14 month old stops breathing in shock - any good ideas for coping with this?

[devondoris]

My DT1 has twice stopped breathing after falling over and bumping the back of his head. After the first time (back in the summer) I called 999 though he was OK by the time they arrived. He did it again yesterday afternoon, but came round as I was dialling.

He seems to go into shock after the bump, which seems to be no worse than a normal falling over and which he does a lot as he's quite intrepid! He cries in a very scared way, very urgently, and then when he gets to the end of the cry he doesn't take another breath. I've already picked him up by this time, and I rub his back and gently jiggle him and tell him to breath. Yesterday I blew on his face which seemed to remind him to breath. By this stage he was going grey and his eyes had half closed and had begun to flip back, and his head was lolling. I had dialled 999 and was just about to get through when he started breathing again and began to cry, so I stopped as I figured that as he was breathing I probably wouldn't need the paramedics. He breathed properly after that, but was very cuddly for half an hour afterwards as I kept an eye on him for concussion.

Other than doing a first aid course, are there any other things I can do to help him start breathing again (I have done first aid courses in the past so I remember a bit about CPR)? I'm fairly sure that this isn't particularly uncommon so any help would be very, very much appreciated as it's really scary when it happens (obviously!).

Thanks v!

You are right, it is not uncommon to "breath hold" at this age. IME blowing on the face is the best way to get them started again, but it is very frightening when it happens.

When they lose conciousness the automatic bodt systems take over and breathing starts again. Keeping them safe from further injury, for example from falling is the best thing to do.

However, it is always important to make sure that the problem is simple breathholding - for example, toddlers of this age often put things in their mouths, so always check.

It wouldn't do any harm to get him checked over to make sure there is nothing else going on - although it sounds as if this is just breath holding as a rsponse to a shock, and they do outgrow it.

The first aid course is an excellent idea.

I used to teach first aid, and I really believe that everyone who comes into contact with children should do a course.

HTH

Doris this is awful and sounds a lot like DD1s breath holding. Around 18mths she would get in terrible temper tantrums and would scream and the hold her breath until she'd turn blue. It was awful, the first time I was on my own and thought she was going to die. She would mainly only do it around me. The doc said to blow on her, (it didn't seem to work for her) but not to give in to her demands and not to worry about it as long as she was in a safe place (ie not about to pass out and fall down the stairs). I also found out that breath holders that go so far as to pass out, then re-set their body clock and start breathing normally, so is sometimes preferable to the eyes rolling turning blue bit. DD1 does still do this now (3) but it's much less. I usually make sure she's ok and rub her back. After a full on bout she has no idea what she was angry about in the first place and after being especially loving goes about her business.

I also make a note of telling anyone looking after her that she is prone to it, so they are forewarned. Anyone who witnesses her going through it feel really sick afterwards.

Thanks you two. I do feel much better about it now, since I spoke to their childminder who used to be a nurse and various other childreny types of things. She's really good and has loads of experience, particularly with a little boy who had sleep apnoea.

You've all said the same stuff, but I am going to take him to the docs on Monday just to check there isn't anything else going on. Like you Frogs, I think it's a good idea just to rule everything else out. He's not fitting or anything, so I'm not worried about that. He doesn't ever have anything in his mouth fortunately.

Good to know that the automatic stuff stars when they lose consciousness. I'm not sure when he loses it; when it's happening I think he's lost it earlier than he probably has which makes it more frightening. As Pix knows, I like lots of information about theses sorts of things, so thank you both!!!

devondoris, this isn't breathing holding, this sounds like a condition called reflex anoxic seizure. I will be back with more info.

breath holding is more of a concious decision to hold your breath, resulting in you turning blue.

Reflex anoxic seizure is a condition when the child stops breathing and turns completely white and loses conciousness following a shock such as a bump on the head.

My dd1 did exactly what your dt1 did the first two times.

The following four times this happened she also had fits following losing conciousness.

my dd1 ended up needing an EEG (when they attach wires to the head to follow the brain waves) and ECG to check her heart. It wa only a friend of mine who is a paediatrician that diagnosed reflex anoxic seizures. It often gets confused with breath holding.

Thanks belgo. That's exactly it. I've just looked it on the net and the description fits perfectly. I shall go and talk to docs on Monday and do some more ferreting for info. I'm trying to find a first aid course down here but so far there only seems to be one in Taunton in Feb, though I'm sure there must be more. If you get any other info, I'd be really grateful.

