Affective respiratory attacks in children help. Affective-respiratory attacks: symptoms, causes, prevention. Treatment of affective-respiratory attacks in a child

(synonyms: affective-respiratory attacks, rolling up in tears, attacks of breath holding, attacks of apnea) are episodic occurrences of apnea in children provoked by strong emotions, sometimes accompanied by loss of consciousness and convulsions.

An affective-respiratory attack looks like this.

In response to pain, more often when falling, anger, fear, fright, a child cries, followed by stopping breathing on inspiration. Such strong negative emotions are called “affect”. Next comes apnea, when the child cannot exhale and does not breathe; at the same time, the muscles of his larynx are in spasm. Sometimes, in response to the emotion, the child does not even have time to cry, and a spasm of the larynx occurs immediately.

The color of the skin often becomes bright red or cyanotic (blue). Apnea may be short-lived from a few seconds to 5-7 minutes, But lasts on average 30-60 seconds. Although it seems to parents or others around that the child is not breathing for 10-20 minutes. If the period of apnea is prolonged, then loss of consciousness may follow; “going limp” is an atonic non-epileptic attack. The attack is superficially similar to an atonic attack in epilepsy, but ARP occurs due to acute oxygen deficiency in the brain. In response to hypoxia, inhibition occurs as a protective reaction of the brain. It is known that during the period of loss of consciousness the brain consumes less oxygen than when conscious. Next this anoxic attack goes into tonic non-epileptic seizure. The child experiences tension in the whole body, stretching or arching. If the hypoxia process is not interrupted, then what follows is clonic phase(twitching of the child’s limbs and entire body). In response to the resulting breath holding, carbon dioxide accumulates in the body. This biochemical state is called hypercapnia. Hypercapnia causes a reflex release of spasm of the laryngeal muscles, and the child inhales and then begins to breathe. The patient then regains consciousness. After such a prolonged attack with tonic or clonic convulsions, deep sleep often occurs for 1-2 hours.

Most often, rolling up crying is interrupted after apnea, or after the next short “limp” for 5-10 seconds. Next, the spasm of the larynx is reflexively relieved, followed by a sharp inhalation or exhalation, often with crying. Afterwards, breathing returns on its own. Seizures with tonic or clonic convulsions rarely occur.

According to statistics, affective-respiratory syndrome

occurs in 5% of children, equally in boys and girls aged 6 to 18 months, but can occur up to 5 years. In 25% of such patients, there is a burdened medical history, that is, one of the parents also had rolling up in tears.

Think that affective-respiratory attacks- this is a variant of childhood hysteria and, as a rule, arises on a neurotic basis, perhaps due to overprotection, chronic stressful situations in the family.

In some patients with affective-respiratory attacks there is concomitant cardiovascular pathology.

1. Occurs with less excitement.

2. But with more pronounced cyanosis (“cyanosis” or pronounced pallor).

3. Hyperhidrosis (excessive sweating) is more pronounced.

4. The color of the skin is restored more slowly after cyanosis.

5. Outside of crying, during physical exertion there are also episodes of pallor and hyperhidrosis.

6. Such children do not tolerate transport and stuffy rooms well.

7. Parents note increased fatigue in such children.

If there is reason to suspect that a child has cardiovascular pathology, then the examination is carried out by pediatric cardiologist, if necessary - using Holter monitoring.

Affective seizures in epilepsy differ from crying:

1. For epilepsy affective attacks unprovoked (spontaneous), and with affective-respiratory syndrome, paroxysms occur in response to emotional arousal.

2. ARPs become more frequent when tired; with epilepsy - can be in any condition.

3. In epilepsy, attacks are stereotypical (identical), but in ARP they are more variable and depend on the severity of the provocation and the strength of the pain.

4. With epilepsy, the age can be any, with ARP - from 6 to 18 months, and not older than 5 years.

5. In case of epilepsy, treatment with sedatives does not help, and the effect occurs only from the use of antiepileptic drugs; in case of ARP, there is a good effect from sedatives and nootropics.

6. With epilepsy, there is often epileptiform activity on the EEG, especially when conducting video EEG monitoring during an attack; with ARP, as a rule, there is no epiactivity on the EEG.

Children with presence are classified as to a risk group for the development of epilepsy. This does not mean that all children who cry will develop epilepsy. But in patients with a history of epilepsy affective-respiratory syndrome occurs 5 times more often than in patients without epilepsy. This is explained by the concept of “paroxysmal brain” - an innate feature of the brain in the form of an increased response to external and internal factors.

What should parents do to prevent an affective-respiratory attack?
An affective respiratory attack can be avoided. If you assume that your child will perceive certain conditions negatively, then plan for the situation, do not provoke passion, especially during periods of fatigue, hunger, the course of a somatic illness, or manipulation.

The most reasonable thing is divert attention using soft voice intonations.

Be calm and confident in your actions.

What should those around the child do during an episode of crying?

1. Don’t panic, try to stay calm, take the child in your arms. Know that this is only a short episode of apnea, after a few seconds breathing will be restored, and there will be no significant harm to the child’s health.

2. Required restore your breath child - in response to a mild external stimulus, the child will sigh. Blow sharply on the nose area, splash a little cold water on the face, pat or pinch it on the cheeks, rub the ears, stroke the back.

