ABSTRACT
There are two types of breath-holding attack, namely blue and white. Most start at between six and 18 months of age, and disappear by six years. A typical blue spell is precipitated by frustration, rage or pain. The differences from epilepsy include a clear precipitant, the occurrence of forceful crying and then cyanosis before loss of consciousness, and the absence of post-ictal drowsiness. The risk of epilepsy is no greater than that in the general population, but there is an increased incidence of later syncope in response to pain or surprise. Treatment essentially consists of reassurance, but this never works unless an adequate explanation is given. Parents usually want to know whether breath-holding is dangerous, whether it is epilepsy and whether it may turn into persistent seizures. A paediatric opinion may provide the additional conviction that is necessary. Referral should also be made in the presence of other conditions.
