pediatrics
Breath Holding Spells
Pallid breath holding spell
During a pallid breath-holding spell, vagal stimulation severely slows the heart rate. The child stops breathing, rapidly loses consciousness, and becomes pale and limp. If the spell lasts more than a few seconds, muscle tone increases, and a seizure and incontinence may occur. After the spell, the heart speeds up again, breathing restarts, and consciousness returns without any treatment. Because this form is rare, further diagnostic evaluation and treatment may be needed if the spells occur often. Simultaneous ECG and electroencephalography can help differentiate cardiac and neurologic causes. 