3. Sometimes helping children is better leave alone, this will help you calm down.

5. After an attack, try to distract your child.

It is very important to choose the right tactics in raising a child with affective-respiratory syndrome.

Do not try to protect your child from any negative emotions, take care of him or isolate him. If you indulge all his whims, the child becomes more capricious and reacts more vividly to any influences. We need to teach the child to react correctly to upsets, to be more resilient, and to control emotions.

If a child has affective-respiratory syndrome, you need to consult a neurologist.

After a survey, examination, and identification of associated abnormalities, it is necessary to prescribe special drug treatment. The doctor always prescribes treatment and recommendations to parents individually. Consultation with a cardiologist and a child psychologist is also necessary.

Treatment affective-respiratory syndrome.

Considering the neurotic nature of episodes of crying, in the recommendations we pay great attention to the need for psychotherapy. In the psychologist's classes, family relationships are corrected, instilling in the child independence and resistance to negative factors.

Great importance in the treatment of affective-respiratory syndrome has a healthy lifestyle:

1. Maintaining a daily routine: rational distribution of sleep and rest throughout the day and week.
2. Sufficient physical exercise.
3. Elements of hardening, including swimming in the pool, walking in the fresh air;
4. Balanced diet .
5. Limit TV viewing and games on the computer. Would you be surprised that computer games are used even in children under 1 year of age, and without following any standards?

In treatment affective-respiratory syndrome drugs are used , strengthening the nervous system (neuroprotectors), sedatives and B vitamins. Among nootropics, preference is given to pantothenic acid (pantogam, pantocalcin and others), glutamic acid, glycine, phenibut. We prescribe a course of treatment for 1-2 months in average therapeutic doses. So, for a 3-year-old child, we recommend, for example, Pantogam 0.25, ½ part or 1 tablet in two doses (morning and evening) for 1-2 months. Among sedatives, herbal medicine (infusions of sedative herbs, ready-made extracts of motherwort, peony root, and others) can be recommended. Calculation of the dose of sedative extracts: a drop per year of life. For example, a 4-year-old child takes 4 drops 3 times a day (at lunch, in the evening and at night) for 2 weeks -1 month. For intractable recurrent affective-respiratory syndrome can be used tranquilizers, drugs such as atarax, grandaxin, teraligen.

For an integrated approach to therapy, balneotherapy methods can be recommended when natural substances are used. Such methods can be coniferous-sea baths at home.

During the actual crying phase, drug treatment is not indicated. . Trying to pour medicine into a child's mouth during apnea poses a risk of aspiration (entry into the respiratory tract).

In very rare (exceptional) cases, if several aggravating provoking factors are superimposed, an attack of apnea may be prolonged. In this situation it is required providing emergency measures in the form of cardiopulmonary resuscitation(artificial respiration and chest compressions).

If available affective seizures in epilepsy are prescribed only antiepileptic drugs following the basic principles of epilepsy treatment.

Any therapy for affective-respiratory syndrome is prescribed only by a neurologist, often with the selection of drug doses. Self-medication can be dangerous.

So, from this article it became known that affective-respiratory attacks occur frequently in 5% of children under the age of 5 years (usually 6-18 months). Rolling up in crying frightens parents, but these conditions are not so dangerous; children emerge from them on their own. There is no need to panic, pull yourself together. Simple measures will help you get out of an apnea attack faster: blow, splash water. Apnea attacks can be avoided without provoking anger, fear and other negative emotions in the child; and most importantly, nurturing resilience in him. A neurologist will prescribe individual treatment for your child, and after he has figured it out, he will rule out more severe pathologies such as epilepsy and cardiovascular pathology. Consult your doctor.

An affective-respiratory attack is a sudden short-term cessation of breathing in a child while crying. It develops against the background of an affective state and may be accompanied by loss of consciousness, and in rare cases, convulsions. It occurs, according to various sources, in 5–13% of children.

Affective-respiratory attacks last up to 2–3 years (less often – up to 4–5)

Affect is a short-term sudden emotional outburst, characterized by an explosive nature and high intensity of manifestations.

Affective-respiratory manifestations are usually of a functional nature: there are no structural disorders or deviations in the course of biochemical processes in the tissues of the central nervous and peripheral systems in children prone to seizures.

The condition was first described in 1737: “<…>there is a disease<…>in children, arising from anger or sadness, when the soul is constrained and is forcibly displaced from the heart to the diaphragm, causing breathing to stop or cease,<…>when the outburst of emotions stops, the symptoms disappear.”

The condition, as a rule, first appears between 6 and 18 months of life and continues until 2-3 years of age (less often, 4-5 years of age). In rare cases, the onset of affective-respiratory attacks occurs immediately after birth, or - even less often - at the age of over 3 years. The frequency of attacks varies individually (from several per day to several per year), peaking between the ages of 1 and 2 years.

Affective-respiratory attacks, as a rule, do not have negative consequences, are short-lived, do not worsen the child’s health and are not able to affect the functioning of organs and systems in the future.

Synonyms: affective-respiratory seizures, crying, attacks of breath holding, attacks of apnea.

Causes and risk factors

There is no consensus on the causes of this condition, although the main theory is the psychogenic onset of affective-respiratory attacks.

