Anoxic Seizure Vs Breath Holding Attack

Anoxic Seizure

Reflex anoxic seizure is a spontaneously reversing episode of asystole, triggered by pain, fear or anxiety.  This is the result of increased vagal stimulation.

Mainly in 6months to 2year olds but can occur at any age.


  • lasts around 30-60 seconds
  • suddenly becomes pale and limp
  • if standing will fall
  • stiffens and has clonic jerking of limbs
  • upward eye deviation
  • urinary incontinence is possible
  • recovery is rapid
  • following coming round, child will feel tired and washed out


  • needs referral for an EEG
  • ECG to rule out long QT syndrome / heart block / pre-excitation / ventricular hypertrophy


  • Reassurance is the mainstay of treatments.
  • advice on putting patient in recovery position
  • drug treatment isn’t required
  • pacemaker insertion is only definitive treatment but it’s only used for frequent, severe cases.

Breath Holding Attack

During a blue breath holding attack, the child becomes cries vigorously for less than 15 seconds, then chid becomes quiet with breath held in expiration and the child can’t take a breath.

  • cries vigorously
  • turns blue particularly around lips
  • loses consciousness, may become floppy or stiff
  • due to part of the crying reflex
  • last for less than a minute


  • Improve with age – usually grow out of it by school age
  • Episodes may get more frequent before they settle completely
  • Reassurance only is necessary

 So Anoxic seizure is a seizure secondary to hypoxia of brain when the cardiac output drops due to vagal stimuli causing asystole whereas breath holding attack is a respiratory cause – they stop breathing so become hypoxic. 

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