The breath-holding attacks may occur from the early months of life but are most often seen late in the first, second or third year of life. The attacks have a precipitant, for example a knock or fall, or emotional trauma, e.g. anger, fright or frustration. Often the attack is preceded by a brief episode of crying. The individual then holds their breath with resultant cyanosis or extreme pallor. The attack usually terminates without loss of consciousness but may sometimes end with unconsciousness or rarely a tonic seizure - or tonic-clonic convulsion. In the case of a convulsion, incontinence may occur.
During the attack, the observers may mistakenly think that the child has died because they may be limp, unconscious and deathly white. The recovery from an attack is usually rapid. However, some children may remain lethargic and drowsy for some time after an attack.
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