There is a point of view that attacks are usually observed in emotionally mobile, irritable, capricious children and are some kind of hysterical attacks. In response to painful or negative psycho-emotional effects, the child develops corresponding symptoms.

Some authors note the importance of the problem of interpersonal relationships within families or the phenomena of overprotection. Research conducted in 2008 showed that children prone to affective-respiratory attacks have higher levels of emotionality, activity, emotional intensity and distractibility.

Despite the obvious influence of the psychological component, most experts still believe that this phenomenon occurs not only in emotionally complex children; The following factors play an important role:

• hereditary predisposition (25–30% of children have a family history of affective-respiratory attacks, when at least one of the parents suffered from them;
• cardiovascular pathology;
• deficiency of iron, necessary for the metabolism of catecholamines and adequate transmission of nerve impulses;
• epileptic nature of the condition.

Emotional factors that can trigger an attack:

• irritation;
• discontent;
• feeling of dissatisfaction;
• fear, fright.

Seizures develop more often if the child is overtired or overexcited, hungry or in an unusual environment.

Forms of the disease

The following forms of attacks are distinguished:

• with cyanosis (“blue” form);
• with pallor (“pale” form);
• mixed.

The pathophysiology of a “blue” attack is caused by a sudden spasm of the laryngeal and respiratory muscles, which leads to an increase in pressure in the chest cavity, which provokes a decrease in cardiac output and a decrease in cerebral blood flow with the development of acute transient oxygen starvation. An imbalance in the parts of the autonomic nervous system is assumed to be the trigger mechanism.

In the development of a “pale” attack, the leading role belongs to excessive parasympathetic impulses, when, under the influence of the inhibitory effects of the vagus nerve, the child’s heart rate decreases or asystole develops (instantaneous – no more than 1-2 seconds – cessation of heart activity), which causes an attack. Short asystole occurs in 61–78% of children with the “pale” form of affective-respiratory attacks.

Symptoms

An episode of a “blue” affective-respiratory attack usually begins with uncontrollable crying for several seconds (no more than 10-15), after which a sudden stop in breathing occurs on exhalation, which is characterized by the following symptoms:

• the mouth is open, there is no inhalation;
• crying stops;
• cyanosis rapidly increases;
• within a few seconds (up to several minutes, usually no more than 0.5-1 minute) there is no breathing (apnea develops).

The frequency of attacks varies individually (from several per day to several per year), peaking between the ages of 1 and 2 years.

If apnea lasts more than 1 minute, loss of consciousness, “limpness”, followed by tension in the muscles of the body, stretching or arching are possible. If oxygen access is not restored, the phase of clonic convulsions begins (twitching of the child’s limbs and torso).

Prolonged holding of breath and, as a consequence, oxygen intake provokes hypercapnia (excessive accumulation of carbon dioxide in the blood), which causes a reflex relief of spasm of the laryngeal muscles: the child takes a breath and begins to breathe, regaining consciousness.

After such a prolonged attack with tonic or clonic convulsions, deep sleep usually occurs for 1-2 hours.

Although holding their breath may seem deliberate, children do not do it on purpose; the reflex occurs when a crying child forcefully exhales air from the lungs while crying.

“Pale” attacks are most often provoked by fear, a sudden painful stimulus (injection, hitting the head, falling, etc.) or a combination of these factors. The child may cry, but more often he simply calms down, loses consciousness and suddenly turns pale. Characterized by weakness and heavy sweating, the pulse cannot be felt for several seconds. In the most severe episodes, clonic contractions of the muscles of the limbs and involuntary urination are possible.

Diagnostics

Diagnosis of affective-respiratory attacks does not cause difficulties if the connection with previous traumatic exposure is confirmed and there are similar episodes of respiratory arrest in the anamnesis.

An affective-respiratory attack, as a rule, first appears between 6 and 18 months of life and continues until 2-3 years of age (less often, 4-5 years of age).

• ECG (asystole episodes are recorded);
• EEG (detects a slowdown or decrease in the amplitude of impulses).

Treatment

Special drug treatment for affective-respiratory attacks is not required. This is due to several reasons:

• in the overwhelming majority of cases, affective-respiratory attacks stop on their own when the child reaches a certain age or when the environment changes (kindergarten, preparatory courses in elementary school, etc.);
• At present, there are no drugs with proven effectiveness in preventing attacks;
• this condition is not pathological.

There are several ways to help interrupt an attack and reflexively restore breathing: blow sharply on the child, splash water in the face, gently pat the cheek.

Nonspecific treatment aimed at improving metabolism in brain tissue, normalizing the balance of excitation and inhibition processes is as follows:

• nootropic drugs;
• sedatives of plant origin;
• neurotropic vitamins (group B);
• physiotherapeutic procedures.

Possible complications and consequences

Affective-respiratory attacks, as a rule, do not have negative consequences, are short-lived, do not worsen the child’s health and are not able to affect the functioning of organs and systems in the future.

A prolonged attack with prolonged cessation of breathing for several minutes in the presence of severe concomitant pathologies can lead to cessation of cardiac activity and coma.

There are only a few deaths reported in the literature that were caused by aspiration.

Forecast

Favorable.

Special drug treatment for affective-respiratory attacks is not required.

