Parental attitude of mothers, iron deficiency anemia, and breath-holding spells

Assessing the Level of Awareness About Breath-Holding Spells Among the General Population in the Makkah Region, Saudi Arabia

Background and objective Breath-holding spell (BHS) is a serious condition that affects healthy and normal children. It is a paroxysmal non-epileptic disorder and usually occurs after the child gets angry, annoyed, or aroused. In such a scenario, an episode of crying and silent expiration associated with color changes, either cyanosis or pallor, leads to loss of consciousness in the child. In Saudi Arabia, studies assessing the awareness among parents about BHS have been scarce. In light of this, this study aimed to evaluate the awareness of BHS among parents in Makkah, Saudi Arabia, in 2023. Methodology This was a cross-sectional study conducted between June and October 2023 by using Google Forms to collect data about awareness of risk factors of BHS among the general population in Makkah. We employed a validated and self-generated survey that was distributed through social media platforms. Results The study included 602 participants; 138 (22.9%) of them had witnessed BHS episodes. Of note, 407 (67.6%) thought that there was a connection between BHS and iron deficiency anemia. A significant majority (n=565, 93.9%) mentioned that spells can lead to passing out and seizures, and 542 (90%) thought that spells are dangerous. The majority (n=479, 79.6%) reported that the actions required during spells involve laying the child on the floor, keeping the child away from anything sharp, staying with the child, and calling 911 if the child remains blue or is not breathing for longer than a minute. The most common source of information for the participants was the Ministry of Health (n=182, 30.2%). Conclusions This study found a generally low level of awareness among parents regarding several aspects of BHS. Hence, we recommend conducting educational campaigns to ensure parents have accurate information about BHS so that they can respond appropriately to its occurrence in children.

Evaluation of the effectiveness of valproic acid for treating cyanotic breath holding spells: A Pilot prospective study

BACKGROUND

Cyanotic breath-holding spells (CBHS) are self-limited conditions among younger children. Frequent spells cause parents' fear and anxiety. Seizures, brain damage and sudden death have been rarely reported with BHS. Some reported spells' frequency reduction with iron or piracetam. We evaluated the effectiveness of valproic acid (VPA) to treat CBHS and predictors of improvement.

METHODS

Participants were 90 children with CBHS (≥4/week) (age: 1.6±0.4yrs). They were treated with VPA (5 mg/kg/d). Follow-ups occurred after 3-≥6 months. Autonomic nervous system functions were evaluated.

RESULTS

The majority (74.4%) had daily spells and 19% had ≥2 spells/d. Crying or anger provoked spells. Postural hypotension was found in 46.7%. They had normal electroencephalography and QT, QTc interval or QTd or QTcd and heart rate. Compared to controls, postural fall in systolic (>20mmHg) and diastolic (>10mmHg) blood pressures and mean arterial pressure (>10mmHg) were observed in 46.7%, 74.4% and 72.2% and miosis observed with 0.125% pilocarpine in 28.9% (P=0.001). Spells' frequency reduction (P=0.001) occurred within 3 months with VPA. The independent prdictors for spell' frequency reduction were reduction of anger and crying [OR=4.52(95%CI=2.35-6.04), P =0.01].

CONCLUSION

VPA therapy reduces CBHS' frequency. Mood improvement is a suggestive effective mechanism.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov identifier is NCT04482764.

Paediatric breath-holding spells are associated with autonomic dysfunction and iron deficiency may play a role

AIM

This study assessed cardiac performance and iron in subjects aged 12-36 months with breath-holding spells (BHSs).

METHODS

We consecutively recruited 40 subjects (55% male) experiencing BHSs from the general paediatric outpatients department at the Children's Hospital, Ain Shams University, Egypt, from 2015 to 2016. The 20 matched comparisons were mainly healthy siblings. The workup included iron levels and electrocardiograms.

RESULTS

The age at the onset of BHSs was 5-24 months with a median monthly frequency of 13. Almost two-thirds of the patients had cyanotic spells, and one-third had pallid spells, lasting 25-90 seconds. Lower serum iron levels and higher QT dispersion and T-wave dispersion were recorded in patients than the comparison group, and 4.8% had dysrhythmia and bradycardia. We observed higher durations of bradycardia during attacks and higher occurrences of dysrhythmia during cyanotic spells, which were more frequent in patients with prolonged or frequent BHSs.

CONCLUSION

Our study of patients aged 12-13 months supported the theory of autonomic dysfunction in BHSs. The ECG findings, especially in patients with prolonged or frequent spells, need to be studied further to evaluate the risk of life-threatening events. Iron deficiency may play a role in autonomic dysfunction in patients with BHSs.

Parental attitude, depression, anxiety in mothers, family functioning and breath-holding spells: A case control study

AIM

This study aimed to identify differences in the antenatal stressful life events, parenting style, family functioning, depression and anxiety of mothers who have children with breath-holding spells (BHS) compared with controls.

METHODS

This case control study divided 66 children into a group of children with BHS and a control group, with the children's ages ranging between 6 months and 5 years of age. This study explored underlying anxiety and depression in mothers as well as functioning of their families. Socio-demographical data and stressful life events that the mother experienced during pregnancy were analysed. In order to evaluate the effects of family structure, depression and anxiety in mothers on BHS in children, the Family Assessment Device, and both the Parental Attitude Research Instrument and the Beck Depression Inventory as well as the State-Trait Anxiety Inventory were used to assess both groups.

RESULTS

Exposure to stressful life events during pregnancy (P < 0.001), depressive traits (P < 0.001), state-trait anxiety (P < 0.001), overprotective maternal characteristics (P = 0.027) and most of the family functioning subscales were found to be significantly different between BHS and control groups.

