Affective-respiratory syndrome in children

The biggest stress for a mother is illness in her baby, because the baby cannot explain where he feels pain. What happens to a baby if he turns white or blue from crying? Affective-respiratory attacks occur in infants. Parents must be prepared for such a phenomenon so as not to leave the poor child without help due to panic.

Affective-respiratory attacks (ARA) in children are a breath-holding (apnea) due to spasms of the larynx, which is accompanied by severe crying, weakness or muscle tension, sometimes loss of consciousness and convulsions. 25% of completely healthy babies scare their mothers with this condition once in their lives. In 5% of infants, ARP recurs. Typically, such problems arise at the end of the first year of a toddler’s life. ARP cannot be called a dangerous disease, but attacks should not be left unattended.

How should parents behave during ARP?

In the course of ongoing scientific research, scientists have found that the parents of 25–27% of children suffering from ARP have had similar attacks in the past.
But this does not at all indicate that attacks are inherited. Most likely, it is more appropriate in this case to talk about the traditions of upbringing in a family where two generations - parents and children - at one time suffered from the same problem. As a rule, doctors agree that the main factor causing the beginnings of childhood hysteria in the form of ARP can be considered conflicts between parents, stressful situations for the child in the family, and excessive parental care. An affective-respiratory attack is mainly a neurotic disorder, so parents should pay priority attention to unobtrusive correction of the child’s psychological worldview. When you somehow witness ARP in your child, it is advisable to immediately think about how you build a relationship with your child

Perhaps you are overprotective of him, sometimes trying to protect him from minor life adversities, or are you pampering him too much when parents do not deny their child anything? Here you may need to contact a psychologist if there is no mutual understanding between spouses in your family

When you somehow witness ARP in your child, it is advisable to immediately think about how you build a relationship with your child. Perhaps you are overprotective of him, sometimes trying to protect him from minor life adversities, or are you pampering him too much when parents do not deny their child anything? Here you may need to contact a psychologist if there is no mutual understanding between the spouses in your family.

The correct daily routine, which is based on a balanced, correct physical and mental load, is of great importance for the development of a strong child’s psyche. It will not be amiss if you closely monitor your baby during the day - this way you can predict and prevent the development of ARP. For example, a hungry and tired child will be more capricious than one who was fed and put to bed on time. This also applies to everything else: getting ready for kindergarten, going to visit or to the store - everything should cause the baby the least discomfort.

You definitely need to talk to the little man about his feelings. Indeed, in some cases, hysterics appear and continue to occur with enviable regularity only because the child cannot cope with his feelings and stop in time. But you just help the capricious person understand that all his emotions - anger, frustration, resentment - are completely natural, and they can be dealt with one way or another. Be sure to teach your child the art of compromise, because this can later help him out more than once in the future.

In case of particularly severe attacks of breath holding, the doctor may prescribe a course of treatment for the baby using neuroprotectors and sedatives (Pantogam, Glycine, Pantocalcin) lasting 1.5–2 months.

If the mother can prevent the child from approaching that dangerous edge beyond which whims and hysterics begin, it is quite possible to do without drug treatment.

How to recognize ARP?

Whatever the causes of affective-respiratory attacks in children, the symptoms of this problem are usually the same. A sudden deterioration in well-being occurs in a baby when he starts crying. Child:

stops breathing;
opens his mouth, his lips acquire a bluish tint;
goes limp and slowly falls.

There are white and bluish attacks of breath holding. During the first type, the boy or girl turns pale, his/her heartbeat becomes slow, and fainting is possible. Most often, this phenomenon is the result of pain. In the second type of ARP, the baby inhales sharply due to an outburst of anger, oxygen stops flowing through the larynx, and the poor thing loses consciousness. The body may not go limp, but arch.

The duration of an attack of any type is no more than 1 minute. But when a mother observes such signs in her child, this is enough time to fear for his life.

ARP is not a reason to panic, but if they occur, a consultation with a neurologist is necessary. A qualified specialist will determine whether the symptoms that you mistook for affective-respiratory syndrome are the result of more dangerous diseases. This opinion regarding affective-respiratory attacks in children is shared by Dr. E.O. Komarovsky is a famous and very experienced pediatrician.

What to do during an attack?

First of all, don’t panic yourself. The emotional state of the surrounding adults is transmitted 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 him with cold water, wipe his face, tickle him 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 a pediatric 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. Place in a children's team. 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 to consult a child psychologist, who 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 - anything.

It is necessary not to allow the emotional reaction to 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.

Respiratory distress syndrome of the fetus and newborn: when the first breath is difficult

The time required for the complete development of all organs of the child in the intrauterine period is 40 weeks. If the baby is born before this time, his lungs will not be formed enough to breathe properly. This will cause disruption of all body functions.

Insufficient lung development causes neonatal respiratory distress syndrome. It usually develops in premature babies. Such babies cannot breathe fully, and their organs lack oxygen.

This disease is also called hyaline membrane disease.

