Affective respiratory attacks (ARS). Clinic, development mechanisms and treatment of childhood affective-respiratory attacks Affective respiratory attacks in children

Unfortunately, parents cannot protect their child from all troubles and illnesses, no matter how hard they try to look after him with maximum care and protect him from all sorts of threats and risks. Affective-respiratory attacks in a child cause severe anxiety, and sometimes real shock in adults. The baby begins to turn blue or pale, go numb, suffocate, the reasons for this condition and what to do is unknown.

Affective-respiratory attacks in children are a condition in which, after a strong emotional stress, fear, anger, resentment, uncontrollable cessation of breathing occurs. This usually happens at maximum inspiration.

To understand the reasons for the occurrence of this condition in a child, you just need to listen carefully and think about the name of the pathology. A state of passion is an emotional outburst of any nature that a person cannot control.

“Respiratory” - means breathing. That is, the problem affects not only emotions, but also the respiratory system. Well, there is no need to explain what seizures are. In adults, this condition is observed very rarely; it is much more common in young children. Treatment of the child is necessary; we will discuss the dangers of ARP below in more detail.

Seizures accompanied by respiratory arrest in a child can occur not only during hysteria; there are other provoking factors:

• a fall;
• strong pain;
• surprise, fright.

Adults are required to pay attention to the child’s condition in a timely manner and help him - often parents believe that the child is pretending, scold him and leave him alone with a terrible pathology.

How to recognize pathology

Such attacks in a child almost always begin with crying. More precisely, at first a scene is played out during which something unacceptable and intolerable for the baby happens. He begins to cry, scream, may stomp his feet, throw small objects away from himself and push adults away.

Such attacks in a child in themselves are not frightening; a common reaction of adults in this case is to spank the intractable, disobedient and ill-mannered child.

And this is where ARP happens most often:

1. Having filled his lungs with air for another round of hysterical crying, the baby suddenly falls silent and freezes.
2. The baby's mouth can open and close, but no sound is made.
3. Such attacks can last up to one minute, while the baby’s face turns pale or blue - color skin determine the reasons why the attack occurred. When frightened or in pain, the skin turns pale; when angry and angry, it turns blue.

Sometimes during a seizure the child’s body becomes very tense, literally arching. And sometimes the baby goes limp and simply “slides” into the arms of an adult. Such symptoms drive parents into hysterics. Although the baby often comes to his senses on his own after some time.

Causes

All people are divided according to their temperament and emotional makeup into Various types. Some people remain cold-blooded and apathetic even in emergency situations, for others, a small thing is enough to flare up like a match and get out of balance. In a child, all emotions and experiences are expressed more clearly than in adults. You can judge a person’s character by his behavior in infancy.

If a child has an impulsive, hot-tempered character, if he reacts violently to a dropped pacifier, a bottle of food not given on time, or a late diaper change, parents should be very attentive and careful. Affective-respiratory attacks usually occur in those children aged 1 month to two years who are spoiled and easily excitable. For adults, a child's hysteria for no particular reason should become a wake-up call– the child has a tendency to ARP.

This is not to say that treatment should be started immediately. But if the child does not learn to control himself, to put up with adults’ refusal to buy candy or the reluctance of a friend in the sandbox to share a toy, very soon treatment will be necessary - such attacks can lead to very serious consequences for the child.

Basic treatment methods

Drug treatment, despite the fact that this childhood condition is very frightening for adults, is required only if ARP is bothered every 5-7 days. Then the attacks are considered a pathology and require observation by a neurologist.

But the little capricious one needs emergency treatment if a strong, prolonged attack occurs. Parents can help the baby in this way:

• take the baby in your arms and place him on your lap;
• pat him on the cheeks, blow lightly on his face;
• gently and lightly tickle the child along the body;
• Sprinkle it with cool water - do not splash it so that it flows like a stream.

It is important to stir up the child, bring him to his senses, and prevent a protracted seizure. And then, when he can breathe in and out again, you need to talk to him gently, calm him down, caress him. Under no circumstances should you tell your child how much he scares you, much less scold him and scream.

Drug treatment is required if the attacks become very frequent and breathing disappears for more than one minute. In this case, due to oxygen starvation brain first the child faints. This terribly scares parents, but in fact, in this way the body tries to protect itself and keep it safe.

When a person loses consciousness, all his organs and tissues consume much less oxygen. Therefore, with hypoxia, fainting often occurs - doctors in this case diagnose an atonic attack of a non-epileptic nature, special treatment which is not required.

