Prevention and causes (ARP) of an affective-respiratory attack in a child, advice to parents. Affective-respiratory attacks. Breath holding attacks - causes, treatment Affective respiratory attacks in a newborn

These are attacks in which, after exposure to an emotional or physical stimulus that is excessive for the nervous system, the child holds his breath, short-term apnea (stopping breathing) occurs, sometimes convulsions and loss of consciousness join. Such attacks usually pass without consequences, but require the supervision of a neurologist and a cardiologist.

Affective-respiratory attacks occur in children aged 6 months to one and a half years. Sometimes they appear in a child of 2-3 years of age. Newborns do not suffer, up to 6 months there are practically no attacks due to the pronounced immaturity of the nervous system, and with age the child “outgrows” them. The frequency of seizures is up to 5% of the number of all babies. Such a child requires special attention in education, because childhood attacks are equivalent to hysterical attacks in adults.

Why do seizures occur?

The leading causes are hereditary. There are children who are excitable from birth, and there are features of the nature of the parents who involuntarily provoke these attacks. Parents of these children also experienced bouts of "rolling" in childhood.. In children, affective-respiratory paroxysms may occur in response to the following situations and stimuli:

• ignoring the demands of the child by adults;
• lack of attention of parents;
• fright;
• excitation;
• fatigue;
• stress;
• overload of impressions;
• falls;
• injuries and burns;
• family scandal;
• communication with an unpleasant (from the point of view of the child) relative.

Adults should understand that the child reacts this way unconsciously, and not at all intentionally. This is a temporary and abnormal physiological reaction that is not controlled by the child. The fact that a child has such a reaction is “to blame” for the features of his nervous system, which can no longer be changed. The child was born like this, early age is the beginning of all manifestations. This needs to be corrected by pedagogical measures in order to avoid problems with character at an older age.

What does it look like?

Affective-respiratory syndrome pediatricians are conventionally divided into 4 types. The classification is:

• A simple option, or holding the breath at the end of exhalation. Most often it develops after a child's discontent or injury. Breathing is restored on its own, blood oxygen saturation does not decrease.
• The "blue" variant, which most often occurs after the pain reaction. After crying, a forced expiration occurs, the mouth is open, the child does not make any sounds - “rolled up”. Rolling eyes and stopping breathing are visible. The baby first blushes brightly, then turns blue, then goes limp, sometimes loses consciousness. Some regain consciousness after regaining breath, while others immediately fall asleep for an hour or two. If you record an EEG (encephalography) during an attack, then there are no changes on it.
• "White" type, in which the child almost does not cry, but turns pale and immediately loses consciousness. Then comes sleep, after which there are no consequences. The convulsive center on EEG is not found out.
• Complicated - begins as one of the previous ones, but then paroxysms similar to an epileptic seizure join, which can even be accompanied by urinary incontinence. However, subsequent examination does not reveal any changes. Such a condition can pose a danger to all tissues due to severe oxygen starvation, or cerebral hypoxia.

Such convulsions do not pose a threat to life, but a consultation with a neurologist is mandatory in order to distinguish them from more severe cases. Breathing stops for a time from a few seconds to 7 minutes, while it is very difficult for parents to maintain self-control. The average time to stop breathing is 60 seconds.

Mechanism of development and clinical picture

Seizures look frightening, especially in infants. When the child stops breathing, the supply of oxygen to the body stops. If the breath hold lasts for a long time, the muscle tone reflexively falls - the baby "goes limp". This is a reaction to acute oxygen deficiency to which the brain is exposed. Protective inhibition occurs in the brain, its work is rebuilt in order to consume as little oxygen as possible. Eye rolling sets in, which scares the parents a lot.

With continued breath holding, the muscles sharply increase their tone, the child's body tenses, arches, clonic convulsions may occur - rhythmic twitches of the torso and limbs.

All this leads to the accumulation of carbon dioxide in the body - hypercapnia. From this, the spasm of the muscles of the larynx stops reflexively, and the baby takes a breath. Inhalation is usually done when crying, then the child breathes well and calmly.

In practice, seizures rarely occur. After apnea, usually the child immediately stops rolling, for some, breathing is restored after “softening”.

Breath and emotions

It is not for nothing that the attack is called affective-respiratory, abbreviated as ARP. A small child expresses his anger and displeasure in this way if something is done “not according to him”. This is a real affect, an emotional attack. Such a child is initially characterized by increased emotional excitability and capriciousness. If you leave the features of character without attention, then at an older age the child gives real hysterical reactions if he is denied something: he falls to the floor, yells at the whole store or kindergarten, stamps his feet and calms down only when he gets what he wants. The reasons for this are twofold: on the one hand, the child has hereditary features of the nervous system, on the other hand, parents do not know how to handle him in such a way as to smooth out all the “corners” of character.