Prevention

The main preventive direction is psychotherapeutic influence (formation and maintenance of a child’s productive position in relation to the environment, an adequate perception of his place in the family hierarchy and correct reactions to certain external influences).

Psychological techniques that will help prevent the development of attacks are as follows:

• prevent situations of long waits or being on the road, rush, when the child is hungry, wants to sleep or experiences a feeling of physical discomfort (taking into account the fact that the provocateurs of affective-respiratory seizures are hunger, overwork, and a feeling of irritation);
• talk through traumatic situations with the child, provide him with the opportunity to express his desires;
• clearly indicate in advance the rules of conduct accepted in a particular place;
• switch the child’s attention from negative emotions to positive impressions.

Video from YouTube on the topic of the article:

Problems of maintaining and strengthening the health of children should be considered from the moment of birth. Prevention is the best way to avoid many diseases in later life.

Affective-respiratory attacks in children, only at first glance, are an ordinary problem, to which the less attention you pay, the faster it goes away. You shouldn't think like that. In fact, it is important to know that nervous disorders only get worse over time. Dangerous consequences can manifest themselves in the form of poor performance at school, mental and physical development delays. Somatic disorders may also occur, for example, increased aggregation of erythrocytes, decreased activity of the alveoli in the lung tissue, hypoxia of brain structures, etc.

Affective-respiratory attacks should be prevented whenever possible. With development, first aid should be provided promptly and fully to the baby. The video at the end of this page shows the opinion of an authoritative specialist. He gives convincing explanations of the reasons for the sudden stop of breathing in a child against the background of neurological damage. And the article discusses the etiology, pathogenesis and clinical symptoms of hysterical seizures, methods of their prevention. It tells what parents should do if they see that their child is developing an affective-respiratory attack or convulsions. Before apnea occurs, it is important to try to calm the baby.

What it is? ARP development mechanism

Understanding what breath-holding spells or an affective-respiratory attack is in a child helps to cope with this common problem. The situation is as follows. In common parlance, this condition is called “rolling up.” Roughly speaking, the baby, against the background of strong nervous overexcitation, loses control over his autonomic nervous system. A full-blown hysterical attack develops with all the accompanying symptoms. Affective-respiratory attacks are especially dangerous in infants or newborns, since in the first weeks and months of life there is no clear control over the work of all structures of the central and autonomic nervous system.

Hysteria begins with exposure to a trigger. Negative emotions such as fear, indignation, frustration, irritation, nervousness, pain, etc. can act as an irritant. At the moment when the baby experiences strong negative emotions, he experiences the effect of a primary convulsive reaction. Moreover, it mainly affects the intercostal muscles and the diaphragm. There is a feeling that he cannot breathe air. This causes severe fear, which, against the background of hypercapnia, forms the preconditions for respiratory arrest.

The development of an attack of affective breath-holding can be preceded by aggression or hysteria: the child begins to stomp his feet, scream, demand something, try to hit a parent or others, etc. This is the so-called primary hysterical reaction, which subsequently triggers the mechanism of blocking the respiratory muscles. It is worth understanding that children really cannot inhale and exhale air for completely physiological reasons. And they need help.

Paroxysms can occur in different situations. This distinguishes affective-respiratory syndrome in children from true epilepsy, which always has similar clinical manifestations.

What else is important for parents to know?

The most important thing that modern guardians of a child prone to affective-respiratory breath-holding and convulsive syndrome should know are options and ways to prevent such paroxysms.

Let's start by understanding the definition of APR as a manifestation of insufficient development of the child's autonomic nervous system. By its pathological nature, an affective-respiratory attack in children is a cessation of respiratory movements of the chest due to the lack of innervation (paralysis) of the intercostal muscles and diaphragm. Overexcitation of the nervous system can also turn off the child’s consciousness. This is necessary to quickly restore the reserve of the central nervous system. The lack of oxygen supply to the brain structures makes the baby temporarily forget about the emotional background that led him to such a state. Thus, affective-respiratory syndrome can be considered as a protective reaction of brain structures.

After an attack, the child experiences severe drowsiness and relaxation of the muscular frame of the body. It's best to let him sleep. After awakening, there will be no trace left of the hysterical paroxysm.

According to clinical manifestations, affective-respiratory attacks are divided into white and blue. In the first case, there is a short-term loss of consciousness and severe pallor of the skin. With blue ARP, there is cessation of breathing lasting up to 1 minute, loss of muscle tone and blue discoloration of the nasolabial triangle.

Causes of affective-respiratory attack in children

Many pediatricians still recognize only one cause of affective-respiratory attack in children, and this is typical hysteria. However, in reality everything is much more complicated. There are multiple or complex causes of an affective-respiratory attack, and among them there is indeed an excessive or hysterical reaction of the autonomic and central nervous system to the influence of a negative traumatic factor. But this is far from the only factor that provokes ARP.

So, pathogenetic influence factors include:

• weakness of the autonomic nervous system, such children will suffer from vegetative-vascular dystonia in the future;
• consequences of severe birth trauma (cerebral hypoxia, low assessment of the condition of the non-born on the Apgar scale);
• violation of the daily routine and regular lack of sleep (often found in children attending kindergarten and parents going to bed late);
• insufficient amounts of B vitamins and some important amino acids in the diet;
• the presence of serious chronic somatic pathologies;
• increased convulsive readiness;
• increased muscle tone;
• disruption of the development of cerebral blood vessels of the neck;
• thyroid diseases;
• adenoiditis, tonsillitis and other chronic pathologies of the upper respiratory tract that complicate the process of physiological breathing.

