Infantile breath-holding attack

　　1. Causes

　　Apnea attacks often have triggering factors, and symptoms are prone to occur after the child is angry, afraid, frustrated, or in pain.

　　2. Pathogenesis

　　The pathogenesis may be caused by various reasons, and it is currently believed that it is mainly due to maladjustment of the central nervous system, other factors include the action of the vagus nerve causing bradycardia and respiratory depression, disorders of peripheral vascular reactions, etc. In pulmonary dynamics, reflex regulation to inappropriate stimulation causes expiratory asphyxia and hypoxemia, and iron deficiency makes the child's behavior more irritable.

　　Hypoxia can lead to cyanosis or pallor, which may be accompanied by spasms or inspiratory dyspnea. In cases of tissue hypoxia, blood oxygen capacity is normal, and PaO2, CaO2, SaO2 are generally normal. Due to the impaired oxygen utilization of tissue cells (intrinsic respiration), PvO2, CvO2, SvO2 increase, and (A-V) dO2 is less than normal. The skin and mucosal color of the patient often appears bright red or rose red because the amount of oxygenated Hb in the capillaries is higher than normal. Clinical hypoxia is often mixed. For example, in pulmonary heart disease, due to pulmonary dysfunction, respiratory hypoxia can occur, and heart failure can lead to circulatory hypoxia.

　　Before an attack, the child shows obvious mood disturbances, starting with 1-2 minutes of whining, then the crying sound gradually becomes louder, turning into loud screams, followed by a moment of silence, with the child opening their mouth wide, taking a deep breath, and their face changing significantly. After a moment, the child will try to take a deep breath. If the child does not lose consciousness at this time, it is called 'mild'; if the apnea attack continues, the skin color may turn blue or pale, consciousness may become cloudy, and finally, loss of consciousness may occur, with muscle tone changing from soft to opisthotonos, even with body spasms, which is called 'severe'. According to foreign reports, about 55% of children may have convulsions at the end of the attack, and some may even have enuresis. After the attack stops, the child may have inspiratory dyspnea or return to spontaneous breathing.

　　Pay attention to reasonable upbringing and mental health care to ensure the healthy growth of the child's body and mind. Parents should not overindulge in children in their daily lives, pay attention to the arrangement of the living environment, eliminate factors that cause mental tension and conflict, and try to avoid sudden unexpected stimuli. During an attack, the child should be made to lie on their side or on their back to avoid head injury and aspiration of foreign objects; when there is a blockage, the foreign objects in the mouth and airway should be cleared to keep the airway open.

　　Inquire about the age of onset, frequency, triggering factors, environment, the color of the face and trunk during the attack, body posture, presence of spasms, and family history, etc., combined with clinical manifestations, for diagnosis. No special findings are found in routine examinations when not attacked, but there may be changes such as decreased blood oxygen partial pressure and hypoxemia during attacks, and some children may have decreased serum iron and increased iron-binding capacity.

　　1. Foods Beneficial for Pediatric Apnea Attacks

　　Mushroom foods such as dried and fresh mushrooms, shiitake, oyster mushrooms, and black fungus, eat more fresh vegetables and fruits rich in vitamins and minerals, and eat moderate amounts of fish, shrimp, lean meat, milk, beans, eggs, and other protein-rich foods. Add some chestnuts and other nuts. Eat more of the following foods: milk, soybeans, walnuts, chestnuts, burdock, carrots, spinach, millet, eggs, peanuts, corn, cauliflower, seafood, chili, perch, dried scallops, oranges, grapefruits, pineapples, pears, seaweed, black fungus, and apricots.

　　2. Foods to Avoid for Pediatric Apnea Attacks

　　Avoid eating large amounts of acidic meat such as pork, beef, and mutton, and pay attention not to eat greasy and indigestible foods.

　　I. Treatment

　　The treatment of apnea attacks includes the following aspects:

　　1. Guidance for Parents

　　Firstly, the mechanism of apnea attacks should be explained clearly to the family, do not mistake it for a mere behavioral problem, and do not take lenient measures to avoid the child's emotional discomfort before they cry or shout, as this often reinforces the child's use of crying and shouting to achieve their own demands, which is more likely to trigger apnea attacks. Instead, use calm behavior correction methods to deal with it.

　　2. Emergency Measures

　　During apnea attacks, especially for parents of severe children, the child should be placed on their side or back to avoid head injury and aspiration of foreign objects; when there is an obstruction, foreign objects in the mouth and airway should be cleared to keep the airway open, which is very important.

　　3. Drug Treatment

　　Currently, two relatively safe drug treatments are advocated, one is oral iron 5-6mg/(kg·d), and the other is a compound piracetam similar to gamma-aminobutyric acid at 40mg/(kg·d), taken twice a day orally.

　　II. Prognosis

　　The prognosis is generally good.