Why does pathology occur?

The causes of the disease are a lack or change in the properties of surfactant. This is a surfactant that ensures the elasticity and firmness of the lungs. It lines the inside surface of the alveoli - the breathing “sacs” through the walls of which oxygen and carbon dioxide are exchanged. With a lack of surfactant, the alveoli collapse and the respiratory surface of the lungs decreases.

Fetal distress syndrome can also be caused by genetic diseases and congenital lung abnormalities. These are very rare conditions.

The lungs begin to fully form after the 28th week of pregnancy. The earlier premature birth occurs, the higher the risk of pathology. Boys are especially often affected. If a baby is born before 28 weeks, he will almost inevitably develop the disease.

Other risk factors for pathology:

Mechanism of development (pathogenesis)

The disease is the most common pathology of newborns. It is associated with a lack of surfactant, which leads to collapse of areas of the lung. Breathing becomes ineffective. A decrease in oxygen concentration in the blood leads to an increase in pressure in the pulmonary vessels, and pulmonary hypertension increases the impairment of surfactant formation. A “vicious circle” of pathogenesis arises.

Surfactant pathology is present in all fetuses up to the 35th week of intrauterine development. If there is chronic hypoxia, this process is more pronounced, and even after birth, lung cells cannot produce sufficient amounts of this substance. In such babies, as well as with extreme prematurity, neonatal distress syndrome type 1 develops.

A more common occurrence is the inability of the lungs to produce enough surfactant immediately after birth. The reason for this is the pathology of childbirth and cesarean section.

In this case, the expansion of the lungs during the first inhalation is disrupted, which prevents the normal mechanism of surfactant formation from starting.

RDS type 2 occurs with asphyxia during childbirth, birth trauma, or surgical delivery.

In premature babies, both of the above types are often combined.

Impaired lung function and increased pressure in their vessels cause intense stress on the newborn’s heart. Therefore, manifestations of acute heart failure with the formation of cardiorespiratory distress syndrome may occur.

Sometimes other diseases arise or manifest themselves in children in the first hours of life. Even if the lungs functioned normally after birth, concomitant pathology leads to a lack of oxygen. This starts the process of increasing pressure in the pulmonary vessels and circulatory disorders. This phenomenon is called acute respiratory distress syndrome.

The adaptation period, during which the lungs of a newborn adapt to breathing air and begin to produce surfactant, is prolonged in premature infants. If the child's mother is healthy, it is 24 hours. If a woman is ill (for example, diabetes), the adaptation period is 48 hours. During this entire time, the child may experience respiratory problems.

Manifestations of pathology

The disease manifests itself immediately after the birth of a child or during the first day of his life.

Symptoms of distress syndrome:

bluish skin;
flaring nostrils when breathing, fluttering of the wings of the nose;
retraction of the pliable areas of the chest (xiphoid process and the area under it, intercostal spaces, areas above the collarbones) on inspiration;
fast shallow breathing;
decrease in the amount of urine excreted;
“Moans” when breathing, resulting from spasm of the ligaments, or “expiratory grunting”.

Additionally, the doctor records such signs as low muscle tone, decreased blood pressure, lack of stool, changes in body temperature, swelling of the face and limbs.

Possible complications

Respiratory distress syndrome can rapidly deteriorate a newborn's condition during the first days of life and can even cause death. The likely consequences of the pathology are associated with a lack of oxygen or with incorrect treatment tactics, these include:

accumulation of air in the mediastinum;
mental retardation;
blindness;
vascular thrombosis;
bleeding in the brain or lungs;
bronchopulmonary dysplasia (improper development of the lungs);
pneumothorax (entry of air into the pleural cavity with compression of the lung);
blood poisoning;
renal failure.

Complications depend on the severity of the disease. They may be significantly expressed or not appear at all. Each case is individual. It is necessary to obtain detailed information from the attending physician on further tactics for examining and treating the baby. The mother of the child will need the support of loved ones. Consulting a psychologist will also be useful.

Source: https://ginekolog-i-ya.ru/respiratornyj-distress-sindrom-novorozhdennyh.html

Treatment of affective-respiratory attack

Therapy for disorders of psycho-emotional behavior in children, which causes sudden holding of breath, consists mainly of correcting educational aspects and actions on the part of parents. In order for the child not to encounter this pathology, or to avoid its further development in case of manifestation, it is necessary to follow the following recommendations:

Avoid conflict situations. If circumstances arise that the child begins to lose his temper and shows irritation, then you should not shout at him or tell him what to do next. You should take a neutral position and give him the opportunity to express his opinion and wishes. If they do not go beyond the scope of actually implementing them, then give the child some freedom of action and, if possible, give him advice. This will relieve irritation and prevent a hysterical attack.
Stimulation to action. Young children are excellent at following simple and clear commands for action. If there is a situation where a child is screaming and throwing a tantrum, you do not need to wait until he begins to hold his breath. You should order him in a confident and persistent voice to get up and go to his mother or father. This works much better than asking people to stop crying.
Education of emotions. The baby still does not have enough special knowledge to distinguish which emotions are good and which are better not to use in everyday life. Therefore, in moments of calm and good mood, parents should teach the baby that crying, loud screams and hysterical behavior are very bad, and obedience to parents is what the child should strive for every day.
The truth about consequences. Children should know from an early age what awaits them in the future if they do this or that action. This also applies to behavior patterns. You should not be afraid to traumatize the impressionable mind of the baby. He needs to be told that if he cries, screams and gets irritated all the time when he doesn’t like something, then he will never have friends, everyone will turn away from him and he will be left alone. Children are always socially active and the possible lack of company causes them wariness and fear.