After some time, the atonic state turns into a tonic state. That is everything muscle tissue tense up. The child's body stretches out like a string, and then the limbs begin to contract convulsively. The child’s condition is very reminiscent of an epileptic seizure, but this is not it - according to statistics, only in 7% of cases of ARP at an early age leads to the development of epilepsy in schoolchildren.

During this same period of time, carbon dioxide begins to accumulate in the blood. This causes a reflex that relaxes the smooth muscles of the larynx, which are in a state of spasm during ARP. The child unconsciously takes a breath and comes to his senses. It is noteworthy that after an affective-reflex attack, the baby almost immediately falls asleep and sleeps soundly for at least an hour.

Also treatment medicines and physiotherapy is required if, with frequent ARP, any pathology from the nervous system. In any case, consultation and examination by a neurologist is necessary.

Traditional medicine for ARP

It must be said right away - treatment folk remedies with such pathology it is ineffective. Some pediatricians and herbalists recommend a course for children homeopathic medicines sedative effect. Homemade medicines are also suitable - for example, decoctions of valerian, lemon balm, motherwort. But, as practice shows, treatment by a psychotherapist and correct behavior Parents are much more effective in this situation.

Preventive actions

Attacks will not recur and treatment with medications or folk remedies will not be needed if parents realize that in most cases the cause of ARP in a child lies in his dissatisfaction with the emotional situation in the family. Conflicts between parents, constant punishment from mom or dad, or, conversely, excessive care and permissiveness - these are the factors that become the cause of the baby’s unstable state and his inappropriate behavior in a non-standard situation that goes beyond the usual.

Yesterday I almost went grey. It was terrible. Yarushka found the TV remote control and pulled it into his mouth, I took the remote control away, which apparently upset the child madly... he immediately started crying, my husband and I didn’t even have time to do anything (usually a baby doesn’t behave this way, he can of course be naughty, but not so) and literally in a couple of seconds the crying disappeared, the mouth was open, the child began to turn blue before our eyes. God, it was just a nightmare. I started shaking it, my husband snatched it from my hands, turned it face down, and started hitting it on the back (as they do when a child has choked). I ran to the phone to dial 03. By the way, miraculously it turned out to be “busy”... and I heard one short cough... I run into the room, there is silence, my husband is standing with his back to me, there is a completely limp child in his arms, I see how the arms and legs are hanging completely limply, the head is the color of INK... silence. I start howling. God, I don’t wish this on anyone! The husband rushes to the window, throws it wide open and leans out waist-deep with Yarushka in his arms. I shout “Alive??!!!”, my husband does not answer, he is in insane shock... I see that his face turns pale, the blueness recedes.

This is how we first encountered a respiratory-affective attack..

We'll go see a neurologist on Tuesday. I found a good article by Komarovsky. Maybe it will be useful to someone.

Affective-respiratory attacks (attacks of breath holding) are the most early manifestation 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 their breath may seem deliberate, children usually do not do it on purpose. It's just a reflex that occurs when crying baby 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 breath-holding episodes do not last more than 30-60 seconds and pass after the child catches his 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 you refuse to fulfill his demands, achieve what you want, or attract attention, the child begins to cry and scream. Intermittent deep breathing stops on inhalation, and slight cyanosis appears. In mild cases, breathing is restored within a few seconds and the child’s condition returns to normal. Such attacks are superficially similar to laryngospasm - a spasm of the muscles of the larynx. Sometimes the attack drags on somewhat, and either develops a sharp decline muscle tone - 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. This “motor storm” of protest reveals some features of hysterical attacks of older children.

After 3-4 years of age, a child with breath-holding or hysterical reactions may continue to have hysterical attacks or have other character problems. However, there are ways that can help you prevent the dreaded two-year-olds from turning into the dreaded twelve-year-olds.

Principles proper education small child with respiratory-affective and hysterical attacks. Seizure prevention

Attacks of irritation are quite normal for other children, and indeed 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 when expressing our dissatisfaction. Two year old children 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 - so 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 provides for a uniform attitude of all family members towards the child - so that he does not use family disagreements to satisfy all his desires. It is not advisable to overprotect your child. It is advisable to define a child in preschool institutions(nursery, 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 burst into crying and screaming 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 grocery store by simply not shopping when your child is hungry. A child who has a fit of irritation during the rush to go to nursery in morning hours peak, when parents also go to work, and an older brother or sister is going to school, you should get up half an hour earlier or, conversely, later - when the house becomes calmer. Recognize difficult 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 be unable to verbalize (or simply acknowledge) his feelings of rage. In order for him to 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 are less common and are then usually observed against the background of tonic convulsions (tonic-clonic convulsions). Convulsions may be accompanied involuntary urination. After convulsions, breathing resumes.