What to do during an attack?

First of all, do not panic yourself. The emotional state of the surrounding adults is transmitted to the baby, and if confusion and fear are “warmed up”, then it will only get worse. Hold your breath yourself. Feel that nothing terrible happened to you and the baby from a temporary delay in breathing movements. Blow on the baby's nose, pat him on the cheeks, tickle. Any such impact will help him quickly recover and breathe.

With a prolonged attack, especially with convulsions, put the baby on a flat bed and turn his head to one side. That way he won't choke on vomit if he throws up. Spray it with cold water, wipe your face, and gently tickle it.

If during an attack the parents “tear their hair”, then the condition of the baby is aggravated. After an attack, even if there were convulsions, let the baby rest. Don't wake him up if he's asleep. It is important to remain calm after an attack, to speak quietly, not to make noise. In a nervous situation, the attack may recur.

For any seizure with convulsions, you should consult a neurologist. Only a doctor can tell ARP from epilepsy or other neurological disorders.

Make an appointment with your doctor for a consultation if this happened for the first time. It is necessary to distinguish between illness and affective reaction. If the attack has been more than once, but there is no illness, you need to think about raising the baby.

If this happened to the baby for the first time, you should call the children's ambulance, especially if there are convulsions. The pediatrician will assess the severity of the condition and decide whether hospitalization is required. After all, not always parents can fully follow the baby, and so the consequences of a traumatic brain injury, poisoning or an acute illness can manifest themselves.

Simple rules for parents

The task of parents is to teach the baby to manage his anger and rage so that it does not interfere with the rest of the family.

Discontent, anger and rage are natural human emotions, no one is immune from them. However, for the baby, boundaries must be created that he has no right to cross. For this you need this:

• Parents and all adults living with a child should be united in their demands. There is nothing more detrimental to a child when one allows and the other forbids. The child grows up as a desperate manipulator, from which everyone then suffers.
• Define in the children's team. There the hierarchy is built naturally, the child learns to "know his place in the pack." If the seizures occur on the way to the garden, you need to consult a child psychologist who will specifically indicate what needs to be done.
• Avoid situations where an attack is likely to occur. The morning rush, the line at the supermarket, a long walk on an empty stomach are all provocative moments. It is necessary to plan the day in such a way that the baby is full, has sufficient rest and free time.
• Switch attention. If the child bursts into tears and the crying intensifies, you need to try to distract with something - a passing car, a flower, a butterfly, snowfall - whatever. It is necessary not to let the emotional reaction "flare up" .
• Clearly define boundaries. If a child knows for sure that he will not receive a toy (candy, gadget) from either his grandmother or his aunt, if his father or mother forbade him, then after the most desperate crying he will still calm down. Everything that happens should be spoken in a calm tone. Explain why crying is useless. “Look, no one in the store is crying or screaming. You can't - you can't." Sensitive children need to add that mom or dad loves him very much, he is good, but there are rules that no one is allowed to break.
• Call a spade a spade and pronounce the consequences of whims. “You are angry and I can see it. But if you continue to cry, then you will have to calm down alone in your room. Children need to be honest.

How is the diagnosis made?

First, the doctor comprehensively examines the child. If necessary, ultrasound of the head (neurosonography) and EEG are prescribed, sometimes a heart examination (ECG, ultrasound). ARP is diagnosed only when no organic disorders are found.

Treatment begins with the correct organization of the child's life. Recommendations are simple - regimen, diet, walks, classes by age. But without following these recommendations, no treatment will help, because a measured, orderly lifestyle is the main thing a child needs.

Some parents need classes with a family psychologist so that they learn to understand their own children. Medical treatment is rarely required, and in this case is most often limited to neuroprotective and nootropic drugs, as well as vitamins.

The best prevention is a calm, friendly atmosphere in the family without quarrels and lengthy showdowns.

Many parents sometimes noticed that during a strong tantrum, the child begins to scream and for a moment (or maybe for a longer period of time) he falls silent, as if he begins to take in more air, for an even stronger cry. Indeed, in most cases, the child "gains strength" to give out another loud cry, but it happens that affective respiratory attacks in children are to blame. This is a kind of childhood manifestation that manifests itself in adults.

