Introduction
Sometimes, the children elicit temporary breaks in breathing in the event of a sudden incident like pain, anxiety, fear, and other low-order emotions. Pallid spells are one such event where the kid exhibits brief breaks in breathing, often accompanied by a painful incident. Though it is not a grave condition, it can be terrifying for the parents to witness breath-holding.
What Are Pallid Spells?
Pallid spells are a peculiar subclass of breath-holding spells precipitated upon exposure to pain. These spells are frequently encountered in the younger population group, typically in children within 48 months. The child experiences transient holding of breathing, which lasts no longer than a minute, and it eventually makes the child collapse (faint). It is a form of the body's normal reflex (response) toward specific undesirable emotional experiences. Pallid spells are precipitated by pain or emotional distress, and the child's skin turns out ash colored.
What Are Breath-Holding Spells?
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Exposure to low-order emotional experiences like anxiety, fear, tension, frustration, pain, anger, annoyance, and disappointments in children can potentially precipitate a sudden cessation of the respiration process, which is medically known by the term breath-holding spells.
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The intake and giving out of respiratory air will stop briefly, specifically in less than a minute. Finally, the child ends up collapsing and passing out.
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Though it seems terrifying, it is not. Usually, the child regains consciousness immediately and does not necessitate treatment.
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Breath-holding spells are broadly categorized into two groups: pallid and cyanotic. It is frequently encountered within six years. However, the initial spell episode may elicit even as early as six months of age. Occasionally, the spell attack recurs until a certain age. If the child's face color is blue, it is called a cyanotic breath-holding spell; if the color of the face is white-colored, it is called a pallid breath-holding spell.
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When it develops in infants, it is precipitated by continuous crying. At times, the baby's sound would not come with breaths held up, and at a certain point, the child passes out. The parents panic and seek immediate treatment.
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There is no need for treatment unless the spells are reported to last longer with frequent spell episodes. Frequent spells are considered for medical assistance to deal with it.
How Do Pallid Spells Differ From Cyanotic Spells?
Both pallid and cyanotic spells come under the category of breath-holding spells. However, both spells differ in certain aspects. Cyanotic breath-holding spells are triggered by annoyance, frustration, anger, alarm, and panic, while pain and emotional upset are reported as potential triggers for pallid spells. Cyanotic spells bring about a blue tint on the skin.
On the other hand, pallid spells turn the skin gray and bleached. Pallid spells are associated with a collapsed heart rate. At the same time, the cyanotic spell does not precipitate any change in the heart rate. The child's cry is more intense in the cyanotic spell, while pallid spells are associated with a single cry.
What Causes Pallid Spells?
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The mechanism behind the pallid spells is still under study. However, certain hypotheses suggest that the body's vasovagal response precipitates pallid spells.
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Vasovagal response refers to exaggerated feedback from the body toward certain stimuli (triggers). These stimuli can be visual or emotional.
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Scare or pain induces emotional distress in the child, capable of reflecting a vasovagal response in the body. An exaggerated response eventually brings down the beating rate of the heart.
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As the heart beats slower, the blood flow to the entire body parts slows down and diminishes. Collapsed blood flow to the brain cells results in a drop in the oxygen supply, and the child faints.
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Impaired oxygen supply to the cell within a minute brings about the paleness of skin, and therefore, the affected child turns ash colored instantly.
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Certain studies have highlighted the association of pallid spells with anemia (collapsed red cell count) or iron deficiency. However, no significant data is available regarding the same.
What Are the Symptoms Associated With Pallid Spells?
Some of the routinely encountered symptoms of pallid spells include the following:
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The baby cries, sometimes without appreciable sounds, even though the mouth will be kept open as if the baby is crying.
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The skin turns pale and ash-colored, indicating sudden oxygen depletion in the body.
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The child tends to bend the body backward and arch up. The body, legs, and arms become rigid and firm.
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Occasionally, the child may pass urine and feces involuntarily during the spell episode.
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Exaggerated sweating occurs suddenly, and the child gets wet in the sweat.
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Certain studies reported that the child rarely elicits uncoordinated body movements mimicking seizure.
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The heartbeat falls considerably for a very short period during the episode.
How Are Pallid Spells Diagnosed?
Diagnosis of the pallid spell is based on the symptoms elicited during the spell episode. In most instances, the symptoms are narrated by the parents. Pallid spells lack a specific test to finalize the diagnosis of the condition. However, symptomatic analysis often guides on the right track. Blood tests are often advised in suspected cases to aid in detecting anemia.
What Are the Treatment Approaches Available for Pallid Spells?
Pallid spells are routinely benign and non-toxic and do not entail treatment interventions. However, treatment must be initiated when spell episodes are precipitated very often, eliciting seizure-like jerks of considerable intensity. The treatment strategy is designed considering the intensity, frequency, and severity of pallid spells and the child's age. Some of the widely accepted treatment interventions include the following:
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Iron Supplements: If the child suffers from iron deficiency, iron supplements are advised to deal with the spells resulting from iron deficiency.
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Glycopyrrolate: It is advised for children who develop remarkable collapse in the heart rate in association with pallid spells.
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Fluoxetine: It deals with panic disorders and thereby controls the trigger for pallid spells.
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Cardiac Pacemakers: It is advised for severe pallid spell cases, where the child experiences a momentary interruption in a heartbeat during the spell.
Conclusion
Pallid spells are unfamiliar breath-holding spells where the constant rhythmic beating of the heart gets disrupted and collapses remarkably. During the event, the child develops a transient break in the breathing process. Though non-dangerous, the extreme spell requires treatment to tackle the collapsed heart rate. The parents should be given proper guidance and understanding regarding the condition to initiate appropriate preventive strategies to check the precipitation of spell episodes.