If you have seizures, it may be difficult to differential diagnosis respiratory-affective paroxysms with epileptic seizures. In addition, in a certain percentage of cases, children with affective-respiratory convulsions may subsequently develop epileptic paroxysms (attacks). Some neurological diseases can also be the cause of such respiratory-affective attacks. In connection with all these reasons, to clarify the nature of paroxysms and the purpose proper treatment Every 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 do it yourself deep breath 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 form of entertainment. Even such a simple attempt as tickling sometimes brings results.

If the attack drags on and is accompanied by prolonged general relaxation or convulsions, place the child on a flat surface and turn his head to the side so that he does not choke if he vomits. Read in detail my recommendations “HOW TO HELP DURING AN ATTACK OF SEIZURES OR CHANGES IN CONSCIOUSNESS”

After an attack, reassure and reassure your child if he does not understand what happened. Reemphasize the need for good behavior. Don't retreat just because you want to avoid repeat breath-holding episodes.

These are attacks in which, after exposure to an emotional or physical stimulus that is excessive for the nervous system, the child holds his breath, short-term apnea (breathing stops) occurs, and sometimes convulsions and loss of consciousness occur. Such attacks usually pass without consequences, but require observation by a neurologist and cardiologist.

Affective-respiratory attacks occur in children aged 6 months to one and a half years. Sometimes they appear in a 2-3 year old child. Newborns do not suffer, up to 6 months of age there are practically no attacks due to the pronounced immaturity of the nervous system, and with age the child “outgrows” them. The frequency of attacks is up to 5% of all children. Such a child demands special attention when raising, because children's seizures are equivalent to hysterical fits in adults.

Why do seizures occur?

The leading causes are hereditary. There are children who are excitable from birth, and there are character traits of their parents that involuntarily provoke these attacks. Parents of such children also experienced bouts of “rolling down” in childhood.. In children, affective-respiratory paroxysms can occur in response to the following situations and stimuli:

• adults ignoring the child’s demands;
• lack of parental attention;
• fright;
• excitation;
• fatigue;
• stress;
• overload with impressions;
• falls;
• injuries and burns;
• family scandal;
• communication with an unpleasant (from the child’s point of view) relative.

Adults must understand that the child reacts this way unconsciously, and not at all intentionally. This is a temporary and abnormal physiological reaction that is not under the child's control. The fact that a child has such a reaction is “to blame” for the characteristics of his nervous system, which cannot be changed. The child was born this way early age- the beginning of all manifestations. This needs to be corrected by pedagogical measures in order to avoid character problems at an older age.

What does it look like?

Pediatricians conditionally divide affective-respiratory syndrome into 4 types. The classification is as follows:

• A simple option, or holding your breath at the end of the exhalation. Most often develops after a child’s dissatisfaction or trauma. Breathing is restored on its own, and blood oxygen saturation does not decrease.
• The “blue” option, which most often occurs after a pain reaction. After crying, a forced exhalation occurs, the mouth is open, the child does not make any sounds - “rolled”. Rolling of the eyes and cessation of breathing are visible. The baby first turns bright red, then turns blue, then goes limp, and sometimes loses consciousness. Some regain consciousness after regaining their breathing, while others immediately fall asleep for an hour or two. If you record an EEG (encephalography) during an attack, there are no changes in it.
• “White” type, in which the child almost does not cry, but turns sharply pale and immediately loses consciousness. Then comes sleep, after which there are no consequences. No seizure focus is detected on the EEG.
• Complicated - begins as one of the previous ones, but then paroxysms similar to epileptic seizure, which may even be accompanied by urinary incontinence. However, subsequent examination does not reveal any changes. This condition can pose a danger to all tissues due to severe oxygen starvation, or brain hypoxia.

Such convulsions do not pose a threat to life, but consultation with a neurologist is required in order to distinguish them from more severe cases. Breathing stops for a period of time from several seconds to 7 minutes, and it is very difficult for parents to maintain composure. The average time to stop breathing is 60 seconds.