Affective respiratory attack in a child (ARP) is not dangerous and should not cause concern to parents (only if the child is not older than 3 years). This is a condition characterized by delayed or unnatural breathing and, in some cases, convulsions.

What happens to the baby? Since the nervous system of young children is unstable, they are very easily overexcited, loading themselves emotionally and psychologically.

At a certain moment of screaming or hysteria, the baby freezes, his breathing seems to suddenly break off, and this causes cause for concern.

Inside the body, a laryngeal spasm begins to occur, which is not visible from the outside. Such spasm causes discomfort and even pain to the child.

In addition to internal discomfort, an attack is also manifested by vegetative changes, namely a change in skin tone. After all, the body does not receive oxygen, and it is forced to react.

The duration of the attack varies from a few seconds to one minute, but no more.

The frequency of manifestation of this phenomenon is purely individual, since each child is an individual and has peculiarities of behavior. For example, children with increased nervous excitability may experience RDA more often than their calmer peers.

Do not think that ARP is ubiquitous, not at all. These attacks may not appear in the most restless children, and vice versa, develop in calm ones.

With age, this pathology disappears without a trace. There is no evidence for affective respiratory attacks in adults. However, if the baby continues to choke after three years, this is a cause for concern and a more in-depth examination.

Classification

The classification of ARP includes two subspecies of the disease:

1. Pale type.
2. Blue type (with cyanosis).
3. Mixed type.

These names characterize the children's skin color, which the child acquires during an attack. Moreover, a pale color happens much less frequently than blue and indicates pain inflicted on the child (prick, blow, bruise, etc.). Perhaps the overflow of the pale type into loss of consciousness, due to an excess of carbon dioxide in the body

The blue color, in turn, manifests itself during a serious emotional overstrain (the inability to get what you want or the fear of being with a stranger or an unfamiliar area).

The psyche of a child, especially a newborn, is rather fragile and requires total control by the parents, precisely because of such unpleasant and to some extent dangerous manifestations.

Despite the fact that ARP does not cause delays in the development of the child, there is a danger of a violation of the respiratory system of the baby.

The reasons

Affectively respiratory syndrome in children manifests itself not just like that, but for a specific reason. In particular, babies are at risk, which are influenced by the following factors:

• heredity (if one of the parents suffered from a similar illness in childhood, with a probability of up to 35% the child will inherit this syndrome);
• cardiovascular pathology;
• iron deficiency;
• the epileptic component (the presence of a patient's history of epilepsy increases the risk of developing this syndrome).

From the side of the nervous system, provoking factors can be:

• intense irritation or anger;
• feeling of dissatisfaction;
• fear, panic state;
• resentment;
• overwork;
• overexcitation.

An important role in the occurrence of such attacks is played by the behavior of parents and the general atmosphere in the house.

Symptoms

The main symptom of the manifestation of ARP is a short-term breath holding on inspiration. That is, the patient exhaled, but could not inhale and seemed to freeze in this state.

The blue type of the disease develops according to the following scenario:

The child cries a lot or just screams, he develops a hysterical seizure. During the cry, he involuntarily exhales air from the lungs and at this moment there is an involuntary cessation of breathing.

• open mouth;
• the crying stops;
• a bluish tint of the face, lips begins to appear;
• complete absence of breathing, but not more than a minute.

By the way, ARP can also develop in infants.

After the attack has stopped, the child may become limp and fall asleep. This sleep lasts up to 2 hours, depending on the intensity of the seizure.

In the event that the breath is held for more than one minute, the child may begin to have convulsions. In medicine, there is such a thing as a clinical spasm (occurs when there is insufficient oxygen supply to the body).

As for the pale type of the disease, it manifests itself a little differently. In the case of a strong fear of an injection or something else that he is afraid of, when he is hurt, the child calms down (in most cases), turns pale and loses consciousness.

The earliest sign of an impending affective attack is pale skin. There is also the possibility of missing a pulse for a short period of time.

The child seems to be in a state of passion and cannot control his fear. In the most severe cases, involuntary urination may occur.

Diagnostics

Affective syndrome in babies is easy to diagnose. The main role in determining the disease is played by the anamnesis. The doctor interrogates the parents and finds out what preceded such a manifestation (trauma, serious unequal overstrain, etc.).

Instrumental diagnostic methods include:

1. Electrocardiogram (ECG).
2. Electroencephalogram (EEG).

Treatment

As a rule, such a condition does not require treatment by doctors, since it is not pathological.