To prevent attacks with breath holding, it is important to exclude, if possible, all possible causes of this pathological condition. It is important for parents to remember that affective respiratory syndrome can cause sudden death. And in the future, this condition can lead to serious neurological disorders, including epilepsy.

Classification of attacks depending on clinical manifestations

The modern classification of attacks of affective-respiratory arrest with convulsive syndrome implies subdividing them into 4 distinct types.

Depending on the clinical manifestations of pathological spasm of the respiratory muscles, the following types of attacks are distinguished:

• blue ARP begins with hysteria, followed by a sharp deep breath and then asphyxia (lack of breathing) sets in, hyperemia of the skin quickly gives way to cyanosis, the child loses muscle tone and becomes limp, and may lose consciousness;
• white ARP is more complicated, with obligatory loss of consciousness and the rapid onset of characteristic pallor of the skin of the face, neck and chest;
• a simple type of ARP occurs without hypercapnia and hypoxia, the breath holding is short-term and does not exceed 20 seconds;
• a complicated type of ARP occurs with severe hypoxia of the brain (if there is no breathing for more than 60 seconds), accompanied by involuntary urination and convulsions in the lower and upper extremities.

In all 4 types, respiratory activity is completely restored on its own. Emergency medical care may be required only in the case of a complicated version of the development of ARP. But frequent attacks always lead to disruption of social adaptation. They can provoke a delay in the mental and mental development of the child. Therefore, it is important to carry out psychocorrection in a timely manner and do everything necessary to prevent affective-respiratory attacks in children.

Symptoms and clinical picture

It is important to understand that the clinical picture of ARP may resemble an epileptic attack. Therefore, it is important to conduct a full examination to exclude epilepsy. Symptoms may include the following:

• the increase in hysterical reaction to external negative influence occurs within 2-4 minutes;
• with a gradual deepening of hysteria, the child experiences overexcitation of the cerebral cortex;
• control over the muscles is lost - at this moment you can see stopping breathing and loss of tone of the whole body;
• the baby seems to go limp, stops breathing and slowly slides to the floor;
• the skin of the face, neck and chest begins to change color - at first they turn sharply red, then, depending on the type of attack, they turn white or blue;
• a short-term loss of consciousness may occur;
• After a few seconds, the child comes to his senses, abruptly stops crying and begins to breathe fully.

In the complicated type, the clinical picture is supplemented by clonic convulsions. From the outside they look like slight twitching of the arms and legs of an unconscious baby. The picture is very difficult for the parents of the injured child to perceive. Usually in such situations, parents begin to panic. And this only makes things worse. Why? Let's tell you further.

Diagnosis and differences from epilepsy

It is important to understand that affective-respiratory convulsions are only superficially similar to the manifestation of epilepsy. However, to exclude such a condition, it is not enough to know the main differences. Diagnosis necessarily includes an EEG (electroencephalogram of the brain). This examination shows the absence of a focus of excitation in the cortex and brain structures in ARP and its presence in epilepsy. Therefore, this examination is definitely worthwhile. At least to calm myself down. And treat the baby more correctly.

It is also important to exclude hysteria. It is based on an attack of aggression, but it does not provoke respiratory arrest and loss of consciousness. If a child has a hysterical attack, you should maintain your own calm and not show your child that this behavior greatly upsets you. Under no circumstances should a child be allowed to achieve his goals with such hysterical attacks. Otherwise, such a style of behavior will be fixed at a reflex level. You will receive regular affective-respiratory attacks at the slightest reason for the child’s negative perception of reality.

The distinctive features of epileptic seizures and affective-respiratory attacks are as follows:

• Various circumstances lead to ARP, and epilepsy manifests itself without external causes;
• ARP always develops differently, but epileptic seizures are always the same;
• In children under 4 years of age, epileptic seizures account for no more than 2% of the total number of such disorders;
• in children over 5 years of age, attacks of affective-respiratory disorder are diagnosed only in 1% of the total number of cases;
• with ARP, valerian, motherwort and nootropic treatment help;
• in case of a true epileptic seizure, it is useless to give sedatives;
• There are significant pathological changes in the EEG only in epilepsy.

If the baby has an attack, then it is necessary to show him to the doctor within the next 1.5 hours. These manifestations can be the result of very dangerous diseases. Only in a medical institution can an ECG of the heart and an ultrasound of internal organs be done to exclude heart defects, pulmonary vein embolism and other dangerous conditions; spirography, an X-ray of the lungs, and examination of the trachea for the presence of foreign bodies may also be required.

You may also need to consult a pulmonologist, neurologist and allergist. After collecting all the necessary information, the doctor will be able to make an accurate diagnosis and prescribe adequate treatment.

Providing first aid to a child with ARP

You need to know what to do when such symptoms appear, and what you should avoid categorically. Providing first aid to a child when symptoms of ARP appear should begin with clearing the airways. You can take the baby out into the fresh air. You need to unfasten the top buttons and remove the pressure on your neck.

