{ "schema_version": 1, "kind": "condition", "id": "breath-holding-spells", "name": "Breath-holding spells", "category": "chronic", "sources": "Breath-Holding Spells - StatPearls (NCBI Bookshelf NBK539782) - https://www.ncbi.nlm.nih.gov/books/NBK539782/ · Breath-holding spells - disease-level clinical article (breath-holding-spells-full.txt) · Breath-holding spells - disease-level clinical article (breath-holding-spells-clinical.txt)", "review_status": "reviewed", "verified_against": "Breath-Holding Spells - StatPearls (NCBI Bookshelf NBK539782) - https://www.ncbi.nlm.nih.gov/books/NBK539782/ · Breath-holding spells - disease-level clinical article (breath-holding-spells-full.txt) · Breath-holding spells - disease-level clinical article (breath-holding-spells-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 319, "generic": "Confirm the story, exclude seizure and long QT (Recognition & Referral)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Breath-Holding Spells - StatPearls (NCBI Bookshelf NBK539782) - https://www.ncbi.nlm.nih.gov/books/NBK539782/", "rationale": "The point here is to stop a dangerous mislabel. A breath-holding spell is diagnosed on a history with a clear trigger and a clean recovery; the two things it is mistaken for - an epileptic seizure and a cardiac arrhythmia such as long QT - are both potentially fatal and neither is excluded by the child looking well in the clinic. The article's own instruction is to rule them out, and an ECG is the cheap half of that.", "cautions": [ "WHAT A TRUE SPELL IS - a frequent and harmless event, seen in as many as 5% of children, and it comes in two forms. In the cyanotic kind, anger or frustration sets it off: the child holds their breath and the face goes blue or purple. In the pallid kind, a sudden fright comes first and the breathing then stops.", "THE HISTORY IS THE DIAGNOSIS, AND IT HAS TO BE CLEAN - the story must name an unmistakable emotional trigger, and then a spell of one type or the other, cyanotic or pallid. Decisively: there must be NO aura beforehand, and the child must NOT have any postictal features once they come round. No trigger, or a drowsy confused child afterwards, means this is not a breath-holding spell.", "IT CAN LOOK LIKE A FIT AND STILL BE A SPELL - a spell can knock a child out cold and can tip over into a convulsion. A jerk at the end of a spell does not by itself make it epilepsy. Telling a seizure disorder apart from these spells is genuinely difficult, so an electroencephalogram (EEG) is sometimes done - but absent a red flag, an EEG is generally NOT advised.", "DO THE ECG - THIS IS THE LINE THAT KILLS IF IT IS SKIPPED - an ECG is a cornerstone of the work-up, there to exclude a cardiac cause that would matter. The article names long QT syndrome among the conditions to rule out, and asks that the other causes of a faint or a fit be excluded too - epilepsy and the arrhythmias. A pallid spell, an episode with no crying, one during exercise or swimming, or a family history of sudden death or deafness makes the ECG urgent.", "THE CHILD MUST BE NORMAL BETWEEN EPISODES - the children who get these spells have a neurological examination that is normal and are hitting their milestones for their age; the rest of the examination should turn up nothing worrying either. Developmental regression or an abnormal neurological examination is a different diagnosis.", "ANYTHING THAT DOES NOT FIT GETS REFERRED, NOT WATCHED - where any piece of the assessment sits at odds with that story, it earns a work-up without delay and a referral onward: paediatric cardiology, paediatric neurology or genetics, as the case demands.", "CHECK THE IRON - send iron studies, because iron deficiency runs high in this group of children. This is the one test that also changes treatment, and iron deficiency is common in Egyptian toddlers.", "THE DIFFERENTIAL WORTH HOLDING IN MIND - the article lists arrhythmia, epilepsy, sepsis and nonaccidental trauma among the conditions to consider, and adds stridor of the larynx present from birth, and a congenital heart lesion that depends on a patent ductus. An episode described by a carer but never by the parent, or bruising that does not fit, deserves the same suspicion as any other unexplained collapse.", "WHAT TO TELL THE PARENTS, AND WHAT NOT TO DO - nothing lasting comes of these spells, so tell the parents to make as little of an episode as they can, or the child learns a behaviour out of it. Reassurance, plus that behavioural handling, is the standard treatment. Put NOTHING in the child's mouth, and do NOT shake, slap or splash the child.", "THE PROGNOSIS THEY CAME FOR - the spells do no damage and they do NOT injure the brain. Where neurological development is normal already, it stays normal. In most children the episodes have stopped by the age of 6.", "WHY NO ANTI-EPILEPTIC IS PRESCRIBED HERE - the article reports randomised trials in which piracetam at 40 mg/kg/d cut the spells markedly against placebo, and suggests levetiracetam may do better still. It then qualifies the whole class at once: because the condition settles by itself, the good and the harm of any treatment have to be balanced with care. That is a specialist decision and no such row is offered here." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "breath-holding-spells" }, { "id": 320, "generic": "Iron", "line": 2, "is_adjunct": true, "form": "oral.liquid", "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Breath-Holding Spells - StatPearls (NCBI Bookshelf NBK539782) - https://www.ncbi.nlm.nih.gov/books/NBK539782/", "rationale": "The only medicine the article supports in primary care. Its claim: iron supplements can make the spells come less often. Its amount: 3 to 6 mg/kg/d to begin with. It is offered second, below the assessment row, because giving iron never substitutes for the ECG.", "cautions": [ "IT IS GIVEN EVEN WHEN THE CHILD IS NOT ANAEMIC - iron may be started whether or not the child turns out to be iron-deficient, since it can bring the spells down in number. Still send the iron studies, because a genuinely iron-deficient toddler in Cairo needs a cause looked for as well as a syrup.", "IRON IS NOT A SUBSTITUTE FOR THE CARDIAC AND NEUROLOGICAL CHECK - the article's instruction to obtain an ECG and to refer anything that does not fit the history stands whether or not iron is started. A child whose spells continue on iron has not been treated; they have been observed.", "EXPECT THE USUAL IRON PROBLEMS AND WARN THE FAMILY - dark stools, constipation, nausea and staining of the teeth with liquid preparations. Give it away from milk, and keep the bottle out of reach: iron overdose is one of the commonest serious accidental poisonings in small children.", "NO RESPONSE IS A REASON TO GO BACK TO THE DIAGNOSIS - the article frames this as a self-limiting condition in which the good and the harm of treating have to be balanced with care, so a course of iron that changes nothing should prompt a second look at whether these are breath-holding spells at all." ], "peds_mgkg_low": 3.0, "peds_mgkg_high": 6.0, "peds_max_mg": null, "peds_basis": "day", "peds_unit": "mg", "peds_note": "The article gives 3 to 6 mg/kg/d to start and stops there - it does not say whether that means elemental iron or a weight of ferrous salt, and it sets no maximum, no duration and no adult dose. Prescribe it as elemental iron, which is the usual reading, and check the elemental content of the Egyptian syrup in hand before converting. There is no adult indication here, so no adult dose is printed.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 30, "high_mg": 60, "capped": false }, { "weight_kg": 20, "low_mg": 60, "high_mg": 120, "capped": false }, { "weight_kg": 30, "low_mg": 90, "high_mg": 180, "capped": false }, { "weight_kg": 40, "low_mg": 120, "high_mg": 240, "capped": false } ], "brands": [ { "trade_name": "FERRITOP 15MG/5ML SYRUP 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HIKMA PHARMA", "price_egp": 10.0, "pack_count": null, "unit_price": null, "strength_mg": 15.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANSCHLARIN SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AVERROES PHARMA-EGYPT", "price_egp": 10.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FEROSE 50MG/5ML 100ML SYRUP", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SPIMACO > EIMC", "price_egp": 16.2, "pack_count": null, "unit_price": null, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GOLDEN FER 10 MG/ML SYRUP 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES", "price_egp": 34.0, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FABUGLYCINA SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PRAXO PHARM", "price_egp": 45.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FERRMARRON SYRUP 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > ABBOTT LABORATORIES", "price_egp": 60.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FERROSWAB 100MG/10ML 20 UNIDOSE ORAL SOLN.* 10 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNISWAB", "price_egp": 137.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BALANCERON DROPS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ORGANIX > BALANCE PHARMA", "price_egp": 160.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HAEMOPOWER 50MG/5ML ORAL SYRUP 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 16.25, "pack_count": null, "unit_price": null, "strength_mg": 50.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "HAEMOPOWER 50MG/ML ORAL DROPS 30 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 20.0, "pack_count": null, "unit_price": null, "strength_mg": 50.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "breath-holding-spells" } ] }