Attacks pass on their own when the baby reaches three years old, but in most cases even earlier in a year or two years.

It does not make sense to treat ARP, the only thing that a doctor can prescribe is non-specific treatment, which will be aimed at bringing the baby's nervous system back to normal, improving metabolic processes in the brain. Such treatment includes:

• nootropics;
• sedative herbal medicines;
• B vitamins;
• physiotherapy.

Preventive conversations with a child psychologist and directly with parents can be attributed to specific treatment.

Proper Parental Behavior

What should parents do if they discover the presence of seizures in their child.

• do not give in to a panic state;
• try to bring the child to his senses (blow sharply on him, splash water in the face, lightly pat on the cheek);
• do not draw the attention of the child to the presence of a similar problem;
• engage with the baby, teach him to control his emotions;
• warn kindergarten teachers about the features of the baby, and tell them how to act in a similar situation.

Prevention and consequences

As a rule, the consequences of this disease are unlikely and occur in extreme cases. The most negative of those that can develop in 10-15% of cases are coma and cessation of cardiac activity.

For the entire time of the existence of the ARP, the lethal outcome was noted only a few times.

• limiting situations that can lead to the development of a tantrum or strong crying, fear;
• feed the baby in a timely manner, as hunger provokes ARP;
• do not overwork the child;
• to listen to the child in any situation not to bring to tantrums;
• teach the baby the rules of behavior in various places (learn to control their emotions);
• with the development of hysteria, switch the child's attention to positive moments.

So, affective-respiratory attacks in children are unpleasant, but not dangerous manifestations. Despite the fact that the prognosis of this disease is favorable, it must be borne in mind that we are talking about a child. Do not delay contacting a doctor, it is better to control this process together with a specialist than on your own. Take care of your children and don't get sick!

(synonyms: affective-respiratory attacks, rolling in crying, breath-holding attacks, apnea attacks) are episodic occurrences of apnea provoked by strong emotions in children, sometimes accompanied by loss of consciousness and convulsions.

It looks like an affective-respiratory attack like this.

In response to pain, more often when falling, anger, fear, fright, the crying of the child occurs, followed by respiratory arrest. Such strong negative emotions are called "affect". Next comes apnea, when the child cannot exhale, does not breathe; while the muscles of his larynx are spasmodic. Sometimes, in response to an affect, the child does not even have time to cry, and a spasm of the larynx occurs immediately.

The color of the skin often becomes bright red or cyanotic (bluish). Apnea can be short from a few seconds to 5-7 minutes, but lasts 30-60 seconds on average. Although it seems to parents or others around that the child is not breathing for 10-20 minutes. If the apnea period is prolonged, then a loss of consciousness may follow, “softening” is an atonic non-epileptic seizure. The attack is outwardly similar to an atonic seizure in epilepsy, but ARP occurs due to acute oxygen deficiency of the brain. In response to hypoxia, inhibition occurs as a protective reaction of the brain. It is known that during the period of loss of consciousness, the brain consumes less oxygen than when in consciousness. Next this anoxic attack goes into tonic non-epileptic seizure. The child has a tension of the whole body, stretching or arching. If the process of hypoxia is not interrupted, then further follows phase of clonic seizures(twitching of the limbs and the whole body of the child). In response to the resulting breath holding, carbon dioxide accumulates in the body. This biochemical state is called hypercapnia. Hypercapnia causes a reflex spasm of the muscles of the larynx, and the child takes a breath, and then begins to breathe. The patient then regains consciousness. After such a prolonged attack with tonic or clonic convulsions, deep sleep often occurs for 1-2 hours.

Most often, rolling in crying is interrupted after apnea, or after the next short "softening" for 5-10 seconds. Further, the spasm of the larynx is reflexively removed, followed by a sharp inhalation or exhalation, often with crying. After breathing is restored on its own. Rarely comes to seizures with tonic or clonic convulsions.

According to the statistics of affective-respiratory syndrome

occurs in 5% of children, equally in boys and girls aged 6 to 18 months, but may be up to 5 years. In 25% of such patients, an anamnesis is burdened, that is, one of the parents also had rolling in tears.

Think that affective respiratory attacks- this is a variant of childhood hysteria and, as a rule, arise on neurotic grounds, may be due to overprotection, chronic stressful situations in the family.

In some patients with affective respiratory attacks there is concomitant cardiovascular disease.

