Infantile breath holding seizures
Introduction
Introduction to children's breath holding episode Pediatric breath-holding, also known as apnea, refers to the sudden apnea of a child when he is crying. In the onset of breath holding, due to breath caused by hypercapnia and cerebral hypoxia, and cerebrovascular contraction and secondary airway spasm when crying, the heartbeat slows down and causes blood flow to decrease, and finally fainting and convulsions. This disease is a paroxysmal neurosis that is more common in infants and young children. basic knowledge The proportion of illness: the incidence rate of infants and young children is about 0.003%--0.005% Susceptible people: children Mode of infection: non-infectious Complications: pediatric throat
Cause
Pediatric breath episode
Poor nervous system regulation (35%):
It is currently believed that the central nervous system is mainly dysregulated, and other factors include vagal nerves causing heart rate slowing and respiratory depression, dysregulation of peripheral blood vessels, etc. In pulmonary dynamics, reflex regulation of inappropriate stimuli causes exhalation asphyxia Hypoxemia and iron deficiency make the child's behavior irritating.
Improper stimulation (25%):
Respiratory adjustment problems such as respiratory movement, movement of the ribs and sternum, reflexes caused by inappropriate stimulation (pressing the eyeball can cause breath holdings), mild obstructive breathing during waking and sleep, autonomic dysfunction Such as abnormal peripheral pulmonary vascular bed shunt, postural changes or upright vascular motion reflexes, excessive sympathetic reflexes (usually causing cyanotic attacks), or parasympathetic reflexes (pale type that causes breath holdings), iron deficiency The increase in serotonin and norepinephrine in the body affects the behavior of the child.
Emotion (25%):
The disease is mainly related to emotions, and emotional factors or physical stimuli can be induced. The episode of breath holding is related to the body's iron deficiency. Iron supplementation can reduce the chance of breath holding.
Prevention
Pediatric breath prevention
Pay attention to reasonable education and mental health, so that children can grow up physically and mentally. The key is correct education. Eliminate the various factors that cause mental stress. Coordinate family relationships and create a relaxed environment. Don't be a child, don't be too reprimanded, and be patient in educating your shortcomings. Explain to parents that the prognosis is good, reducing their anxiety and emotional conflicts.
Complication
Pediatric breath syndrome Complications in children's throat
Hypoxia can cause cyanosis or paleness, which can be accompanied by convulsions and inspiratory asthma.
Symptom
Pediatric breath-holding symptoms Common symptoms Children crying restlessness, asthma, genital horns, twitching, twitching, mouth, breathing, pale, enuresis, loss of consciousness
Before the attack, the child has obvious emotional discomfort. The first is 1~2min of sore throat, then the crying gradually increases, becoming a crying cry, then there is no sound, Zhang Dazui, deep exhale, and the complexion changes obviously. The child is forced to inhale, such as the unconscious loss of the child, called "light"; if the child's breath holdings continue, the skin color becomes cyanosis or pale, the consciousness gradually becomes groggy, and finally the consciousness is lost. Muscle tone changes from soft to angular arch, and even with physical spasm, called "heavy". According to foreign reports, at the end of the attack, about 55% of children may have convulsions, and some may even have enuresis. After that, the child may have inspiratory asthma or return to spontaneous breathing.
Examine
Pediatric breath check
Ask about the age, frequency, predisposing factors, environment, color of the face and trunk at the time of onset, body posture, presence or absence of sputum, and family history, etc., in combination with clinical manifestations.
There were no special findings in routine examinations at the time of non-onset, and there may be hypoxemia changes such as decreased blood oxygen partial pressure during the onset. In some cases, serum iron may decrease and iron binding capacity may increase.
The EEG examination was normal, and the X-ray and other chest examinations were normal.
Diagnosis
Diagnosis and identification of pediatric breath holding
diagnosis
Diagnosis can be performed based on clinical manifestations and examinations.
Differential diagnosis
Epilepsy
Although epileptic seizures also have changes in muscle tone, body posture and skin color, muscle tension and body posture change first, skin color changes later, the most important identification is that EEG has abnormal characteristics, in addition, head trauma The resulting epilepsy may have myoclonic convulsions. After the episode, the child's groggy time is longer than that of children with breath-holding episodes, and there is no obvious cause before the attack, no crying, skin color changes after convulsions.
2. Upright syncope
Spontaneous, no crying at the time of onset, often in sudden changes in body position or environmental factors such as temperature rise, suddenly encountering fear, seeing the scene of bleeding, the attack is often very sudden, accompanied by muscle Loss of tension, when the attack occurs, the child tries to prevent himself from falling, such as restoring the child in the supine position.
3. Choking
In children with hypoxia or suffocation or loss of consciousness and changes in muscle tone, central asphyxia shows no respiratory breath when chest wall movement or forced breathing, the seizure is often without any incentive, sudden, normal baby or brain stem Children with lesions can occur, asphyxia can occur in waking and sleep, and breath holding attacks only occur when awake, which can be identified.
4. Gastroesophageal reflux
Some children with gastroesophageal reflux can cause reflex suffocation, a suffocation caused by a reflexive neural pathway that is stimulated by the pharynx, which transmits the signal to the sensory afferent nerve. The brain stem, and then by the autonomous efferent nerve back to the respiratory muscles, produces symptoms similar to the onset of breath, but the two causes are completely different.