What is SARS?

Acute respiratory distress syndrome is caused by coronavirus (SARS-CoV).

It was first discovered in Asia in February 2003. The global epidemic is believed to have begun when the virus spread from small mammals in China. Coronaviruses are a group that cause intestinal or respiratory tract infections in a variety of animals, including humans.

When viewed under a microscope, it has a halo or crown. Responsible for 10-30% of colds. These viruses are a common cause of mild to moderate inflammation of the upper respiratory tract in humans and are associated with respiratory, gastrointestinal, hepatic, and neurological diseases in animals.

The virus is present in the respiratory secretions of infected people.

The main mode of spread is through “close contact between people.”

In the context of SARS, close contact means caring for or living with a person with SARS or direct contact with the patient's respiratory secretions or body fluids.

Spread occurs when droplets from an infected person's sneeze through the air are deposited on the mucous membranes of the mouth, nose, or eyes of loved ones.

The virus can spread when a person touches a surface or object contaminated with infectious droplets, then touches their mouth, nose, or eyes.

It is also possible that the coronavirus could spread more widely through the air (air spread) or other ways that are not yet known.

The virus can live on hands, tissues, and other surfaces for 6 hours in droplets and up to 3 hours once the droplets have dried . It has been shown to live for up to 4 days in infected stool. The coronavirus can live for months or years below freezing temperatures.

Chest radiograph showing pneumomediastinus (arrowheads), surgical emphysema (arrows) in the left axilla. There are patchy areas of consolidation in both the lower and middle zones.

Symptoms and signs

Each affective-respiratory paroxysm is necessarily preceded by some strong emotion. Just like that, being in a familiar and calm state, the child does not fall into an attack. Each attack develops in strict accordance with the order of changing stages; each attack is exactly similar to the previous one.

Trying to cope with the emotion, the baby begins to breathe unevenly, cry, and then suddenly becomes silent, freezes and remains in this state for some time, his mouth is usually open. Parents may hear wheezing and clicking sounds. The baby cannot control holding his breath and interrupt it of his own free will. Apnea does not obey the will of the child.

With a simple attack, breathing is restored in about 15 seconds. The baby looks normal and has no other symptoms. With other forms of ARP, the baby may fall, lose consciousness, and his skin and mucous membranes become pale or bluish. During an attack, the pulse is almost not palpable or it is very weak.

The body may arch (Dr. Komarovsky calls this a “hysterical bridge”) if the muscles are very tense, or go limp, like a rag doll, if they are relaxed. Convulsions, if present, most often manifest themselves in the form of involuntary twitching, for example, of the limbs.

Recovery always begins with normalization of breathing. Then the skin and mucous membranes acquire a normal color, and the muscles come into order. Recovery from a normal attack is quick, the child may immediately ask for food or start playing. The longer the attack lasts, the more time it takes to fully recover. When a complicated attack occurs, the child continues to quietly cry and whine for some time, and with this he usually falls asleep for a couple of hours.

Symptoms of ARS in children

Affective-respiratory manifestations begin with crying, fear, pain. The child breathes intermittently, suddenly becomes silent, freezes, and his mouth remains open. You can hear wheezing, hissing, and clicking sounds. Manifestations of apnea are involuntary. Breathing is interrupted for a period of 10 seconds to 1 minute. A simple attack ends after 10-15 seconds, there are no additional symptoms. Apnea after a fall or blow is accompanied by blanching of the skin and mucous membranes. The pain reaction develops very quickly, there is no crying or the first sobs are heard. Fainting occurs, the pulse is weak or cannot be felt.

Affective-respiratory syndrome with negative emotions - resentment, rage, frustration - is typical for children 1.5-2 years old. Stopping breathing occurs at the moment of strong crying or screaming. Accompanied by bluish skin, simultaneous hypertonicity or a sharp decrease in muscle tone. The child's body arches or goes limp. Less commonly, clonic convulsive muscle contractions (twitching) develop. In all cases, the breathing process is restored independently, the color of the skin is normalized, and convulsions disappear. After a simple attack, the child quickly recovers - begins to play, run, and asks for food. Prolonged attacks with loss of consciousness and convulsions require a longer recovery. After apnea ends, the child cries quietly and falls asleep for 2-3 hours.

