Pediatric breath-holding episodes are most often seen in infancy and childhood, and are sudden pauses in breathing that occur when a child is crying violently. Pathogenesis Breath-holding episodes are often triggered, and children are susceptible to symptoms following anger, fear, frustration, or pain. The pathogenesis may be due to a variety of causes. It is currently believed that the main cause is maladjustment of the central nervous system; others include vagal effects causing slowing of the heart rate and respiratory depression, peripheral vascular dysfunction, pulmonary dynamics, reflex regulation of inappropriate stimuli causing expiratory asphyxia and hypoxemia, and iron deficiency making the child’s behavior provocative. Problems in respiratory regulation such as respiratory movements of the ribs and sternum, reflexes induced by inappropriate stimuli (pressing on the eyeballs can cause breath-holding episodes), and mild obstructive breathing during wakefulness and sleep. Autonomic dysfunction such as abnormal peripheral pulmonary vascular bed shunts, vasomotor reflexes from positional changes or uprightness, excessive sympathetic reflexes (which usually cause the cyanotic type of breath-holding episodes), or parasympathetic reflexes (which cause the pallid type of breath-holding episodes). Iron deficiency elevates 5-hydroxytryptamine and norepinephrine in the body, affecting the child’s behavior. Symptoms and signs of the child before the attack, there is obvious emotional upset, first 1-2min whimpering, and then gradually increase the cry, become a big cry, followed by a moment of no sound, open mouth, deep exhalation, change of color, after a moment of the child appeared to inhale forcefully, such as this time the child has no loss of consciousness phenomenon, known as the “light type”; if this time If the child has no loss of consciousness at this time, it is called “mild”; if the breath-holding episodes continue, the color of the skin becomes cyanosis or pallor, and the child’s consciousness gradually becomes drowsy. Finally, the loss of consciousness, the muscle tone from flaccid to angulation, and even accompanied by body spasms, known as the “heavy type”. According to foreign reports, at the end of the seizure, about 55% of the children may have convulsions, and some of them may even suffer from enuresis. After the seizure stops, the children may have inspiratory wheezing or return to spontaneous respiration. Examination methods During the seizure, there may be a decrease in blood gas partial pressure and other hypoxemic changes. Some children may have decreased serum iron and increased iron binding capacity. Electroencephalography is normal, and X-ray chest radiograph is normal. Differential Diagnosis 1. Epilepsy Although grand mal seizures also have changes in muscle tone, body posture and skin color, the changes in muscle tone and body posture come first and the skin color changes come later. The most important differentiation is that the EEG is characterized by abnormalities. In addition, the epilepsy section due to head trauma attends myoclonic convulsions, after the seizure, the child is drowsy for a longer period of time than that of the children with breath-holding seizures, and there is no obvious trigger, no crying before the seizure, and the skin color changes after the convulsions. 2.Upright syncope is spontaneous, no crying during the seizure, and often occurs when there is a sudden change in body position or environmental factors, such as temperature rise, sudden encounter with something to be afraid of, or seeing a bleeding scene. Its seizure is often very sudden, and accompanied by loss of muscle tone, seizure, the child try to avoid making their own fall, such as placing the child in a flat position can be restored. 3, asphyxia pediatric asphyxia due to lack of oxygen or cause the loss of physicians and changes in muscle tone. Central asphyxia manifests when the chest wall movement or forceful breathing, no respiratory ventilation. Its episodes are often unprovoked and sudden. It can occur in normal infants or in children with lesions of the brainstem. Choking can occur during wakefulness and sleep, while breath-holding episodes occur only during wakefulness, which can be differentiated. Gastroesophageal reflux Some children with gastroesophageal reflux can cause reflex asphyxia, which is a kind of asphyxia caused by reflex nerve pathway. The child is stimulated by the pharynx, which transmits signals to the brainstem through sensory afferent nerves and then returns to respiratory muscles through autonomic efferent nerves to produce the symptoms similar to those of breath-holding episodes, but the two kinds of triggering factors are completely different. The first step is to explain to parents the mechanism of breath-holding episodes, and not to mistake them for behavioral problems. Rather than avoiding the emotional upset of the child, parents should adopt a palliative approach before the child cries, which tends to strengthen the child’s ability to meet his/her own demands by crying in the future, which is more likely to cause breath-holding episodes, and instead use a calming behavioral modification approach to deal with the problem. 2, emergency measures in the breath-holding episodes, especially heavy children parents should make the child side or supine, to avoid head injury and inhalation of foreign objects, when there is an obstruction phenomenon, it is very important to remove the oral cavity and the airway of foreign objects to keep the airway open. 3, drug treatment At present, there are 2 kinds of safe drug treatment, one is oral iron 5-6mg/kg.d. The other is piracetam 40mg/(kg・d), which should be taken orally 2 times a day.