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Abstract & commentary
Synopsis: It would seem prudent that children experiencing repetitive breath-holding spells should be studied for iron deficiency and given appropriate therapy for this when present.
Source: Mocan H, et al. Arch Dis Child 1999;81:261-262.
Breath-holding spells are a frequent complaint in pediatric practice. They are clinical episodes based upon history given by the family as well as direct observation of the spells. Spells are usually defined as stopping of the child’s breathing during expiration after a deep inspiration during crying. Spells are classified as cyanotic, pallid, and mixed according to the color of the patient’s skin during the spell. It has been estimated that as many as 27% of otherwise healthy children experience breath-holding spells.1 The cause of breath-holding spells has not been defined2; however, an association with iron deficiency anemia has been suggested and reports have described correction of these spells coincident with iron medication.3
Mocan and associates from Turkey studied 91 children, 6-31 months of age, with typical breath-holding spells. Studies of iron status included hemoglobin, mean cell volume (MCV) serum iron, and total iron-binding capacity. Other studies included blood sugar serum calcium, ECG, EEG, and skull x-rays. Sixty-three patients with breath-holding spells had concomitant iron deficiency anemia and were treated with oral iron, 6 mg/kg/d for three months. The remaining 28 patients were not treated. Frequency of the spells were assessed. Fifty percent (32/68) patients treated with iron had complete cessation of spells and another 33.3% (21/68) had partial remissions, with at least a 50% decrease in the frequency of spells. In contrast, only 6/28 (21%) of the non-iron-deficient, nontreated patients had complete or partial improvement during three months of observation. Mocan et al acknowledge that they did not measure serum ferritin levels in these children, and it is possible that some of their "non-iron-deficient" children may have had a degree of iron deficiency.
Comment by Howard A. Pearson, MD, FAAPM
Breath-holding spells are most frequent in children of the same age group in which iron deficiency is most prevalent. It would seem prudent that children experiencing repetitive breath-holding spells should be studied for iron deficiency and given appropriate therapy for this when present. One might consider a short course of empiric iron therapy even without blood studies. Mocan et al conclude that anticonvulsants are not the treatment of choice for breath-holding spells in infancy. (Dr. Pearson is Professor of Pediatrics, Yale University School of Medicine.)
1. Bridge EM, et al. J Pediatr 1943;23:539-561.
2. Dimaro FJ, et al. Clin Pediatr 1990;29:17-24.
3. Daoud AS, et al. J Pediatr 1997;130:547-550.