Affective respiratory seizures in children

It is difficult to maintain parental composure when the crying child begins to fall to the floor and convulse, forgetting to breathe. This phenomenon is called an affective-respiratory attack, and the task of parents is to know how to respond correctly in such situations and what to do.

What it is?

In medicine, affective-respiratory seizures (ARP) have several names: they are called breath-holding attacks, as well as affective-respiratory syndrome. In fact, these are periodic apnea, which can be accompanied by loss of consciousness and convulsive manifestations.

The title consists of two parts, each of which has a great sense of what is happening. "Affective" is an uncontrollable emotion, and "respiratory" is a respiratory one. Against the background of strong emotion, breathing is disturbed, the child "forgets" how to breathe in and out during strong crying, resentment, pain, fear.

According to the World Health Organization, such attacks from time to time occur in at least 5% of the world's population, both in adults and in children, but ARPs occur much more often in childhood.

At the same time, studies have shown that to a greater extent, children aged from six months to one and a half years are susceptible to such attacks, and after the child reaches the age of five, such attacks practically do not happen. In infants up to six months and newborns, such attacks are possible, but this is considered a rare occurrence.

Both boys and girls are susceptible to ARP with the same frequency, but doctors noticed that in young boys, affective-respiratory seizures usually stop earlier than in girls: at 3 years old for boys and at 4-5 years old for girls.

Causes of occurrence

All children are more emotional than adults. It is a fact. Naturally, the strength of emotions in babies is always more pronounced, and anger, and disappointment, and resentment, and strong fear are manifested more strongly. However, not all babies suffer for this reason from affective-respiratory seizures with convulsions and breath holding. Doctors and scientists have long tried to find the reasons that provoke an attack in the course of experiencing a strong emotion, and came to the conclusion that something from this list may act as a trigger.

Features of the nervous system - unbalanced, very impressionable, sensitive, emotionally unstable children more easily fall into a state of passion.
Heredity - a quarter of young patients with ARP have relatives who have suffered or are suffering from the same attacks. In this case, children inherit, most likely, not the very propensity to breath-holding attacks, but nevertheless the type of higher nervous activity and features of the nervous system indicated in the previous paragraph.
Educational mistakes - seizures are initially formed as a child's reaction to the wrong attitude of parents to his behavior and emotions, gradually paroxysms become the norm of behavior for a particular baby. Usually ARP is noted in children who are allowed too much, who are erected by their parents on the family "throne" as the most important family member.
Endogenous and exogenous factors - here scientists include physical pain, fatigue, accumulated emotional stress, tension, hunger.

In most cases, it is not possible to establish the exact cause of the affective-respiratory seizures in a child, since it can be of a mixed nature (with the simultaneous influence of several possible causes).

Varieties of paroxysms

For ease of classification, all affective-respiratory attacks are usually divided into two types - "blue attacks" and "pale attacks" (according to the type of skin color at the time of paroxysm). But in medicine, there is a more detailed classification that describes as many as four types of ARP.

Plain - the attack is accompanied by a holding of breath at the very end of the exhalation. Blood circulation does not change, breathing is restored on its own.
Blue - usually associated with emotions such as anger, anger, pain. During crying or hysterics, the child makes a quick and strong exhalation, the muscles weaken, loss of consciousness may occur, cyanosis occurs - blue skin. After regaining consciousness, the child wants to sleep and can sleep for a couple of hours. The electroencephalogram is not changed, everything is normal.
Pale - paroxysm is accompanied by loss of consciousness and turns pale, but the crying episode itself has almost no place or the crying of the baby is insignificant. The electroencephalogram is also within the normal range, pathological changes are not recorded.
Complicated - proceeds either according to the "pale" or "blue" scenario, but in a severe form, reminiscent of an epileptic seizure. The electroencephalogram is abnormal at the time of the attack, but outside the paroxysm it remains mostly normal.

What's happening?

Since young children still do not know how to evaluate and perceive their own emotions, do not know how to cope with them, control their manifestations, very vivid affective reactions develop. Strong emotion causes the muscles in the larynx to contract.

What happens next resembles laryngospasm - the baby is additionally frightened by a new sensation of the impossibility to take the usual breath due to narrowing of the glottis, a new fright contributes to an even tighter closure.

At the same time, seizures can develop, they are involuntary and are also associated with muscle emotional tension. The attack lasts no more than a minute, most often from 15 to 25 seconds, then the muscles begin to relax, the child begins to breathe normally.