1. Flow with less excitement.

2. But more pronounced cyanosis ("cyanosis" or severe pallor).

3. More pronounced hyperhidrosis (excessive sweating).

4. The color of the skin after cyanosis is restored more slowly.

5. Outside of rolling in crying, during physical exertion, there are also episodes of pallor and hyperhidrosis.

6. Such children do not tolerate transport and stuffy rooms.

7. Parents note increased fatigue in such children.

If there is reason to suspect that the child has a cardiovascular pathology, then the examination is carried out and pediatric cardiologist, if necessary, using Holter monitoring.

Affective seizures in epilepsy are different from rolling in crying:

1. With epilepsy affective seizures unprovoked (spontaneous), and with affective-respiratory syndrome, paroxysms occur in response to emotional arousal.

2. ARP increase with fatigue; with epilepsy - can be in any condition.

3. In epilepsy, seizures are stereotyped (the same), while in ARP they are more variable and depend on the severity of the provocation, on the strength of the pain effect.

4. With epilepsy, the age can be any, with ARP - from 6 to 18 months, and not older than 5 years.

5. With epilepsy, treatment with sedatives does not help, and the effect occurs only from the use of antiepileptic drugs, with ARP - a good effect from sedatives and nootropics.

6. In epilepsy, there is more often epileptiform activity on the EEG, especially when conducting video EEG - monitoring during an attack, with ARP - as a rule, there is no epiactivity on the EEG.

Children with the presence are referred at risk for developing epilepsy. This does not mean that all crying babies will develop epilepsy. But in patients with a history of epilepsy affective respiratory syndrome occurs 5 times more often than in patients without epilepsy. This is explained by the concept of "paroxysmal brain" - an innate feature of the brain in the form of an increased response to external and internal acting factors.

What can parents do to prevent an affective-respiratory attack?
An affective-respiratory attack can be avoided. If you suspect that the child will negatively perceive certain conditions, then plan the situation, don't provoke an affect, especially during the period of fatigue, hunger, the course of a somatic disease, manipulations.

The most reasonable divert attention using soft intonations of the voice.

Be calm and confident in your actions.

What should be done around the child during the episode of rolling in crying?

1. Do not panic, try to stay calm, take the child in your arms. Know that this is only a short episode of apnea, after a few seconds breathing will be restored, there will be no pronounced harm to the child's health.

2. Required restore breathing child - in response to a mild external stimulus, the child will take a breath. Blow sharply on the nose area, splash some cold water on the face, pat or pinch it on the cheeks, rub the ears, pat on the back.

3. Sometimes help children get better leave alone this will help you calm down.

5. After an attack, try to distract the child.

It is very important to choose the right tactics in raising a child with an affective respiratory syndrome.

Do not try to protect the child from any negative emotions, patronize and isolate him. If you indulge all his whims, then the child becomes more capricious and reacts brighter to any influences. It is necessary to teach the child to respond correctly to grief, to be more stable, to control emotions.

If the child has an affective respiratory syndrome, you need to contact a neurologist.

After a survey, examination, identification of concomitant deviations, it is necessary to prescribe a special drug treatment. The doctor always prescribes treatment and recommendations to parents individually. It is also necessary to consult a cardiologist and a child psychologist.

Treatment affective respiratory syndrome.

Given the neurotic nature of episodes of rolling in crying, in the recommendations we pay great attention to the need for psychotherapy. In the psychologist's classes, family relations are corrected, the child is taught independence and resistance to negative factors.

Great importance in the treatment of affective respiratory syndrome has a healthy lifestyle:

1. Compliance with the regime of the day: rational distribution of sleep and rest during the day and week.
2. Sufficient physical exercise.
3. Elements of hardening, including swimming in the pool, walking in the fresh air;
4. Balanced diet .
5. Restricting TV viewing and games on the computer. You will be surprised that computer games are used even by children under 1 year old, moreover, without observing any norms?

In treatment affective respiratory syndrome drugs are used , strengthening the nervous system (neuroprotectors), sedatives and B vitamins. Among nootropics, preference is given to pantothenic acid (pantogam, pantocalcin and others), glutamic acid, glycine, phenibut. We prescribe a course of treatment for 1-2 months in average therapeutic doses. So, for a 3-year-old child, we recommend, for example, pantogam 0.25 ½ part or 1 tablet in two doses (morning and evening) for 1-2 months. Of the sedatives, phytotherapy can be recommended (infusions of sedative herbs, ready-made extracts of motherwort, peony root, and others). Calculation of the dose of sedative extracts: a drop for a year of life. For example, a child of 4 years old, 4 drops 3 times a day (at lunch, in the evening and at night) for 2 weeks -1 month. With intractable recurrent affective respiratory syndrome can be used tranquilizers, drugs such as atarax, grandaxin, teraligen.

