It is an attack that occurs in children under 4 years of age and is closely related to tantrums.
Stage in which it is presented
It can occur at any time between one year and three years of age, although in the vast majority of cases it begins in the first eighteen months, being unknown after four years. In their lesser and milder forms they are quite ordinary; while in the most severe forms, which are associated with major seizures, they are very rare.
Hippocrates , described an attack as:”… The beginning may be due to some mysterious terror, the fear produced by someone screaming or that in the middle of crying the child is not able to quickly catch his breath, as often happens, when any of these things happen to him, his body suddenly becomes cold, he cannot speak, he is unable to breathe, his brain tenses and circulation stops … “
Causes
The usual cause is anger, frustration, punishment, or an effort made by the child to do what he wants. It may be a toy that another child has taken from you or your inability to get the toy that is in the hands of another child. It may be due to the parents’ insistence that they remove their toys, or their refusal to let them do something the child strongly desires.
Importance
It is important to note that the attack may be due to pain from a fall, or a blow, or fear. Repeated attacks are more common in children who are not cared for or treated properly, although I would not go as far as Hinman and Dickey , who consider them primarily an emotional disorder symptomatic of deep insecurity.
The personality of the child is important, so that some have such an attack much more easily than others, even if they face little frustrations or get into mild conflicts with their parents.
It has been said that domesticated monkeys can seizure with apnea attacks when placed in cages. It is wrong to consider them voluntary and, therefore, as behavior problems.
Symptoms
During the attack the child utters two or three high-pitched cries and then holds the breath on the exhale. In the most benign cases, apnea lasts 5 to 10 seconds, the child turns blue, and then recovers.
In somewhat more severe cases, it lasts about five more seconds, the child becomes markedly cyanotic and becomes unconscious, appearing pale and unable to stand. May fall, gives a slight cry, followed by a more vigorous cry, and after a few moments of confusion, returns to normal.
If the apnea lasts for more than 30 seconds, the child is generally stiff and has a few seizures that are indistinguishable from those caused by epilepsy . During the attacks there is marked bradycardia . There may be only one attack in a lifetime or, conversely, they may recur frequently.
If no treatment is applied, it tends to appear less and less frequently, disappearing completely by the fourth year of life. If it is due to pain, it is less likely to recur than if it is due to behavioral problems, unless an excessively tense environment is created, in which case it may be repeated more frequently because it has become a means of attracting attention of others.
Applied studies
Livinsgtone studied 242 cases, of which 87 had one or more attacks a day and 33 had less than one a month. In all cases, except three, the attacks disappeared before the age of five, and in the remaining cases, before the age of six. Electroencephalograms were normal.
Bridge and Sharpey Schafer , discussed the mechanism of apnea attacks. These last authors, described similar attacks in school children and adults provoked voluntarily, they concluded that the blood pressure was caused by the enormous increase in intrathoracic pressure, due in turn to the arrest of breathing at the moment to breathe.
Sharpey Schafer, clarified, among other effects, that the exaggerated increase in ventilation in turn increases blood flow in the muscles, as well as vascular resistance in the brain. Sustained respiration at the time of expiration (apnea) produces a greater than normal drop in cerebral blood pressure, and as cerebral vascular resistance is increased, a considerable decrease in blood flow is caused in brain.