Efficacy of treatment with belladonna in children with severe pallid breath-holding spells

Corcia, M Cecilia Gonzalez; Bottosso, Adrien; Loeckx, Isabelle; Mascart, Françoise; Dembour, Guy; François, Geneviève

doi:10.1017/s1047951118000458

Cited by 4 publications

(6 citation statements)

References 21 publications

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“…Vagally-mediated cardiac inhibition plays an important role in the pathogenesis of pallid breath-holding spells [1]. The underlying mechanism is parasympathetic hyperactivity [24]. Ocular compression in this group shows a hypersensitive cardiac inhibitory reflex that is not present in an age-matched control group [8].…”

Section: Etiopathogenesismentioning

confidence: 99%

“…Pallor and loss of consciousness may occur as a result [8]. In this regard, pallid spells can be prevented by atropine [24]. Rarely, cardiac arrhythmias may also be responsible for some episodes of pallid breath-holding spells.…”

Section: Etiopathogenesismentioning

confidence: 99%

“…In children with pallid breath-holding spells, the use of atropine may be considered to block the vagal reflex if the attacks are frequent and severe and when there is evidence that the attack is secondary to cardiac asystole as indicated by a positive ocular compression test [1]. In a retrospective multicenter study of 84 children with severe pallid breath-holding spells, 45 children received atropine (0.01 mg/kg) in the form of 2% syrup of tincture of belladonna given twice a day and 39 children did not receive belladonna treatment [24]. The two groups of children had similar demographics with the single difference that children in the treatment group presented with more severe spells.…”

Section: Treatmentmentioning

confidence: 99%

“…The two groups of children had similar demographics with the single difference that children in the treatment group presented with more severe spells. Three months after treatment, two (5%) patients in the non-treatment group and 20 (44%) patients in the treatment group had complete remission of the spells (p <0.01) [24]. No major adverse events were encountered.…”

Section: Treatmentmentioning

confidence: 99%

“…The authors concluded that belladonna is highly effective to alleviate severe pallid breath-holding spells. The recommended dose of atropine sulfate is 0.01 mg/kg/day (maximum 0.4 mg) in two divided doses given orally or subcutaneously [1, 24].…”

Section: Treatmentmentioning

confidence: 99%

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Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence

Leung

Wong

et al. 2019

CPR

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Background: Breath-holding spells are common, frightening, but fortunately benign events. Familiarity with this condition is important so that an accurate diagnosis can be made.Objective: To familiarize physicians with the clinical manifestations, diagnosis, evaluation, and management of children with breath-holding spells.Methods: A PubMed search was completed in Clinical Queries using the key term “breath-holding spells”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.Results: Breath-holding spells affect 0.1 to 4.6% of otherwise healthy young children. The onset is usually between 6 and 18 months of age. The etiopathogenesis is likely multifactorial and includes autonomic nervous system dysregulation, vagally-mediated cardiac inhibition, delayed myelination of the brain stem, and iron deficiency anemia. Breath-holding spells may be cyanotic or pallid. The former are usually precipitated by anger or frustration while the latter are more often precipitated by pain or fear. In the cyanotic type, the child usually emits a short, loud cry, which leads to a sudden involuntary holding of the breath in forced expiration. The child becomes cyanosed, rigid or limp, followed by a transient loss of consciousness, and a long-awaited inspiration and resolution of the spell. In the pallid type, crying may be minimal or “silent”. The apneic period in the pallid type is briefer than that in the cyanotic type prior to the loss of consciousness and posture. The episode in the pallid type then proceeds in the same manner as a cyanotic spell except that the child in the pallid type develops pallor rather than cyanosis. In both types, the entire episode lasts approximately 10 to 60 seconds. The spells usually disappear spontaneously by 5 years of age.Conclusion: Although breath-holding spells are benign, they can be quite distressing to the parents. Confident reassurance and frank explanation are the cornerstones of treatment. Underlying cause, if present, should be treated. Interventions beyond iron supplementation may be considered for children with severe and frequent breath-holding spells which have a strong impact on the lifestyle of both the child and family.

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Section: Etiopathogenesismentioning

confidence: 99%

Section: Etiopathogenesismentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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