For an integrated approach to therapy, balneotherapy methods can be recommended when natural substances are used. Such methods can be coniferous-sea baths at home.

During the roll itself in crying, drug treatment is not indicated. . Attempting to pour medicine into the child's mouth during apnea is dangerous by aspiration (inhalation).

In very rare (exceptional) cases, if several aggravating provoking factors are superimposed, an apnea attack may be delayed. In this situation, it is required provision of urgent measures in the form of cardiopulmonary resuscitation(artificial respiration and chest compressions).

If there is affective seizures in epilepsy appoint only antiepileptic drugs following the basic principles of epilepsy treatment.

Any therapy for affective-respiratory syndrome is prescribed only by a neurologist, often with the selection of doses of drugs. Self-medication can be dangerous.

So, from this article it became known that affective-respiratory attacks are common in 5% of children under the age of 5 years (usually 6-18 months). Rolling in crying scares parents, but these conditions are not so dangerous; children come out on their own. There is no need to panic, pull yourself together. Simple measures will help to quickly get out of an apnea attack: blow, sprinkle with water. Apnea attacks can be avoided without provoking anger, fear and other negative emotions in the child; and most importantly - cultivating resilience in him. An individual treatment will be prescribed for your child by a neurologist, after he sorts it out, he will exclude more severe pathologies such as epilepsy and cardiovascular pathology. Consult your doctor.

(ARP) in young children far from uncommon, single attacks are observed in 25% of completely healthy children against the background of strong emotions, and only in 5% of cases they are repetitive. Usually mothers describe this condition as “the child went into crying and turned blue”, at this moment an episode of breath holding (apnea) is noted. Usually affective respiratory attacks appear at the end of the first year of a baby's life, and can be observed until the age of 2-3 years. ARP arise reflexively, the child does not do this on purpose (as it may sometimes seem). Most often, such attacks are an age-related feature and disappear without a trace; after 4 years, affective-respiratory attacks are extremely rare. However, if the child has affective-respiratory attacks, then the supervision of a qualified neurologist is necessary, as well as work with a psychologist.

Affective-respiratory attacks in children appear against the background of emotional overload (strong negative emotions), are accompanied by a spasm of the muscles of the larynx, and resemble. There is a predisposition to the occurrence of such attacks in children due to the peculiarities of metabolism (increased need for calcium, the deficiency of which contributes to the occurrence of spasms of the larynx). Children with hyperexcitability syndrome also have a high probability of developing ARP. A genetic (hereditary) predisposition to the occurrence of such seizures has also been identified.

Affective-respiratory attacks may occur both several times a day, and only once a year. Most often, weekly (as well as monthly) attacks are noted. Most of these episodes occur, as a rule, in the second year of life.

ARP takes place against the backdrop of intense crying, when the child freezes on inspiration with his mouth wide open, without uttering a sound, his lips turn blue, then he becomes limp "like a rag." The duration of a breath holding episode usually does not exceed 30-60 seconds, but for parents they seem like an eternity. This spectacle is not at all for the faint of heart, and mothers often experience the strongest shock themselves.

Since affective-respiratory attacks most often occur against the background of fear, anxiety, or anger, it was previously believed that they are completely due to emotional and behavioral factors and occur in children who are capricious, irritable, prone to hysteria. However, foreign authors conducted studies and proved that seizures occur both in children with normal behavior and in those prone to hysteria with the same frequency.

There are so-called "white" and "blue" seizures."White" seizures usually occur as a reaction to pain (during a fall, injection, etc.), and in their mechanism they are similar to fainting. During an attack, the child turns pale, the pulse may disappear for a short time or slow down sharply. "Blue" attacks are characterized by the appearance of a bluish coloration of the skin on the background of an attack. If the attack is delayed, then the child then becomes completely limp in the arms of the mother, or vice versa, it can arch.

Although affective respiratory attacks pass without a trace when the child reaches the age of 3 years, the supervision of a qualified neurologist is necessary in order to differentiate APR from a number of other diseases that may have similar symptoms. Episodes of loss of consciousness with a change in skin color can be with cardiogenic diseases associated with heart rhythm disturbances. Also, such seizures can be the result of some rare neurological diseases (Arnold-Chiari malformation, Rett syndrome, family dysautonomia). Recently, works have appeared that indicate the relationship of affective-respiratory attacks with blood pathology (erythroblastopenia, iron deficiency states).

