Pediatric Heart Expert Forum
Crys and faints after turning blue
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Crys and faints after turning blue

My Granddaughter is two. She has been diagnosed with a heart murmur but my main concern is something the Drs. call breath holding. She starts to cry and it's like her airway is cut off. She turns blue and falls over on the floor where her eyes are rolled back in her head and she starts to jerk uncontrollably  which looks like a seizure.When she finally comes out of it she looks like she's in the ozone. She either looks like she just woke up and has no idea what happened or she seems to be asleep. It's absolutely horrible to see this happen and have her fall over and hit her head if you can't get to her fast enough. Do you really call this breath holding or is something else going on?
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Dear Karen,

Without evaluating your granddaughter and getting some more history, I cannot say for sure.  However, it certainly does sound like what is called a complex cyanotic (blue) breath-holding spell (BHS), assuming the pediatrician has ruled out a seizure as the primary problem.  BHS is seen in infants and toddlers, and can last sometimes until age 5-8 years.  Its name is a misnomer, though—these children are not holding their breath the way you would think they would be by its name, nor do they have control over this.  These children are typically at end-expiration of their breathing cycle when this happens.  It often happens when they are injured or angry.  What is probably actually happening, though, is a version of fainting, which is an acute drop in blood pressure to the brain.  In fact, 1/3 of family members of patients with BHS have either BHS or fainting.

It is typically self-limited, but can cause problems if it happens in a location that could put her in danger, such as at the top of a staircase, in a bathtub unsupervised, etc.  It is important to know that the way NOT to deal with it is to prevent her from crying or to give her everything she wants.  She still needs limits and discipline like all other children her age.  When BHS occurs, make sure that she is lying down or in a supine position until she is awake; a frequent mistake is parents pick the child up and keep them upright, which prevents the low blood pressure from getting blood back to the brain.  Also, make sure that she is in a safe location so that she doesn’t hurt herself.

Typically, these become less frequent with time, and eventually disappear. However, there is some limited research that suggests that problematic BHS that doesn’t self-resolve over time may improve with two months of supplemental iron therapy, even in children who do not have any evidence of anemia.  More research should be done to fully demonstrate this, though.
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I am not the doctor, but I do have five children and have also dealt with other young children in my family who have breath holding episodes.

What you are describing is absolutely consistent with breath holding episodes. They can be horribly frightening and terrifying to watch, especially when the seizing starts and they "come to". It looks like they could truly stop breathing and never start again. This is something that they outgrow with age, usually around 4-5 (my experience).

However, my daughter with multiple heart defects had an episode where she passed out and stopped breathing in the middle of the sidewalk. She was two at the time. I knew it was very different from breath holding because she passed out in mid-sentence and she was not in the middle of a tantrum or even upset....which means she wasn't holding her breath. She also didn't "seize" when she passed out, she just essentially collapsed and THEN turned blue, not the other way around. She also did not have a previous pattern of breath holding. It turned out she had an episode of arrhythmia due to Wolff-Parkinson-White Syndrome, even though we were told at her age it would be very, very rare for present the way it did as such a young age. Having had previous experience with breath holders, I was able to distinguish the difference and know we were dealing with something different.

I hope the doctor chimes in with an answer for you.
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