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 no organic disorders are found.

Treatment begins with the proper organization of the 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 it 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.

Rate this article:

4.38

Total votes: 131

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). Cramps may be accompanied by involuntary urination. After convulsions, breathing resumes. In the presence of seizures, difficulties may arise in the differential diagnosis of 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 cause such respiratory affective attacks. In connection with all these reasons, to clarify the nature of paroxysms and prescribe the correct treatment, every child with respiratory-affective attacks should be examined by an experienced pediatric neurologist.

Traditional methods

An infusion of valerian roots relieves excitability well. For this, 2 tsp. infuse in 100 ml of water. Give 1 tbsp 3 times a day. l.
Tea made from raspberry leaves, chamomile, mint, linden flowers, and hawthorn has a beneficial effect. You can brew the whole collection or separately.
A glass of warm milk before bed has a calming effect. The child quickly falls asleep and feels cheerful in the morning.

The games that the baby plays play an important role. Modeling with clay or plasticine and drawing are very relaxing.

In many ways, the parents themselves are to blame for the fact that their child throws tantrums. Often they spoil their child so much that they themselves suffer from it. Children very quickly understand that in this way they can achieve what they want, and after three years they are already in full swing manipulating adults. If this is left unattended and not stopped, it will affect the character in the future.

Causes

All people are divided into different types according to their temperament and emotional make-up. 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 lose their 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 be an alarm bell - the child has a tendency towards 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.

Approaches to parenting if your baby has ARP

You shouldn't pamper him too much; he should know that there are things in the house that shouldn't be touched.
But you also can’t be too strict with your baby. We must remember that he is still small, and his psyche is just developing. Constant bans have a bad effect on him.
It is best if the baby has his own corner or room where he can do everything, but only within its boundaries.
The relationship between parents is also important. You can’t sort things out in front of children. The loud screams of adult babies frighten them, and they begin to cry. Fear can also lead to an attack with respiratory arrest.

A properly structured daily routine plays an important role. A well-rested and timely fed baby is less capricious and balanced than a tired and hungry one.

Diagnosis of atypical pneumonia

Chest x-rays, blood cultures, and tests to identify viral pathogens are useful in diagnosing atypical pneumonia.

Tests include:

Chest x-ray or scan - in most people, chest changes show pneumonia.
Enzyme-based immunosorbent assay (ELISA) test.

This test reliably detects antibodies, but only 21 days after the onset of symptoms.

Immunofluorescence analysis. Detects antibodies 10 days after the onset of the disease.
Reverse transcription-polymerase chain reaction (RT-PCR) testing – SARS-CoV can be detected in clinical samples such as blood, stool, nasal secretions.
Antibody tests. Serological testing is performed to detect SARS-CoV antibodies acquired after infection.
Viral culture and direct virus isolation.

For virus culture, some of the liquid that is infected is placed in a container along with cells where the virus can grow. If the virus grows in culture, it will cause changes in the cells that can be seen under a microscope.

Serological tests. A serological test is a laboratory method to determine the presence or level of antibodies to an infectious agent in serum.
Blood clotting tests
Complete blood count - white blood cells (neutrophils, lymphocytes) and platelet counts are often low.

All current tests have some limitations. They may not be able to easily identify the disease during the first week when it is most important.

Key features for diagnosing severe acute respiratory syndrome (SARS)

Compatible clinical symptoms of respiratory illness (temperature: >38°C) and at least one respiratory sign (cough, shortness of breath, difficulty breathing, hypoxia)

Presence of radiological evidence of consolidation

Failure to demonstrate clinical or radiological response to potent antibiotic therapy

Unexplained, persistently abnormal lymphopenia, elevated AST and ALT

Molecular, serological confirmation of SARS-CoV infection

History of exposure to suspected or confirmed SARS patients or history of travel to risk areas or history of exposure to contaminated materials (laboratory workers)

SARS-CoV: acute respiratory syndrome coronavirus; AST: aspartate transaminase; ALT: alanine transaminase.

How to prevent ARP

You should always feel the mood of your child. Notice what irritates him most and try not to create such situations. For example, if he doesn’t like quick preparations, you can start them a little earlier and collect them more slowly.
The categorical word “impossible” can be replaced with a proposal for some interesting action, bypassing the prohibited item. For example, if a child wants to walk through a puddle, he must be gently convinced that it is better to walk along the path and bridge. And explain to him why this is better.
You need to constantly communicate with the child and explain why his behavior is bad, what he is doing wrong. It is necessary to explain that his condition is understood, but one cannot behave this way.
The child also needs to be told what consequences his bad actions will lead to. He must understand that if his parents do something he doesn’t like, namely punish him, then he will be to blame for this.
There is no need to set tasks for your child that he is not able to complete. This will lead to unnecessary irritation. If a child is already good at something, let him develop these skills. At the same time, it will not be amiss to praise him.

With the right approach, parents and their baby build a trusting relationship. The child obeys adults and is not capricious.