Thanks again.

devon doris - my dd1 had her first RAS (reflex anoxic seizure)when she was 10 months old. She had six in total over that year, and since the age of about 2 has had no more - and she is now nearly four. I'm hoping that she has grown out of then, and it's likely that your dt1 will grow out of them as well.

If it's happened twice, it is likely to happen again (sorry!). As I said before, the first two my dd1 had, she didn't fit, but the following four did involve fits lasting two or three minutes. These would tire her out for the rest of the day, and the next day she would be totally recovered.

It's very scarey, isn't it? I have a few more grey hairs because of it.

The good news is that they will always spontaneously start breathing again following an attack. You probably know from your first aid course that it is a good idea to put him into the recovery position and carry on talking to him, and to check his mouth for food.

Do not hesitate to call an ambulance if you are worried. We have rushed dd1A to hospital three times.

It's horrible, but shouldn't actually be dangerous, and my dd1 is fine now.

If it turns out to be, or even if you just suspect it to be, RAS (reflex anoxic seizure), you will find the STARS website, at this link, very helpful

Should have said, our middle son had RAS from a young baby. He had very frequent 'episodes' in the early years, which lessened considerably from about 3 or 4 years and are all but non existant now he is 8yrs (although, by the nature of the condition, we are always aware an 'episode' could present again).

devondoris - mine has these quite frequently, sometimes when she knocks her head and sometimes when she has got herself into a tantrum, it is scary and I did get her checked out by GP, and would advise the same, she is OK as it alays happens after something IFKWIM, and should grow out of them after she is 2, it is if she does it for no reason then you should get worried. It is not a nice feeling and I think we are way into double figures for these episodes, but try and stay calm, blow in face and cuddles afterwards seem to work.

Sorry, hit 'post' too soon.

If it is RAS, and it really does sound like it to me, one thing I can suggest you try, which we found worked very well for us, is when an episode' occurs, you go down on one knee, scooping your child gently but firmly in your arms, and tilting them over your raised knee, with their head pointing towards the ground (face up). Talk reassuringly throughout (whilst trying to remain calm within yourself). As belgo has said, whilst very (and sometimes extremely) scary at times, the episodes are self-limiting.

As it can help to talk to others, do feel free to contact me if you wish.

thank you all. I feel so much more in control already. Just knowing that they're self limiting makes is so much easier to deal with. It just looks as though he's died which is so scarey. Have crying baby so will be back later.

Hi,

agree with everyone else, just want to add my bit.

ds starting having breath holding spells at around 13months(mostly through tantrums, but sometimes with the shock of a bump) and the doctor ignored it, it wasn't until he fitted during one that he got seen by a paediatrician at the hospital. I did a lot of research on the internet and found out that these spells are sometimes attributed to low iron levels. I asked the paed to do an iron test, he was sceptical but agreed... low and behold his serum ferritin levels were half of what they should have been, he had a course of iron syrup for 3 months and he's only had one since (he had a temp of 40c at the time) he's now 2.

The first time he breath held was the most scary thing in the world, but when he fitted then went still i though my little boy had died, so you have my utmost sympathies that you are having these too, and would get it checked out, and don't be palmed off by your doc telling you its normal.

My DS4had something that sounded like this, I can't remember the exact term, but anoxia was in there- I too thought it was breath holding until GP asked if I had actually seen that he was holding his breath, which I hadn't. Always followed some extreme emotion, possibly pain, but also anger or indignation- yes, honestly, it happened once when paling with a friend and he thought she wasn't playing fair. Gp described it as a 'cut out' when nervous system was overloaded. Last attack was age about 6 he's now 12. I aggree, tell everyone who looks after him, but if it's the same as DS4, no harm will come. Go well.

Thanks again to all. I've had a look on the STARS website and got lots more to think about. I'm going to see the doc on Monday, and will make sure I get our own doc as he's very good and won't try to fob off.

I'll let you know what the verdict is! Must go to bed now as it's been an exciting day. Had a visit to the duty doctor this evening due to same son with rash over back and front. She reckons it's viral and not connected! Oh good!

Do you know if they can have the seizures in their sleep? Just wondering.

Thanks again.

My DS would breath hold after a bad bump. One time he went unconcious and all limp in our arms, and then all the breathing mechanisms kicked in again. We were told to blow in his face to force him to draw breath. Haven't tried it since he's been older but it worked when he was younger. Best to get it checked out though.