How can you help a child during an affective-respiratory attack?

1. Do not panic, stop fussing, take the child in your arms. Remember that a short breath holding cannot harm his health.

2. Try to reflexively restore the baby's breathing - pat him on the cheeks, pinch his neck and chest, massage the ears, wipe his face with cold water.

3. The sooner you get started, the better. Do not be distracted by your own emotions, act immediately, at the beginning of the attack, when it is easier to stop.

4. Some children are better left alone and move away, so they calm down and bounce back faster.

5. After an attack, you do not need to start notations, the child may not remember what happened. Try to distract the baby with other activities. Don't focus on what happened.

Do not try to protect the child from the slightest negative emotions and indulge all his whims. You have to teach your child how to properly respond to failures and disappointments. It's normal for everyone to get irritated and angry. The role of parents is to teach the child to control their emotions.

As a rule, special medical treatment for affective-respiratory attacks is not required. Obligatory help of a child psychologist with recurring seizures.

AFFECTIVE-RESPIRATORY SEIZURES.

Affective-respiratory attacks (attacks of breath holding) are the earliest manifestation of fainting or hysterical attacks. The word "affect" means a strong, poorly controlled emotion. "Respiratory" is what has to do with the respiratory system. Seizures usually appear at the end of the first year of life and may last up to 2-3 years of age. While holding your breath may seem intentional, children usually don't do it on purpose. This is simply a reflex that occurs when a crying baby forcefully exhales almost all the air from his lungs. At that moment, he falls silent, his mouth is open, but not a single sound comes out of it. Most often, these episodes of breath-holding do not last more than 30-60 seconds and disappear after the child takes a breath and begins to scream.
Sometimes affective-respiratory attacks can be divided into 2 types - "blue" and "pale".
"Pale" affective-respiratory attacks are most often a reaction to pain during a fall, injection. When you try to feel and count the pulse during such an attack, it disappears for a few seconds. “Pale” affective-respiratory attacks, according to the mechanism of development, approach fainting. In the future, some children with such attacks (paroxysms) develop fainting.
However, most often affective-respiratory attacks develop according to the "blue" type. They are an expression of discontent, unfulfilled desire, anger. If you refuse to fulfill his requirements, to achieve what you want, to draw attention to yourself, the child begins to cry, scream. Intermittent deep breathing stops on inspiration, a slight cyanosis appears. In mild cases, breathing is restored after a few seconds and the child's condition returns to normal. Such attacks are outwardly similar to laryngospasm - a spasm of the muscles of the larynx. Sometimes the attack is somewhat delayed, while either a sharp decrease in muscle tone develops - the child “goes limp” in the mother’s arms, or tonic muscle tension occurs and the child arches.
Affective-respiratory attacks are observed in excitable, irritable, capricious children. They are a kind of hysterical attacks. For more "usual" hysteria in young children, a primitive motor reaction of protest is characteristic: the child, if his desires are not fulfilled, falls to the floor in order to achieve his goal: he randomly beats his arms and legs on the floor, screams, cries and demonstrates his indignation and rage in every possible way. In this "motor storm" of protest, some features of the hysterical attacks of older children are revealed.
After 3-4 years, a child with breath holding attacks or hysterical reactions may continue to have hysterical attacks or other character problems. However, there are ways that can help you prevent your "terrible two-year-olds" from turning into "terrible twelve-year-olds."