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 take a deep breath yourself and then remember this: holding your breath almost never causes harm (you can hold your breath for a while without harm, right?) .

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 is prolonged and 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 suffocate if he vomits.

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

Classification

The classification of ARP includes two subtypes of the disease:

Pale type.
Blue type (with cyanosis).
Mixed type.

These names characterize the child's skin color that the child acquires during an attack. Moreover, a pale color occurs 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 a 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 child’s development, there is a danger of disruption of the baby’s respiratory system.

Symptoms

Symptoms of severe acute respiratory syndrome include cough, difficulty breathing, fever, and mild respiratory symptoms.

Find out more 28 successful people with Down syndrome

Symptoms of atypical pneumonia:

Dry cough;
Difficulty breathing;
High temperature (>100.4°F/38.0°C);
Other respiratory symptoms;

Headache;
General feeling of discomfort;
Body pain;
Diarrhea;
Dizziness.

a) Chest radiograph of a 34-year-old woman with known exposure to severe acute respiratory syndrome, showing no obvious abnormalities. b) High-power computed tomography was performed due to a high index of suspicion and confirmed opacities (arrows) with thickening of the smooth interlobular septum in the left lung.

ARP treatment.

When treating affective-respiratory attacks, it is necessary to take into account that they represent the first manifestation of childhood hysteria and usually occur on a neuropathic basis. Therefore, such treatment should be carried out in two directions.

Firstly, family psychotherapy is needed, which will be aimed at correcting upbringing, eliminating pandering overprotection, and the subsequent normalization of family relationships. It is also advisable to place the child in preschool institutions, where, as a rule, these attacks do not recur. If the manifestation of affective-respiratory attacks became a reaction to placement in a nursery or kindergarten, on the contrary, it is advisable to temporarily take the child from the children's group and re-assign him there only after appropriate preparation.

Secondly, it is necessary to directly treat neuropathy using a number of drugs that strengthen the nervous system and sedatives. Here, the most beneficial is the use of calcium (calcium gluconate, calcium lactate, 0.25-0.5 g per dose), valerian in the form of tincture, as many drops per dose as the child is old, or valerian infusion 3-5 g, multivitamins. In more severe cases, lipocerebrin, phosphrene, glutamic acid, and aminalon are used 2-3 times a day. When frequent (daily, several times a day) seizures are observed (which may indicate increased excitability of the brain), it is necessary to use small doses of antiepileptic drugs (phenobarbital, hexamidine at night).

The use of such drugs is also recommended if paroxysmal activity is detected on EEG studies. It has been characteristically noted that some children with affective-respiratory attacks subsequently experience epileptic paroxysms. During such an attack of affective-respiratory convulsions, assistance to the child is usually not required. And if only a prolonged paroxysm is observed, then action should be taken (spraying with water, patting the cheeks). To promote reflex restoration of breathing.

The older the child becomes, the more important psychotherapy is in the treatment of various paroxysms of neurotic origin. Other types of family psychotherapy are also included - group and collective, as well as individual, aimed at correcting asteroidal personality traits.

If a sick child has somatic asthenia, then it is necessary to carry out restorative therapy, followed by sanitation of foci of chronic infection. Sedative therapy is recommended, and in addition to calcium preparations, valerian, bromides, it is often necessary to use tranquilizers - trioxazine, elenium, seduxen (in age-appropriate dosages). Water procedures, such as pine baths and rubdowns, are also useful. In cases of the most hysterical attack, no help is required for the sick child.

At the beginning of an attack, you can sometimes stop it if you try to switch the patient to a variety of activities, this could be reading books, playing games, or walking

If this cannot be done, then it is better not to focus the attention of others on the seizure, you can also leave the child alone, and very often and it is likely that then the seizure will pass faster

Causes of ARS in children

Children tend to experience anger, rage, resentment, and fear, but these emotions do not always lead to respiratory problems. The causes of apnea with strong affective arousal can be:

Type of higher nervous activity.
Lability and imbalance of the nervous system are manifested by increased sensitivity and emotional instability. Children are easily susceptible to affect, the vegetative component is pronounced.
Hereditary predisposition.
A positive family history is determined in 25% of children with affective-respiratory attacks. Temperament and the characteristics of vegetative reactions are inherited.
Educational mistakes.
Paroxysms are formed and supported by the parents’ incorrect attitude towards the child, his behavior, and emotions. The development of the syndrome is facilitated by permissiveness and upbringing according to the type of family idol.
Internal and external factors.
Attacks occur when exposed to negative factors and can be provoked by physical pain, accumulated fatigue, nervous tension, hunger, and frustration.

Symptoms of the disorder

Often in various sources you can find the abbreviation ARP - affective-respiratory attack. The pathology is characterized by paroxysms and sudden cessation of breathing.

An attack of ARP occurs at the moment of psycho-emotional arousal. When a child starts crying, breathing stops for 10-15 seconds at the height of inspiration. This may be accompanied by a change in complexion or sudden loss of motor skills.