I really dislike the term 'breath holding' because it implies that it is a behavioural problem, and that the child is doing it deliberately, when refex anoxic seizure is clearly not a behavioural problem. I've even had someone tell me that dd1 was stopping breathing and fitting as a way of manipulating me! How ignorant is that.

Well, quite! I've had exactly those thoughts over the last few days as people told me about breath holding because as you say, that seems to be behavioural and what Tommy's doing certainly isn't. I have a friend who's little girl used to breath hold and it was really scary, but it wasn't quite the same as what T's doing.

I kept waking up last night and having to check that all the children were breathing! DD1 was in bed with me as DH is away on stag weekend, but the boys were in their cots in their room. I also kept thinking that DD1 was either DT1 or 2 and thinking that they were in bed with me and had stopped breathing! I realise this is an entirely natural reaction but I wish it didn't make me feel so bloody tired today!! I'd quite like to know if they can have the seizures when they're sleeping. Sounds bizarre but it might help me sleep better.

Belgo - how long afterwards does your daughter stay pale? DT1's still a bit pale and interesting, but I'm not sure if it's because of the viral infection or from the attack. Looking forward to going to the doc tomorrow now. Thanks so much for your support, I really appreciate it.

sooo wish I knew about MN when DS (4) was younger - this is exactly the sort of advice and reassurance I needed. DS did exactly the same, devondoris, both after knocks and during extreme tantrums, and they were also very scary (esp the first one of course). He has grown out of it now and hasn't had one since he was 2.7ish

Just re-read my post and thought that maybe some of you might think I was being dismissive about breath holding, which I'm not so thought I'd better re-post and tell you so! I think it's an easy term to use which covers a lot of issues from behavioural breath holding to RAS non-breathing, all of which are as scary as each other when it's actually happening. Sorry if I did sound as though breath holding wasn't as important - I certainly didn't mean to. It all comes of hitting 'post' rather than 'preview'!

Any advice on how to deal with the issues is helpful, so please don't stop it coming!

DD1 used to hold her breath when she was having a huge temper tantrum and cryting really hard. He lips and nose would turn blue and then she would fall flat on her face. Someone told me to do a short sharp breath into her mouth and the shock made her breath again. She did grow out of it.

with breath holding, the child will go blue, as some posters here have described. With RAS, the child/baby goes deathly white - this is because not only have they stopped breathing, but their heart has stopped beating as well (and then of course it will always start beating again.)

Afaik, it won't happen at night time when they are sleeping.

There is a type of night time epilepsy, but RAS isn't epilepsy. My dd1 had a brain scan EEG which was normal, and epilepsy was ruled out.

Interestingly, my dd2 had a febrile convulsion recently, and dh used to faint easily when he was younger. So I wonder if there is a genetic connection between these incidents.

Deveondoris -my dd1 would stay pale for hours afterwards, in fact, she would only be fully recovered the following day. One time she was unconcious for the best part of an hour, by which time she was in hospital and linked up to a load of monitors.

I'm fortunate because four out of the six attacks DD1 had have been witnessed by family members. I read an article recently about a mother who was accused of harming her child, when in fact the child had RAS. That's how little it is known.

Hello,my middle son was diagnosed with RAS at about 2. He is 8 now and hasn't had an attack since his biggest at 5. We were diagnosed after he did it while grizzling about something on the stairs(slid down them into my arms),and during a tickling game.

STARS has been very useful, as have school.The school nurse designed a flow chart for what school was to do if it happened.I was worried he was going to get CPR'd or whisked off to A&E every time.
I use the print offs if he is going to be somewhere without me for more than a couple of hours.
The main thing I worry about now that he is getting more independant is that if he should have to go to A7E following an accident,the staff need to know urgently as there are implications if he needs a general anaesthetic.

Life became alot easier for us since we got our diagnosis and his paed told us that however scarey it looked,his breathing would always restart spontaneously.It also felt good to be taken seriously.

that's interesting wardrobe mistress, especially that you found a paediatrician who know about the condition. The hospital doctors here just called it a 'crying spell' - a crying spell when she stops breathing and has a fit. It was only by paediatrician friend in the Uk who told us what it was.

My GP here didn't have a clue what it was either, and looked very unimpressed when I gave her the information that I had printed out from the STARS website. She didn't bother looking at it properly, and wrote in dd1's medical notes that her parents thought she had 'STARS'