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I can tell you from personal experience that breath holding spells can be terrifying for parents, even those who have spent a fair amount of their time trying to reassure other parents of the benign nature of these attacks. An American paediatric neurologist (F J DiMario Jr.Pediatrics2001;107:265–9) has provided follow up data on 95 children seen over a period of nine years. All of the children had breath holding spells severe enough for them to be referred to a paediatric neurology clinic. Forty nine were said to have had cyanotic attacks, 27 pallid attacks, and 19 had had both. The spells sometimes started in the neonatal period (4 cases) but half of the children (47) began their attacks at between 6 and 12 months. They began between 25 and 30 months in only three. At their peak, usually around 18 months, they occurred about once a week on average but a quarter of the chidlren had more than one episode a day. The average age when the spells stopped was 36 months but one child was still having them at 7 years. Fifteen had hypoxic convulsions. Of the 67 patients whose breath holding spells had stopped, 12 subsequently had fainting spells. There was a first degree family history of breath holding spells in one third of cases. Estimates of the incidence of breath holding spells have varied but a figure of around 7% with 2% having severe spells (with loss of consciousness) is probably not far off the mark.
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