Stopping breathing during an attack is a reflex reaction of the body to strong emotions experienced by the baby. This attack occurs in several cases:

while crying;
when frightened;
if the baby gets hurt.

Parents are very frightened when they encounter this disorder for the first time. At the moment of crying, the child suddenly suddenly becomes quiet, his skin turns pale or blue, while he opens his mouth, but cannot make a sound. As a rule, this state lasts no more than 40 seconds.

There is a relationship between the change in the color of a child’s skin and the emotions experienced at that moment. Pallor of the skin is observed in the following cases:

a fall;
injury;
fear;
hit.

Often, the child does not have time to react by crying to the pain he is experiencing, when an affective attack immediately begins. The danger of this condition is that parents may not notice the traumatic effect and may not understand why the child’s skin turns pale and he cannot take a breath.

Another type of ARP is accompanied by bluish skin of the baby during an attack. The reason for this reaction is often strong emotions - the child may be dissatisfied or irritated. Not getting what he wants, the baby begins to cry a lot. At the moment when it is necessary to take a breath in order to continue crying, a sudden stop in breathing occurs. At this time, the skin of the face acquires a bluish tint.

During an attack, it is possible to increase the tone of the body muscles. The child may suddenly arch as if he was having a seizure. As a rule, this condition goes away on its own and lasts no more than a few minutes.

The name of the syndrome “affective-respiratory” comes from two words: “affect” - intense uncontrollable emotion, “respiratory” - relating to the breathing process. ARS is a violation of the rhythm of inhalation and exhalation against the background of strong anger, crying, fear, pain. Synonymous names: affective-respiratory attack, crying, apnea attack, breath holding. The prevalence of the syndrome is 5%. The epidemiological peak covers children from six months to one and a half years. After the age of five, attacks develop extremely rarely. Gender characteristics do not affect the frequency of pathology, however, in boys, manifestations often disappear by 3 years, in girls - by 4-5.

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.

It makes no sense to treat 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

Treatment of ARS in children

Treatment of affective respiratory syndrome is carried out comprehensively. The help of a psychologist or psychotherapist is indicated for all children and their families. The decision on the need to prescribe pharmaceuticals is made by the doctor individually, depending on the severity of the symptoms and the age of the patient. The following therapy methods are used:

Psychotherapy.
Classes with a psychologist and psychotherapeutic sessions are aimed at correcting family relationships and developing effective educational tactics. Game trainings are aimed at instilling in the child independence, the ability to withstand frustration and stress factors.
Taking medications.
Children with affective-respiratory syndrome are prescribed neuroprotectors, nootropics, sedatives, amino acids (glycine, glutamic acid), B vitamins. Severe recurrent attacks are treated with tranquilizers.
Lifestyle correction.
To prevent the child’s fatigue and irritability, parents are advised to rationally distribute sleep and rest time, provide the child with sufficient physical activity and nutritious nutrition. It is necessary to limit watching TV and computer games.

Diagnosis and differences from epilepsy

It is important to understand that affective-respiratory convulsions are only superficially similar to the manifestation of epilepsy. However, to exclude such a condition, it is not enough to know the main differences

Diagnosis necessarily includes an EEG (electroencephalogram of the brain). This examination shows the absence of a focus of excitation in the cortex and brain structures in ARP and its presence in epilepsy. Therefore, this examination is definitely worthwhile. At least to calm myself down. And treat the baby more correctly.

It is also important to exclude hysteria. It is based on an attack of aggression, but it does not provoke respiratory arrest and loss of consciousness

If a child has a hysterical attack, you should maintain your own calm and not show your child that this behavior greatly upsets you. Under no circumstances should a child be allowed to achieve his goals with such hysterical attacks. Otherwise, such a style of behavior will be fixed at a reflex level. You will receive regular affective-respiratory attacks at the slightest reason for the child’s negative perception of reality.

The distinctive features of epileptic seizures and affective-respiratory attacks are as follows:

Various circumstances lead to ARP, and epilepsy manifests itself without external causes;
ARP always develops differently, but epileptic seizures are always the same;
In children under 4 years of age, epileptic seizures account for no more than 2% of the total number of such disorders;
in children over 5 years of age, attacks of affective-respiratory disorder are diagnosed only in 1% of the total number of cases;
with ARP, valerian, motherwort and nootropic treatment help;
in case of a true epileptic seizure, it is useless to give sedatives;
There are significant pathological changes in the EEG only in epilepsy.

If the baby has an attack, then it is necessary to show him to the doctor within the next 1.5 hours. These manifestations can be the result of very dangerous diseases. Only in a medical institution can an ECG of the heart and an ultrasound of internal organs be done to exclude heart defects, pulmonary vein embolism and other dangerous conditions; spirography, an X-ray of the lungs, and examination of the trachea for the presence of foreign bodies may also be required.