Mechanism of development and clinical picture

Seizures look scary, especially in infants. When a child stops breathing, the supply of oxygen to the body stops. If you hold your breath for a long time, it reflexively drops muscle tone– the baby “goes limp.” This is a reaction to acute oxygen deficiency to which the brain is exposed. A protective inhibition occurs in the brain, its work is restructured to consume as little oxygen as possible. Eye rolling ensues, which greatly frightens parents.

With continued holding of breath, the muscles sharply increase tone, the child’s body tenses, arches, and clonic convulsions may occur - rhythmic twitching of the torso and limbs.

All this leads to the accumulation of carbon dioxide in the body - hypercapnia. This reflexively stops the spasm of the laryngeal muscles, and the baby takes a breath. Inhalation is usually done while crying, then the child breathes well and calmly.

In practice, seizures rarely occur. After apnea, the child usually immediately stops rolling; in some, breathing is restored after “going limp.”

Breathing and emotions

It’s not for nothing that the attack is called an affective-respiratory attack, or ARP for short. Small child This is how he expresses his anger and dissatisfaction if something is done “not according to him.” This is a real affect, an emotional attack. Such a child is initially characterized by increased emotional excitability and moodiness. If we leave character traits without attention, then at an older age the child gives real hysterical reactions if he is denied something: he falls to the floor, yells at the entire store or kindergarten, stomps his feet and calms down only when he gets what he wants. The reasons for this are twofold: on the one hand, the child has hereditary characteristics nervous system, on the other hand, his parents do not know how to handle him in such a way as to smooth out all the “angles” of his character.

What to do during an attack?

First of all, don’t panic yourself. Emotional condition surrounding adults is passed on to the baby, and if confusion and fear are “stirred up,” it will only get worse. Hold your breath yourself. Feel that nothing bad happened to you and your baby due to the temporary delay in breathing movements. Blow on the baby's nose, pat his cheeks, tickle him. Any such impact will help him quickly recover and breathe.

During a prolonged attack, especially with convulsions, place the baby on a flat bed and turn his head to the side. This will prevent him from choking on vomit if he vomits. Spray it on him cold water, wipe your face, tickle gently.

If during an attack parents “tear out their hair,” then the baby’s condition becomes more serious. After an attack, even if there were convulsions, give the baby a rest. Don't wake him if he's asleep. It is important to remain calm after an attack, speak quietly, and not make noise. In a nervous environment, the attack may recur.

For any attack with convulsions, you should consult a neurologist. Only a doctor can distinguish ARP from epilepsy or other neurological disorders.

Make an appointment with your doctor if this happens for the first time. It is necessary to distinguish between illness and affective reaction. If the attack has happened more than once, but there is no illness, you need to think about raising the baby.

If this happens to your baby for the first time, you should call the nursery " ambulance", especially if convulsions occur. The pediatrician will assess the severity of the condition and decide whether hospitalization is required. After all, parents are not always able to fully monitor their baby, and this is how the consequences of a traumatic brain injury, poisoning or acute illness can manifest themselves.

Simple rules for parents

The task of parents is to teach the child to manage his anger and rage so that it does not interfere with the lives of the rest of the family members.

Discontent, anger and rage are natural human emotions; no one is immune from them. However, boundaries must be created for the baby, which he has no right to cross. To do this you need this:

• Parents and all adults living with the child must be united in their requirements. There is nothing more harmful for a child when one allows and the other forbids. The child grows up to be a desperate manipulator, from whom everyone then suffers.
• Define in children's group. There, the hierarchy is built naturally, the child learns to “know his place in the pack.” If attacks occur on the way to the garden, you need advice child psychologist, which will specifically indicate what needs to be done.
• Avoid situations where an attack is likely to occur. The morning rush, a queue at the supermarket, a long walk on an empty stomach - all these are provoking moments. It is necessary to plan the day so that the baby is well-fed, has sufficient rest and free time.
• Switch attention. If a child bursts into tears and the crying intensifies, you need to try to distract him with something - a passing car, a flower, a butterfly, snowfall - whatever. It is necessary not to let the emotional reaction “flare up” .
• Clearly define boundaries. If a child knows for sure that he will not receive a toy (candy, gadget) from either his grandmother or aunt, if his father or mother forbade it, then after the most desperate crying he will still calm down. Everything that happens needs to be spoken in a calm tone. Explain why crying is useless. “Look, no one in the store is crying or screaming. It’s impossible - it means it’s impossible.” Sensitive children need to add that mom or dad loves him very much, he is good, but there are rules that no one is allowed to break.
• Call a spade a spade and pronounce the consequences of whims. “You're angry and I can see it. But if you continue to cry, you will have to calm down alone in your room.” You need to be honest with children.