Symptoms and Signs

Each affective-respiratory paroxysm is necessarily preceded by a certain strong emotion. Just like that, being in a familiar and calm state, the child does not fall into an attack. Each seizure develops in strict accordance with the order of changing stages, one seizure is exactly similar to the previous one.

Trying to cope with the emotion, the baby begins to breathe unevenly, cry, and then suddenly becomes silent, freezes and remains in this state for some time, the mouth is usually open. Parents can hear wheezing, clicks. The kid cannot control the holding of breath and interrupt it of his own free will. Apnea does not obey the child's will.

With a simple attack, breathing is restored in about 15 seconds. The kid looks normal, he has no other manifestations. In other forms of ARP, the baby may fall, lose consciousness, his skin and mucous membranes become pale or bluish. During an attack, the pulse is almost invisible or very weak.

Parents should be aware that seizures based on resentment, anger, frustration are more typical for babies aged 1.5 to 2 years. In such children, seizures usually proceed according to the "blue" or "pale" type, accompanied by either excessive tension of the body muscles, or its excessive relaxation.

The body can bend in an arc (Dr. Komarovsky calls this a "hysterical bridge") if the muscles are very tense, or limp limply, like a rag doll, if they are relaxed. Convulsions, if any, most often manifest as involuntary twitching, such as limbs.

Recovery always begins with the normalization of breathing. Then the skin and mucous membranes acquire a normal color, the muscles come in order. Recovery from a normal attack is quick, the child may immediately ask for food or start playing. The longer the attack lasts, the longer it takes to fully recover.... With a complicated attack at the exit, the child continues to cry quietly for some time, whine, and with this he usually falls asleep for a couple of hours.

Is it dangerous?

In medicine, affective-respiratory paroxysms are not considered dangerous. Usually children "outgrow" them and with age, ARPs go away without treatment. There is also evidence that such seizures can indirectly affect the risk of developing epilepsy in a child, but scientists have not yet been able to establish a direct connection. The only statistic that speaks in favor of this statement is that in epileptic children, ARP attacks in the past were 5 times more frequent than in other children. This statistic by no means suggests the opposite, that children with ARP begin to suffer from epilepsy.

Of course, at the moment of paroxysm, the child's brain experiences oxygen starvation for 10-60 seconds due to lack of breathing. This can negatively affect the state of the central nervous system, in particular, the child may have problems with attention, memory, thought processes, learning, but such consequences become likely only if attacks of holding the breath (ARP) occur with an enviable frequency.

What to do?

First of all, parents should show the child to a doctor. This is important in order to distinguish ordinary affective-respiratory seizures from the same epilepsy, because the manifestations can be very similar. It is easy to guess which specialists to turn to - a neurologist and a child psychiatrist.

Parents will have to tell these specialists in detail how the seizures proceed, how often they recur, what reasons, in the opinion of mom or dad, are caused. The neurologist examines the child for the safety of reflexes, sensitivity, coordination of movements.

In order not to confuse ARP with epilepsy, electroencephalography is recommended. Usually, with the affective-respiratory syndrome, increased electrical activity of the brain is not detected. The child is given an EKG.

First of all, it is recommended to consult a child psychologist or psychotherapist, and not only for the baby, but also for his entire family. Individual psychocorrectional work will help make relationships in the family more harmonious, and also teach the child to express his strong emotions in words.

The child may be prescribed drugs - nootropics, herbal sedatives, and essential amino acids such as glycine, vitamins. If the attacks are complicated and proceed with severe convulsions, the doctor may recommend tranquilizers, but not for systematic use, but solely with the aim of stopping the paroxysm.

Changing your child's lifestyle can help prevent recurrences. You should adhere to such a regime, in which the baby will not be very tired, his day should be filled with physical activity, nutrition should be complete.

But playing on computers, as well as watching TV, are not recommended, they should be limited as much as possible 1-2 hours a day.

The well-known pediatrician Dr. Komarovsky claims that parents may well be able to prevent attacks by noticing their initial symptoms in time. Until the spasm begins, parents can distract the child, switch his attention to something else.

Forbidding a child to experience strong emotions is useless, - doctors think and confirm mothers' reviews. Therefore, demanding that the child stop yelling, roaring, fearing or getting angry is a pointless business. But it is quite possible to draw the child's attention to something around or ask him to bring something in time.