It is important not to get confused or panic. Try to maintain your composure and smile. This will help the baby recover faster. Try patting him on the cheeks or lightly tickling him. If you have ammonia on hand, give it a sniff. Just don't bring it too close to the baby's face.

In case of loss of consciousness, it is important to create conditions to prevent tongue retraction. To do this, place the child on a flat surface and turn his head to the side. And here you should call an ambulance.

Treatment of affective-respiratory attacks in children

Therapy begins with behavior correction and psychological work with parents. Such conditions most often occur in children raised in families where parents do not follow the rules of communication with them.

Treatment of affective-respiratory attacks begins with a consultation with a neurologist. A specialist can give a referral to a psychologist to correct the mental state of both the baby and his parents. Drug therapy may then be prescribed. But, as a rule, it does not give any special results. It is much more important to take the following steps:

• normalize the child’s daily routine:
• develop a special diet containing all vitamins, minerals and amino acids;
• exclude, if possible, traumatic factors;
• teach your child to listen to his parents and compromise with them.

Effective treatment for respiratory attacks in children may include visiting a chiropractor. Acupuncture and reflexology, massage and therapeutic exercises will help restore the functioning of the autonomic central nervous system.

If the nervous system is hyperexcitable, it makes sense to carry out a course of treatment with nootropic drugs and sedatives. But this can only be done on the recommendation of a doctor and strict adherence to the recommended dosage.

See why affective-respiratory attacks develop in children - the video presents the opinion of a specialist in child neurology:

Parents are very worried if their children are sick, especially when they do not understand what is happening to their baby. Such situations include affective-respiratory attacks. In children, they develop against the background of a special condition associated with excitation of the nervous and respiratory systems during a negative psycho-emotional reaction. This is typical for children aged 1-3 years, since during hysterics they do not control their emotions. Even if holding the breath seems deliberate, the process does not depend in any way on the will of the child.

What are affective-respiratory attacks

The abbreviation ARP stands for affective-respiratory attacks. This medical term refers to a condition that is manifested by a sudden cessation of breathing lasting more than 20 seconds. This pathology is also called “apnea”. Many parents have noted that their baby may involuntarily hold his breath when he cries and screams a lot. Apnea occurs against the background of any strong emotions, including fear, hysteria, or sudden fright. Affective-respiratory attacks in infants are accompanied by:

• decreased muscle tone;
• bradycardia;
• pale skin;
• lethargy.

Sometimes holding the breath is observed during a strong impact, for example, during a fall. Sleep apnea is especially dangerous. The newborn's breathing is held for 10-20 seconds. Apnea is more common in children aged 1-3 years. When the baby reaches 3 years of age, such attacks go away on their own due to age-related changes that occur at high speed.

Causes

A common cause of ARP is the psychological and emotional overload of a child who experiences purely negative and negative feelings. The result is a spasm of the larynx, which is manifested by a sharp break in the cry. Then the child's breathing is held. The danger is that outwardly it looks like the child is pretending. In reality, this is just a reflex in which it is impossible to keep the activity of the larynx under control.

Apnea does not occur in all children. It all depends on the individual characteristics of the body. The risk is high if you have metabolic problems and calcium deficiency. The same applies to children with increased nervous excitability. The main reason is the child’s behavior itself – a negative emotional state. Risk factors are:

• parental behavior;
• experienced fright;
• minor whims;
• problem character of the baby;
• unstable psychological state of the child;
• hysterics;
• mechanical impact, such as a bruise or blow, which brought sharp pain.

One of the main reasons for children's tantrums is the behavior of their parents. When a baby cries in a public place, mom or dad leaves him alone, starts beating him or gently coaxing him and fulfilling all requests. In order not to increase hysteria, it is necessary to adhere to the golden mean. You cannot give in to a child’s manipulation, but leaving him alone or causing physical pain is also unacceptable.

Types

The classification of affective-respiratory attacks in a child divides this pathology into several types according to different criteria. The main thing is the baby’s complexion during an attack. Depending on the skin tone, apnea occurs:

1. Pale. More often observed with a bruise, blow or injection. The baby turns white and his pulse decreases. Neurologists consider this a natural individual reaction to pain.
2. Blue. A more common option, which is noted when the baby is dissatisfied with something. Even the smallest whim can lead you into a state of ARP. Apnea develops with intense crying or screaming.

Both types of ARP have the same level of danger, but with age they disappear in almost everyone. Doctors still advise not to neglect their recommendations if you have such attacks at an early age. Another classification of affective-respiratory attacks in a child divides them into types according to severity:

1. Simple option. It is a breath-hold at the end of exhalation. Observed after injury or during hysteria. The blood continues to be saturated with oxygen, and breathing is restored on its own.
2. Complicated option. Accompanied by paroxysms that resemble an epileptic attack and can develop into tonic and clonic convulsions. Sometimes urinary incontinence may occur. The danger of the condition lies in acute oxygen deficiency (hypoxia) of the brain.