How is the diagnosis made?

First, the doctor comprehensively examines the child. If necessary, ultrasound of the head (neurosonography) and EEG, sometimes a heart examination (ECG, ultrasound), are prescribed. The diagnosis of ARP is made only when there are no organic disorders not detected.

Treatment begins with proper organization child's life. The recommendations are simple - regimen, diet, walks, activities according to age. But without following these recommendations, no treatment will help, because a measured, orderly lifestyle is the main thing a child needs.

Some parents need sessions with a family psychologist so that they can learn to understand their own children. Drug treatment is rarely required, and in this case is most often limited to neuroprotectors and nootropic drugs, as well as vitamins.

The best prevention is a calm, friendly atmosphere in the family without quarrels and lengthy showdowns.

(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 similar in appearance to an atonic seizure in epilepsy, but ARP occurs due to acute oxygen deficiency 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 dream 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, may be due to overprotection, chronic stressful situations in 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 rolling up in crying, when physical activity There are also episodes of pallor and hyperhidrosis.

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

7. Parents celebrate 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. Treatment does not help with epilepsy sedatives, and the effect occurs only from the use of antiepileptic drugs, with ARP - 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 think your child will react negatively certain conditions, then plan 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, spray a little cold water on the face, pat or pinch the cheeks, rub ears, pat on 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 a 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 rolling up in crying, in the recommendations we pay attention to great attention the need for psychotherapy. Correction is carried out in psychologist's classes family relations, instilling in the child independence and resistance to negative factors.

Great importance in the treatment of affective-respiratory syndrome It has healthy image life:

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. You will be surprised that computer games used even in children under 1 year of age, and without observing 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) can be recommended soothing herbs, ready-made extracts of motherwort, peony root and others). 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 integrated approach in 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 rendering urgent measures in the form of carrying out cardiopulmonary resuscitation (artificial respiration And indirect massage hearts).

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. Individual treatment A neurologist will prescribe your child, and after he understands it, he will rule out more severe pathologies such as epilepsy and cardiovascular pathology. Consult your doctor.

Many parents have sometimes noticed that during a strong hysteria the child begins to scream and for a moment (or maybe even for a moment) longer gap time) he becomes silent, as if he is starting to take in more air for an even stronger scream. Indeed, in most cases the child “gains strength” to cry even louder, but it happens that affective respiratory attacks in children are to blame. This is a kind of childhood manifestation that manifests itself in adults.

An affective respiratory attack in a child (ARA) is not dangerous and should not cause concern to parents (only if the child is not older than 3 years). This is a condition that is characterized by delayed or unnatural breathing and, in some cases, seizures.

What happens to the baby? Since the nervous system of young children is unstable, they become overexcited very easily, burdening themselves emotionally and psychologically.

At a certain moment of screaming or hysteria, the baby freezes, his breathing seems to suddenly stop, and this causes cause for concern.

A laryngeal spasm begins to occur inside the body, which is not visible from the outside. Such spasms cause discomfort and even pain to the child.

In addition to internal discomfort, the attack is also manifested by vegetative changes, namely a change in skin tone. After all, the body does not receive oxygen, and it is forced to react.

The duration of the attack varies from several seconds to one minute, but no more.

The frequency of manifestation of this phenomenon is purely individual, since each child is an individual and has behavioral characteristics. For example, children with increased nervous excitability may experience ARP more often than their calmer peers.

You shouldn’t think that ARP is found everywhere, not at all. These attacks may not appear in the most restless children, and, on the contrary, develop in calm ones.

With age this pathology passes without a trace. There is no evidence that affective respiratory attacks occur in adults. However, if the baby continues to choke after three years, this is a reason for concern and a more in-depth examination.

Classification

The classification of ARP includes two subtypes of the disease:

1. Pale type.
2. Blue type (with cyanosis).
3. Mixed type.

These names characterize the child's skin color that the child acquires during an attack. Moreover pale color happens much less frequently than blue and indicates pain to the child (prick, blow, bruise, etc.). It is possible that the pale type may progress to loss of consciousness due to an excess of carbon dioxide in the body

Blue color, in turn, appears during times of serious emotional stress (inability to get what you want or fear of being with stranger or unfamiliar area).