You may also need to consult a pulmonologist, neurologist and allergist. After collecting all the necessary information, the doctor will be able to make an accurate diagnosis and prescribe adequate treatment.

General information

The prevalence of the syndrome is 5%. The epidemiological peak covers children from six months to one and a half years. After the age of five, attacks develop extremely rarely. Gender characteristics do not affect the frequency of pathology, however, in boys, manifestations often disappear by 3 years, in girls - by 4-5.

Affective-respiratory syndrome in children

Prevention of affective-respiratory attacks in children

Trying to protect their child and themselves from the repetition of ARP, many parents choose to model their behavior by indulging in any whim of their child, as long as he does not get nervous. This is fundamentally wrong and in this way you only make it worse for your child, since strangers are unlikely to be loyal to his whims. And a child accustomed to permissiveness will expect the same attitude from others and will not receive it. Such situations, on the contrary, provoke anger and nervous stress in the child and can cause breathing problems.

Try not to shout or swear, both at the child and in front of him. Remember, children are not born hysterical. This behavior is the result of parental upbringing. After all, it is we, trying to protect our child from the cruelty of the outside world, who in the first months of life indulge all his desires, without building any model of behavior or prohibitions. And when a child grows up and they begin to “teach him wisdom,” he does not understand why yesterday it was possible, but now it is impossible. This provokes attacks.

Overprotection gives our children nothing but an incorrect understanding of the outside world. Love your children and let them experience this life under your strict guidance, even if they need to hit a couple of bumps to do this. And in the future they will only say “thank you” to you.

Affective-respiratory attacks.

AFFECTIVE-RESPIRATORY SEIZURES. Affective-respiratory attacks, or paroxysms, seizures (ARP), breath-holding spells, (in common parlance - rolling up) are sudden short-term stops of breathing at the height of inspiration with the inability to exhale, occurring when crying in infants or young children. In this case, the child turns blue or pale to one degree or another. One of the frequently encountered questions regarding emergency care in the practice of pediatricians and child neurologists, this condition is very frightening for parents, so I’ll tell you more about it.

Affective-respiratory attacks (attacks of breath holding) are the earliest manifestation of 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. This is simply a reflex that occurs when a crying child 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.

At this time, parents begin to panic, although this, you see, is not the best help for the child. Therefore, I will present all the materials that I managed to collect on this issue.

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 the requirements, 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 a sharp decrease in muscle tone develops - the child goes “limp” in the mother’s arms, or tonic muscle tension occurs and the child arches.

ARPs are accompanied by an increase in vagal tone. With pallid paroxysms, delays in heartbeat (asystole) are sometimes observed, and electroencephalographic (EEG) pathological changes are common in both types of paroxysms. Attacks are observed in the age range from newborn to 5-6 years, although most often observed before the age of 2-3 years.

Attacks can be either rare (once every few months) or frequent, many times a day. The duration of holding your breath can vary from 1-2 seconds to tens of seconds. According to some authors, an attack of ARP can develop into an epileptic seizure.

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 (a familiar picture, Yes?). In this “motor storm” of protest, some features of hysterical attacks of older children are revealed.

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 terrible two-year-olds from turning into the terrible twelve-year-olds.

Principles of proper education of a small child with respiratory-affective and hysterical attacks.

Seizure prevention. Attacks of irritation are quite normal for any 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 are more frank and direct. They are simply venting their rage. I think many people have already become familiar with this in practice, right?

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 (attacks), 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 requires a unified 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 place the 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 gets irritated during the rush to get to nursery during the morning rush hour, when parents are also going to work and an older sibling is going to school, should get up half an hour earlier or, conversely, later - when the house is 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. Children do not like the words “no” and “no”. 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 conclusion about his emotions, try to reflect the feelings experienced by the child, 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, "Although 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.

What to do during a breath-holding attack.

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.

If the attack is prolonged and 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 suffocate if he vomits.

Examination.

Careful description of the episode is an integral part of treatment. In particular, increased attention should be paid to the circumstances and sequence of events during the attack. This information can serve as an important diagnostic clue. For example, most ARPs are preceded by agitation and crying, which contrasts with epileptic seizures, cardiac disorders, and orthostatic syncope, which often occur without any emotional provocation.

In older children with ARP, additional diagnostic clues may include episodes of urinary incontinence, which often accompany some types of seizures. Also informative are reports about the occurrence of ARP during sleep or complete calm.

Practitioners need to identify information about whether distress is associated with eating or other physical activity, or sensations of chest pain or other physical symptoms. Such findings are suggestive of some other disorder, such as cardiopulmonary (heart and lung) problems.

Genealogical history is another important criterion for assessing a patient. Previous reviews suggest that 20% to 30% of children with childhood APD have family members with similar affective disorders.

If medical history or physical examination indicate epileptic seizures or other central nervous system disorders, video EEG monitoring (preferably recording these conditions) and consultation with a pediatric neurologist are recommended. If a cardiovascular problem is implicated, it would seem appropriate to perform Holter monitoring and consult with a pediatric cardiologist.