Symptoms of an affective-respiratory attack in a child

More often, ARPs appear in the second year of life. They happen monthly or weekly. When crying violently, the child at some point stops breathing. He freezes, mouth open, lips turning blue. The baby becomes lethargic and gradually slides to the floor. The condition persists for 30-60 seconds. Depending on the type of attack, the child has the following symptoms:

1. With blue ARP. In this case, the skin turns bluish. The baby cries a lot, screams loudly, and falls to the floor. The child does everything to achieve his goal. Anger causes rolling of the eyes and spasm of the larynx, which blocks the flow of oxygen. Breathing becomes deep and intermittent. The chest muscles contract. The child arches or, conversely, weakens and may even lose consciousness.
2. With pale ARP. It all starts with loud crying or screaming, although some young patients hardly cry. The baby's pulse slows down and his breath of air is delayed. If the baby does not calm down, then the psycho-emotional state only worsens. About 20% of cases result in lack of air, faintness or loss of consciousness.

Complications during affective-respiratory attacks

If a small patient suffers from periodic breath holding for a long time, then he is at risk of developing serious diseases of the central nervous system. To prevent the development of complications, it is necessary to promptly respond to behavioral abnormalities in the baby. The list of possible complications after affective-respiratory attacks includes:

1. Nervous tics. Constant stress destroys the nervous system, causing involuntary twitching of the legs, eyes, eyelids, arms or other movements.
2. Epileptic seizures. The most dangerous complication observed in children whose parents do not take care of their psychological health.
3. Muscle cramps. After a hysteria, the little patient falls to the ground, his arms and legs twist, his back arches. The convulsive attack lasts several minutes.

Treatment of affective-respiratory attacks in a child

In most cases, treatment of affective-respiratory attacks in children is carried out without the use of medications. Therapy consists of conversations with the little patient and parents, the latter’s correct behavior and communication with a psychologist. If medications are necessary, amino acids, neuroprotectors, sedatives and nootropics, tranquilizers and vitamins are used. The list of medications used includes:

• Atarax;
• Glycine;
• Pantogam;
• Teraligen;
• Grandaxin;
• Pantocalcin;
• Phenibut;
• glutamic acid.

1. Encourage the baby to take action. Instead of asking the child to stop crying, the parent should tell the child in a calm and confident tone to get up and come to the mother or father.
2. Avoid conflicts. There is no point in shouting at your child or pointing out further actions if he begins to lose his temper. The position should be neutral so that children have the opportunity to express their wishes. If they do not go beyond the limits, then it is worth giving the child advice and some freedom of action.
3. The truth about the future. From childhood, children should know that all actions lead to certain consequences. If a child cries often, he will not have friends, his health will deteriorate, and his parents will often become upset. This needs to be explained to the baby.
4. Teaching emotions. Children do not yet have the knowledge that would help them separate emotions into bad and good. It is necessary to explain this if the baby is in a positive mood.

AFFECTIVE-RESPIRATORY SEIZURES.

Affective-respiratory attacks (attacks of breath holding) are the earliest manifestation of fainting or hysterical attacks. The word "affect" means a strong, poorly controlled emotion. “Respiratory” is something that has to do with the respiratory system. Attacks usually appear at the end of the first year of life and can continue until 2-3 years of age. Although holding your breath may seem deliberate, children usually do not do it on purpose. This is simply a reflex that occurs when a crying child forcefully exhales almost all the air from his lungs. At this moment he falls silent, his mouth is open, but not a single sound comes from it. Most often, these episodes of holding the breath do not last more than 30-60 seconds and pass after the child takes a breath and starts screaming again.
Sometimes affective-respiratory attacks can be divided into 2 types - “blue” and “pale”.
“Pale” affective-respiratory attacks are most often a reaction to pain from a fall or an injection. When you try to feel and count the pulse during such an attack, it disappears for a few seconds. “Pale” affective-respiratory attacks, according to the mechanism of development, are close to fainting. Subsequently, some children with such attacks (paroxysms) develop fainting states.
However, most often affective-respiratory attacks develop according to the “blue” type. They are an expression of dissatisfaction, unfulfilled desire, anger. If the child refuses to fulfill his demands, to achieve what he wants, to attract attention, he begins to cry and scream. Intermittent deep breathing stops on inhalation, and slight cyanosis appears. In mild cases, breathing is restored after a few seconds and the child’s condition returns to normal. Such attacks are externally similar to laryngospasm - a spasm of the muscles of the larynx. Sometimes the attack drags on somewhat, and either a sharp decrease in muscle tone develops - the child “goes limp” in the mother’s arms, or tonic muscle tension occurs and the child arches.
Affective-respiratory attacks are observed in children who are excitable, irritable, and capricious. They are a type of hysterical attack. More “ordinary” hysteria in young children is characterized by a primitive motor reaction of protest: when desires are not fulfilled, the child falls to the floor in order to achieve his goal: he randomly hits the floor with his arms and legs, screams, cries and demonstrates his indignation and rage in every possible way. In this “motor storm” of protest, some features of hysterical attacks of older children are revealed.
After 3-4 years of age, a child with breath-holding spells or hysterical reactions may continue to have hysterical attacks or have other character problems. However, there are ways that can help you prevent the terrible two-year-olds from turning into the terrible 12-year-olds.