The psyche of a child, especially a newborn, is quite fragile and requires total control on the part of the parents, precisely because of such unpleasant and to some extent dangerous manifestations.

Despite the fact that ARP does not cause delays in the development of the child, there is a danger of violation respiratory system baby.

Causes

Affective respiratory syndrome in children does not manifest itself just like that, but for a specific reason. In particular, children who are influenced by the following factors are at risk:

• heredity (if one of the parents suffered from a similar illness in childhood, with a probability of up to 35% the child will inherit this syndrome);
• cardiovascular pathology;
• iron deficiency;
• epileptic component (the presence of a patient’s history of epilepsy increases the risk of developing this syndrome).

On the part of the nervous system, provoking factors may include:

• severe irritation or anger;
• feeling of dissatisfaction;
• fear, panic state;
• resentment;
• overwork;
• overexcitement.

An important role in the emergence similar attacks The behavior of the parents and the general atmosphere in the house play a role.

Symptoms

The main symptom of ARP is short-term breath holding during inspiration. That is, the patient exhaled, but cannot inhale and seems to freeze in this state.

The blue type of disease develops according to the following scenario:

The child cries a lot or simply screams, and develops a hysterical attack. While screaming, he involuntarily exhales air from his lungs and at this moment an involuntary cessation of breathing occurs.

• open mouth;
• the crying stops;
• a bluish tint to the face and lips begins to appear;
• complete absence of breathing, but no more than a minute.

By the way, ARP can also develop in infants.

After the attack has stopped, the child may become limp and fall asleep. This sleep lasts up to 2 hours, depending on the intensity of the attack.

If the breath is held for more than one minute, the child may experience convulsions. In medicine, there is such a thing as a clinical convulsion (occurs when there is insufficient oxygen supply to the body).

As for the pale type of the disease, it manifests itself a little differently. When strong fear before an injection or something else that he is afraid of, when pain is caused to him, the child becomes quiet (in most cases), turns pale and loses consciousness.

Most early sign impending affective attack - pale skin. There is also the possibility of no pulse for a short period of time.

The child seems to be in a state of passion and cannot control his fear. In the most severe cases Involuntary urination may occur.

Diagnostics

Affective syndrome in children is easy to diagnose. Anamnesis plays a major role in determining the disease. The doctor interviews the parents and finds out what preceded similar manifestation(trauma, serious unequal overexertion, etc.).

TO instrumental method diagnostics include:

1. Electrocardiogram (ECG).
2. Electroencephalogram (EEG).

Treatment

As a rule, such a condition does not require treatment from doctors, since it is not pathological.

The attacks go away on their own when the child reaches three years of age, but in most cases even earlier, at one or two years of age.

There is no point in treating ARP; the only thing a doctor can prescribe is nonspecific treatment, which will be aimed at normalizing the baby’s nervous system and improving metabolic processes in the brain. This treatment includes:

• nootropics;
• sedative herbal medicines;
• B vitamins;
• physiotherapy.

Specific treatment includes preventive conversations with a child psychologist and directly with parents

Proper parental behavior

What should parents do if they discover that their child is having seizures?

• do not panic;
• try to bring the child to his senses (blow sharply on him, splash water in his face, lightly pat him on the cheek);
• do not focus the child’s attention on the presence of a similar problem;
• work with the baby, teach him to control his emotions;
• warn teachers in kindergarten about the baby’s characteristics, and tell them how to act in such a situation.

Prevention and consequences

Typically the consequences of this disease unlikely and occur in extreme cases. The most negative of those that can develop in 10–15% of cases are coma and cessation of cardiac activity.

During the entire existence of the ARP, a fatal outcome was noted only a few times.

• limiting situations that could lead to the development of hysteria or severe crying, fear;
• feed the baby in a timely manner, since hunger provokes ARP;
• do not overtire the child;
• listen to the child in any situation without leading to hysterics;
• teach your child the rules of behavior in different places (teach to control your emotions);
• When hysteria develops, switch the child’s attention to positive aspects.

So, affective-respiratory attacks in children are unpleasant, but not dangerous manifestations. Despite the fact that the prognosis for this disease is favorable, it must be taken into account that we are talking about a child. Do not delay in contacting a doctor; it is better to control this process together with a specialist than on your own. Take care of your children and don't get sick!