Colic


Jagruti P Sanghvi
,

501, Gresil Apartments, Irla Lane, Vile Parle (W), Mumbai 400 056, India.
Email: [email protected]
 


Breath holding spells are stereotypical episodes of brief, involuntary cessations of breathing with cyanosis and hypoxia that may occur in children in response to stimuli such as anger, frustration, fear, or injury. Typically, they occur between 9 months to 3 years with a peak incidence at about 2 years(1). As the child matures and his understanding develops, these episodes decrease in frequency and ultimately disappear. We report the rare incidence of recurrent breath-holding spells in a one-month old child with severe infantile colic.

A one- month-old first-born boy of a non-consanguineous marriage presented with an episode of sudden high-pitched crying followed by apnea and central cyanosis. There were no perinatal complications. He was fed with expressed breast milk and formula. The infant was being treated for with infantile colic with carmicides, dimethicone, dicyclomine and occasionally sedatives. There was no history suggestive of convulsions, recurrent vomiting or regurgitation suggestive of gastro-esophageal reflux. Physical examination was within normal limits. The history was typical of a cyanotic breath-holding spell. However, in view of atypical age group, a 2D-echocardiography was done to rule out any cardiac cause, which was normal. Domperidone was started to combat any gastro-esophageal reflux. The parents were counseled. However, the child had 2 more similar episodes in the next 2 days. Hemoglobin, CBC, serum electrolytes, BUN, creatinine, ammonia, and ABG were normal. EEG and MRI Brain were normal. Thus, after ruling out other possibilities, a diagnosis of recurrent breath-holding spells was made. Parents were counselled. Iron was not given. On regular follow-up till six months of age, there are no further episodes in the child.

It is hypothesized that breath-holding spell occurs due to autonomic nervous system dysregulation(2, 3). This child suffered from severe infantile colic, which caused recurrent crying that was difficult to console. It is possible that autonomic dysregulation could be a common factor for infantile colic and breath-holding spells. There is no report of an association between recurrent breath holding spell with infantile colic. Though, breath holding spells per se are described in newborns(4,5).
 

 

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