CONCLUSIONS

The association of anxiety, depression, prenatal stressful events and poor family functioning in mothers who have children with BHS is significantly higher than controls. An evaluation of these problems may be beneficial in the management of BHS.

Clinico-laboratory profile of breath-holding spells in children in Sohag University Hospital, Upper Egypt

Introduction

Breath-holding spells (BHSs) are involuntary pauses of breathing, sometimes accompanied by loss of consciousness. They usually occur in response to an upsetting or surprising situation. Breath-holding spells are usually caused by either a change in the usual breathing pattern or a slowing of the heart rate. In some children, BHSs may be related to iron deficiency anemia. The aim of the work was to study the clinical and laboratory profile of BPHs in children presented to the Neuropediatric Clinic at Sohag University Hospital.

Methods

An observational prospective study was done at Sohag University Hospital over a period of one year on children diagnosed as having BHSs by clinical history and laboratory evaluation, including complete blood count (CBC), serum iron, serum ferritin, total iron binding capacity, and Electroencephalography (EEG).

Results

During the period of study (one year), we reviewed data of 32 children who had been diagnosed as having BHSs. We found that cyanotic spells (71.88%) predominated over pallid spells. There were positive family histories (31.25%) and consanguinity (53.135) in the studied patients. We found a high incidence of iron deficiency anemia (62.5%) in association with BHS. Abnormal EEGs were found in (65.63%) of studied children.

Conclusion

BHS is a common, important problem associated with iron deficiency anemia, which is, in turn, a common nutritional problem in our country.

Management of common behaviour and mental health problems

Behavioural problems are usually influenced by both biological and environmental factors. Disruptive behavioural problems such temper tantrums or attention deficit hyperactivity disorder are displayed during the first years of childhood. Breath-holding attacks are relatively common and are an important problem. Although the attacks are not serious and the prognosis is usually good, parents often fear that their child may die during an attack. Parents therefore require explanation and reassurance from health professionals. Conduct disorders (often referred to as antisocial behaviours), such as aggression to others or theft, are more serious as they tend to be repetitive and persistent behaviours where the basic rights of others are violated. Emotional problems, such as anxiety, depression and post-traumatic stress disorder tend to occur in later childhood, and are often unrecognised because young children often find it difficult to express their emotions, or it may go unnoticed by the child's parents. This article briefly discusses the most common behavioural problems, including autism, that affect children of all ages.

Novel Findings in Breath-Holding Spells: A Cross-Sectional Study

The mechanism of breath-holding spells (BHS) is not fully understood and most probably multifactorial; so, this study was designed to clarify the pathophysiology of BHS through assessing some laboratory parameters and electrocardiographic (ECG) changes which might be contributing to the occurrence of the attacks. Another aim of the study was to evaluate the differences in the pathophysiology between pallid and cyanotic types of BHS. This was a prospective study performed in Zagazig University Hospitals. Seventy-six children diagnosed with BHS were included as follows: 32 children with cyanotic BHS, 14 children with pallid BHS, and 30 healthy children as a control group. All children were subjected to the following: full history taking, clinical examination, and laboratory work up in the form of CBC, serum iron, ferritin, and zinc levels. Twenty-four hours ambulatory ECG (Holter) recording was also performed. No significant statistical difference was found between cyanotic and pallid groups regarding family history of BHS, severity, and precipitating factors of the attacks. Frequent runs of respiratory sinus arrhythmia (RSA) during 24  hours ECG were significantly higher in children with BHS; the frequency of RSA was significantly correlated with the frequency (severity) of the attacks. Low serum ferritin was significantly associated with BHS groups but not correlated with the severity of the attacks. Autonomic dysregulation evidenced by frequent RSA is considered to be an important cause of BHS in children and is correlated with the frequency of the attacks. Low serum ferritin is additional factor in the pathophysiology. Both pallid and cyanotic BHS are suggested to be types of the same disease sharing the same pathophysiology.

Drug utilization in pediatric neurology outpatient department: A prospective study at a tertiary care teaching hospital

Background:

Neurological disorders are a significant cause of morbidity, mortality and adversely affect quality of life among pediatric patients. In India, more than 30% population is under 20 years of age, many of whom present late during the course of illness. Several drugs prescribed to pediatric population suffering from neurological disorders may be off label or unlicensed.

Aims and Objectives:

To study drug use pattern, identify off-label/unlicensed drug use and to check potential for drug-drug interactions in patients attending outpatient department of pediatric neurology at a tertiary care teaching hospital.

Methodology:

Prescriptions of patients attending pediatric neurology outpatient department were collected prospectively for 8 weeks. They were analyzed for prescribing pattern, WHO core prescribing indicators, off-label/unlicensed drug use and potential for drug-drug interactions.

Result:

A total of 140 prescriptions were collected, male female ratio being 2:1. Epilepsy was the most common diagnosis (73.57%) followed by breath holding spells, migraine and developmental disorders. Partial seizure was the most common type of epilepsy (52.42%). Average number of drugs prescribed per patient was 1.56. Most commonly prescribed drug was sodium valproate (25.11%) followed by phenytoin (11.41%). About 16% of the prescriptions contained newer antiepileptic drugs. More than 60% of the drugs were prescribed from WHO essential drug list. In 8.57% of cases drugs were prescribed in off-label/unlicensed manner. Twenty-six percent prescriptions showed potential for drug interactions.

Conclusion:

Epilepsy is the most common neurological disease among children and adolescents. Sodium valproate is the most commonly prescribed drug. A few prescriptions contained off-label/unlicensed drugs.