TREATMENT

Firstly, family psychotherapy is needed, aimed at correcting upbringing, eliminating indulgent overprotection, normalizing family relationships, etc. It is advisable to place the child in preschool institutions, 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.

Secondly, it is necessary to treat neuropathy using a number of drugs that strengthen the nervous system and sedatives. The most beneficial is the use of calcium (calcium gluconate, calcium lactate 0.25-0.5 g per dose), valerian in the form of tincture, as many drops per dose as the child is old, or valerian infusion 3-5 g, multivitamins. In more severe cases, lipocerebrine, phosphrene, glutamic acid, and aminalon are used 2-3 times a day. For very frequent (daily, several times a day) seizures (which may indicate increased excitability of the brain), it is necessary to use small doses of antiepileptic drugs (phenobarbital, hexamidine at night). The use of these drugs is also recommended if paroxysmal activity is detected on EEG studies. As already indicated, some children with affective-respiratory attacks subsequently experience epileptic paroxysms. During an attack of affective-respiratory convulsions, assistance to the child is usually not required. Only with prolonged paroxysm should any influence (spraying with water, patting the cheeks, etc.) promote reflex restoration of breathing.

If a sick child has somatic asthenia, restorative therapy and sanitation of foci of chronic infection are necessary. Sedative therapy is recommended, and in addition to calcium preparations, valerian, bromides, it is often necessary to use tranquilizers - trioxazine, elenium, seduxen (in age-appropriate dosages). Water procedures are useful - pine baths, rubdowns, etc. During the most hysterical attack, no help is required for a sick child.

At the beginning of an attack, you can sometimes stop it by switching the patient to some type of activity - books, games, a walk. If this cannot be done, it is better not to focus the attention of others on the seizure, leave the child alone, and then the seizure will pass faster.

Let me summarize everything that has been said:

* There is no need to be afraid: children do not die from such attacks (the probability is negligible), - they recover from attacks on their own, even if the parents do nothing (blow, wash with water), but a little later...

* You shouldn’t overly patronize and indulge, but you shouldn’t completely neglect your children. Try to prevent and prevent the onset of an attack. Parents usually already imagine situations and the child’s condition that threaten to result in an attack.

* physical exercises and so on without restrictions. But try not to let the child get overexcited. Televisions and computers are prohibited.

* attacks become more frequent in spring and autumn - you need to take vitamins and take soothing baths, drink teas and do exercises.

* there are regularities: The longer the interval between attacks, the greater the likelihood that the next attack will occur later and vice versa. Those. If there has been no attack for 2-3 months, then its likelihood decreases. And if there was an attack, another week later, then the next one could come today.

And of course: be especially attentive to the child’s wishes during this period.

* During an attack, you should not panic, but pay attention to the child: in which direction the head is tilted, at what angle, whether he shakes his head, whether he goes limp or, on the contrary, his body becomes rigid, when this happens, whether his eyes are rolled up and etc. This is necessary so that the doctor can accurately diagnose!!!

* These seizures may be a symptom of epilepsy. But epilepsy is not diagnosed until 5-7 years of age (until a brain tomography and other examinations cannot be performed. By that time, the vast majority of children “grow out” of this condition. But they still need regular monitoring by a neurologist.

* Of course, there is nothing good about seizures: the nutrition of brain cells stops for a few seconds. Some cells die, but this is invisible to humans and does not affect mental development. But this depends on the frequency of attacks. Of course, if there are attacks almost every day, then the brain suffers greatly.

The most important advice is - don’t be lazy to consult a doctor - a professional will figure it out and prescribe the right action plan for you.

based on materials from the global network.

Affective-respiratory paroxysms

TREATMENT

Secondly, it is necessary to treat neuropathy using a number of drugs that strengthen the nervous system and sedatives. The most beneficial is the use of calcium (calcium gluconate, calcium lactate 0.25-0.5 g per dose), valerian in the form of a tincture of drops per dose, depending on how old the child is, or an infusion of valerian 3-5 g and sodium bromide in a dose of 0 .5 g per 100 ml of water, 1 teaspoon (dessert) per dose, as well as small doses of bromine preparations, for example bromocamphor in tablets of 0.15 g or 0.25 g, multivitamins. In more severe cases, lipocerebrin (0.15 g tablets), phosphrene (tablets), glutamic acid (0.25 g each), aminalon (0.25 g each) are used 2-3 times a day. For very frequent (daily, several times a day) seizures (which may indicate increased excitability of the brain), it is necessary to use small doses of antiepileptic drugs (phenobarbital, hexamidine at night). The use of these drugs is also recommended if paroxysmal activity is detected on EEG studies. As already indicated, some children with affective-respiratory attacks subsequently experience epileptic paroxysms. During an attack of affective-respiratory convulsions, assistance to the child is usually not required. Only with prolonged paroxysm should any influence (spraying with water, patting the cheeks, etc.) promote reflex restoration of breathing.