Principles of proper education of a small child with respiratory-affective and hysterical attacks. Seizure prevention.
Attacks of irritation are quite normal for other children, and in general for people of all ages. We all experience bouts of irritation and rage. We never get rid of them completely. However, as adults, we try to be more restrained in expressing our dissatisfaction. Two-year-old children are more frank and direct. They are simply venting their rage.
Your role as parents of children with hysterical and respiratory-affective attacks is to teach children to control their rage, to help them master the ability to restrain themselves.
In the formation and maintenance of paroxysms, the incorrect attitude of parents towards the child and his reactions sometimes plays a certain role. If a child is protected in every possible way from the slightest upset - everything is allowed to him and all his demands are fulfilled - as long as the child does not get upset - then the consequences of such upbringing for the child’s character can ruin his entire future life. In addition, with such improper upbringing, children with attacks of breath holding may develop hysterical attacks.
Proper upbringing in all cases requires the same attitude of all family members towards the child - so that he does not use family disagreements to satisfy all his desires. It is undesirable to overprotect the child. It is advisable to place the child in preschool institutions (nurseries, kindergarten), where attacks usually do not recur. If the appearance of affective-respiratory attacks was a reaction to placement in a nursery or kindergarten, on the contrary, it is necessary to temporarily remove the child from the children's group and re-assign him there only after appropriate preparation with the help of an experienced pediatric neurologist.
The reluctance to follow the child’s lead does not exclude the use of some “flexible” psychological techniques to prevent attacks:
1. Anticipate and avoid flare-ups.
Children are more likely to cry and scream when they are tired, hungry or feel rushed. If you can anticipate such moments in advance, you will be able to circumvent them. You can, for example, avoid the hassle of waiting in line at the cashier at the store by simply not going shopping when your child is hungry. A child who gets irritable during the rush to get to nursery during the morning rush hour, when parents are also going to work and an older sibling is getting ready for school, should get up half an hour earlier or, conversely, later - when the house is calmer. Recognize the difficult ones. moments in your child’s life and you will be able to prevent attacks of irritation.
2. Switch from the stop command to the forward command.
Young children are more likely to respond to a parent's request to do something, called "go" commands, than to listen to a request to stop doing something. So if your child is screaming and crying, ask him to come to you instead of telling him to stop screaming. In this case, he will be more willing to fulfill the request.
3. Tell the child his emotional state.
A two-year-old child may not be able to verbalize (or simply acknowledge) his feelings of rage. So that he can control his emotions, you should give them a specific name. Without making a judgment about his emotions, try to reflect the feelings the child is experiencing, for example: “Maybe you are angry because you didn’t get the cake.” Then make it clear to him that despite his feelings, there are certain limits to his behavior. Tell him, “Even though you are angry, you should not yell and scream in the store.” This will help the child understand that there are certain situations in which such behavior is not acceptable.
4. Tell your child the truth about consequences.
When talking to young children, it is often helpful to explain the consequences of their behavior. Explain everything very simply: “You have no control over your behavior and we will not allow it. If you continue, you will have to go to your room."

Convulsions during respiratory-affective attacks
When a child’s consciousness is impaired during the most severe and prolonged affective-respiratory attacks, the attack may be accompanied by convulsions. The cramps are tonic - muscle tension is noted - the body seems to become stiff, sometimes arches. Less commonly, during respiratory-affective attacks, clonic convulsions are observed - in the form of twitching. Clonic convulsions occur less frequently and are then usually observed against the background of tonic convulsions (tonic-clonic convulsions). Cramps may be accompanied by involuntary urination. After convulsions, breathing resumes.
In the presence of seizures, difficulties may arise in the differential diagnosis of respiratory-affective paroxysms with epileptic seizures. In addition, in a certain percentage of cases in children, affective respiratory convulsions may subsequently develop epileptic paroxysms (attacks). Some neurological diseases can also cause such respiratory-affective attacks. In connection with all these reasons, to clarify the nature of paroxysms and prescribe the correct treatment, each child with respiratory-affective attacks should be examined by an experienced pediatric neurologist.

What to do during a breath-holding attack.
If you are one of those parents whose child holds their breath in a fit of rage, be sure to take a deep breath yourself and then remember this: Holding your breath almost never causes harm.
During an affective-respiratory attack, you can use any influence (blow on the child, pat the cheeks, tickle, etc.) to promote the reflex restoration of breathing.
Intervene early. It is much easier to stop a rage attack when it has just begun than when it is in full swing. Young children can often be distracted. Get them interested in something, say a toy or other entertainment. Even such a simple attempt as tickling sometimes brings results.
If the attack is prolonged and accompanied by prolonged general relaxation or convulsions, place the child on a flat surface and turn his head to the sides so that he does not suffocate if he vomits. Read in detail my recommendations “HOW TO HELP DURING A SEIZURE OR CHANGES IN CONSCIOUSNESS”
After an attack, reassure and reassure the child if he does not understand what happened. Reemphasize the need for good behavior. Don't back down just because you want to avoid repeat episodes of holding your breath.

Treatment.
When treating affective-respiratory and (or) hysterical attacks, it is necessary to take into account that they represent the first manifestation of childhood hysteria and usually arise on a neuropathic (in a nervous child) basis. Therefore, treatment should be carried out in two directions.
First, proper upbringing is necessary (see the corresponding section of these recommendations.
Secondly, it is necessary to treat neuropathy using a number of drugs that strengthen the nervous system, sedatives (calming) drugs, and sometimes antiepileptic drugs.