Principles of correct upbringing of a small child with respiratory-affective and hysterical attacks. Seizure prevention.
Annoyance attacks are quite normal for other children, and indeed for people of all ages. We all have bouts of anger and rage. We never get rid of them completely. However, as adults, we try to be more restrained in expressing our dissatisfaction. Two-year-olds are more outspoken and direct. They just give vent to their rage.
Your role as parents of children with tantrums and respiratory attacks is to teach children to control their rage, to help them master the ability to control.
In the formation and maintenance of paroxysms, the incorrect attitude of parents towards the child and his reactions sometimes plays a certain role. If a child is protected in every possible way from the slightest disorder - everything is allowed to him and all his requirements are fulfilled - if only the child is not upset - then the consequences of such upbringing for the character of the child can ruin his whole future life. In addition, with such an incorrect education, children with breath-holding attacks may develop hysterical attacks.
Proper upbringing in all cases provides for a unified attitude of all family members towards the child - so that he does not use family disagreements to satisfy all his desires. It is undesirable to patronize the child excessively. It is advisable to place the child in preschool institutions (nursery, kindergarten), where attacks usually do not recur. If the appearance of affective-respiratory attacks was a reaction to being placed in a nursery, kindergarten, on the contrary, it is necessary to temporarily take the child from the children's team and re-identify him there only after appropriate preparation with the help of an experienced pediatric neurologist.
The unwillingness to follow the lead of the child does not preclude the use of some "flexible" psychological techniques to prevent seizures:
1. Anticipate and avoid outbursts.
Children are more likely to burst into tears and screams when they are tired, hungry, or feel rushed. If you can anticipate such moments in advance, you will be able to bypass them. You can, for example, avoid tedious waiting in line at the cashier's in the store by simply not going shopping when your child is hungry. A child who is seized by a fit of irritation during the rush to go to nursery during the morning rush hours, when the parents also go to work, and the older brother or sister is going to school, should get up half an hour earlier or, conversely, later when the house becomes quieter. moments in the life of your child and you will be able to prevent bouts of irritation.
2. Switch from the "stop" command to the "forward" command.
Young children are more likely to respond to a parent's request to do something, so-called "go" commands, than to listen to a request to stop doing something. Therefore, if your child is screaming and crying, ask him to come to you, instead of demanding that you stop screaming. In this case, he will more willingly fulfill the request.
3. Name the child his emotional state.
A two-year-old child may not be able to verbalize (or simply understand) their feelings of rage. So that he can control his emotions, you should give them a specific name. Without jumping to conclusions about his emotions, try to reflect the child's feelings, such as "Maybe you're angry because you didn't get a cake." Then make it clear to him that despite his feelings, there are certain limits to his behavior. Tell him, "Even though you are angry, you must not yell and shout in the shop." This will help the child to understand that there are certain situations in which such behavior is not allowed.
4. Tell the child the truth about the consequences.
When talking to young children, it is often helpful to explain the consequences of their behavior. Explain everything very simply: “You are not in control of your behavior and we will not allow it. If you continue, you will have to go to your room."

Convulsions in respiratory-affective attacks
When a child's consciousness is disturbed during the most severe and prolonged affective-respiratory attacks, the attack may be accompanied by convulsions. Convulsions are tonic - muscle tension is noted - the body seems to become stiff, sometimes arched. Less commonly, with respiratory-affective seizures, clonic convulsions are noted - in the form of twitches. Clonic convulsions are less common and then usually occur against the background of tonic (tonic-clonic convulsions). Seizures may be accompanied by involuntary urination. After convulsions, breathing resumes.
In the presence of convulsions, difficulties may arise in the differential diagnosis of respiratory-affective paroxysms with epileptic seizures. In addition, in a certain percentage of cases in children with saffective-respiratory convulsions, epileptic paroxysms (attacks) may develop in the future. Some neurological diseases can also cause such respiratory-affective attacks. In connection with all these reasons, in order to clarify the nature of the paroxysms and prescribe the correct treatment, each child with respiratory affective seizures should be examined by an experienced pediatric neurologist.

What to do during an attack of holding your breath.
If you are one of those parents whose child holds their breath in a fit of rage, be sure to take a deep breath yourself and then remember this: holding your breath is almost never harmful.
During an affective-respiratory attack, it is possible to use some kind of influence (to blow on a child, pat on the cheeks, tickle, etc.) to contribute to the reflex restoration of breathing.
Intervene early. It is much easier to stop a rage attack when it is just starting than when it is in full swing. Young children can often be distracted. Get them interested in something, say a toy or other form of entertainment. Even such an ingenuous attempt, like tickling, sometimes brings results.
If the attack is prolonged and is accompanied by prolonged general relaxation or convulsions - put the child on a flat surface and turn his head to the side so that he does not suffocate in case of vomiting. Read in detail my recommendations "HOW TO HELP DURING AN ATTACK OF SEIZURES OR CHANGES OF CONSCIOUSNESS"
After the attack, encourage and reassure the child if he does not understand what happened. Re-emphasize the need for good behavior. Stick with it just because you want to avoid repeating breath-holding episodes.

Treatment.
In the treatment of affective-respiratory and (or) hysterical attacks, it must be taken into account that they are the first manifestation of childhood hysteria and usually occur on a neuropathic (in a nervous child) soil. Therefore, treatment should be carried out in two directions.
Firstly, proper upbringing is necessary (see the relevant section of these recommendations.
Secondly, it is necessary to treat neuropathy with the use of a number of drugs that strengthen the nervous system, sedative (calming) drugs, and sometimes antiepileptic drugs.