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).