Sudden breath holding in children: actions of parents

Reasons for holding your breath

Periodic cessation of respiratory activity is observed in children under six months. This is not a pathology. Medical attention, no treatment required. Up to 10% of the duration of dreams is spent holding your breath.

Intermittent breathing activity during sleep is caused by factors:

1. Lack of oxygen. The nasolabial triangle, legs, arms, and torso turn blue. It is observed in infants up to 12 months. The baby is unable to take a deep breath and gasps for air with his mouth.
2. Diseases of infectious etiology. In combination with cessation of respiratory activity, snoring, squelching, and tachycardia are observed. Manifestations are typical for pneumonia, severe bronchitis, and asthma.
3. Irregular heart rhythm, confused, irregular breathing are a sign of increased body temperature. The above symptoms may indicate pathologies of cardiovascular diseases.
4. False croup, obstructive bronchitis. Manifestations: heart rhythm disturbances, cough, whistling on inhalation and exhalation.

Nocturnal nasal congestion in children

Unobstructed inhalation of air through the nose is necessary for a newborn. During sleep, the brain, organs, tissues, and cells of the body are saturated with oxygen. Natural, full breathing is the key to health, activity, and vigor. When you have a runny nose or difficulty breathing, the body suffers from a lack of oxygen. The baby does not get enough sleep, gets up in the morning lethargic, lacking initiative, and complains of headaches.

The nasal cavity, passing air through itself, moisturizes, cleanses, and warms it. If the nose is stuffy and does not participate in breathing, the baby breathes through the mouth. Because of this, polluted air enters the body, there is a risk of developing infectious diseases of the ENT organs, and the mucous membranes dry out.

Causes of pathology

There can be many causes of sleep apnea in children. These include:

• Prematurity or low birth weight. In this case, the respiratory center may be underdeveloped, and this causes the breathing rhythm to become disrupted.
• Congenital pathologies in the respiratory system that make breathing difficult.
• Entry of amniotic fluid into the respiratory tract during childbirth.
• Overheating of the child's body. If your baby is overly bundled up or left in the sun, he may overheat and this may cause him to stop breathing.
• Snoring in your sleep. In children of any age, snoring during sleep can cause sleep apnea.
• Obesity. Older and overweight children tend to snore in their sleep, which can affect their breathing rhythm.
• Head injuries during childbirth or at a later time.
• Inhibition of the respiratory center by medications.
• Chemical poisoning.
• Infectious lesions of the brain.
• Narrowing of the airways in the upper section.
• Obstruction of the nasopharynx.
• The presence of enlarged tonsils or adenoids.
• Allergic reactions.
• Heredity.

Whatever the cause, sleep apnea in children can result in sudden cardiac arrest, leading to imminent death. Therefore, parents need to know what to do if such a condition occurs.

Types of breath holding in children

Based on the manifestations, variants of intermittent respiratory activity are distinguished:

1. Cyanotic. Manifestations: sudden cessation of inhalation, exhalation, blue discoloration of the nasolabial triangle, arms, legs, torso. Skin color ranges from a bluish tint to a rich crimson-lilac.
2. Less severe symptoms. Parents may not notice the manifestations for a long time. Pallor, as the blood has drained from the skin, loss of consciousness.

Muscle spasms and hypertonicity appear. Intermittent respiratory activity occurs at the moment of rest; the child is not able to control the process.

Types and symptoms of apnea

Holding your breath during sleep in newborns is a dangerous pathology

There are two types of apnea in newborns.

The first of these is the cyanoid type, which is characterized by a sudden stop in breathing and the rapid spread of cyanosis to the face and limbs of the baby. The baby's skin rapidly changes color.

The second option is invisible to parents, since it is only accompanied by paleness of the skin, which is caused by a sharp outflow of blood from the skin. In some cases, the baby may experience loss of consciousness.

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The pathological condition is characterized by the appearance of certain symptoms.

Quite often, cessation of breathing is accompanied by a slow pulse. The skin on the baby's face is bluish. The disease may be accompanied by a lack of breathing movements. The severity of this pathological condition directly depends on the duration of breath holding.

Complications of frequent sleep apnea

The phenomenon is common in children aged 2.5 – 5.5 years. By the age of five, the manifestations disappear. According to statistics, a fifth of people experience respiratory arrest periodically, regardless of age.

Anxiety is caused by a sharp interruption of inhalation and exhalation in newborns. The skin of the face and body turns blue, the brain suffers due to lack of oxygen, and the activity of the cardiovascular system is disrupted. Premature babies are susceptible to the development of pathology due to the immaturity of the breathing centers in the brain. The manifestation is provoked by genetic predisposition, difficult pregnancy, childbirth, diseases of infectious etiology.

The term apnea means the cessation of inhalation and exhalation for ten or more seconds, with a frequency of 12-15 times in 60 minutes. It is observed in 3-4% of newborns. It is diagnosed more often in children after one and a half years. They provoke the appearance of metabolic diseases, endocrine system diseases, neurological diseases, diseases of the ENT organs, diseases of the cardiovascular system. Stopping respiratory activity is dangerous for infants and is a cause of infant mortality.

Apnea in children under one year of age: why it occurs, dangerous or not dangerous

Due to insufficient morphological and functional development of the respiratory system of a child born prematurely, he often has respiratory arrests for 20 seconds or more (pauses can be shorter), accompanied by a slow heart rate (bradycardia) and a decrease in the level of oxygen in the blood.

Apnea in premature infants is one of the most common disorders that require the newborn to be in the intensive care unit under constant medical supervision. The earlier the child was born, the more often the episodes of apnea occur and the longer their duration.

The danger of apnea of ​​prematurity is not only the risk of sudden death due to the fact that breathing does not resume, but also the insufficient supply of oxygen to the brain tissue. A set of special measures eliminates this problem.

Neonatologists cope with apnea of ​​prematurity using CPAP machines and masks for infants working under special programs

As a rule, the respiratory system and the mechanisms for regulating its work in prematurely born newborns are fully formed and rebuilt by 37-40 weeks from the day of conception. That is, by the time the child would have been born if the mother had carried him to term. However, in very premature infants, apnea often occurs in a later period.

Episodes of sleep apnea in full-term infants under one year of age also occur and may be a normal variant. In the first year of life, short-term pauses in breathing during night sleep should not alarm parents if:

• their number does not exceed one episode per hour;
• the baby breathes effortlessly, deeply and evenly;
• apnea lasts no more than 5 seconds;
• the child does not show anxiety, his heartbeat does not slow down, and his skin does not appear blue.

However, if you notice that during sleep your baby stops breathing for some period of time, it is best and most correct to find the opportunity to undergo a special examination - polysomnography. Or, at a minimum, get an appointment with a specialized “sleep specialist” - a pediatric somnologist.

Diagnosis of breathing in babies

When parents observe cessation of breathing during sleep, show the baby to a specialist. The doctor will prescribe diagnostic measures - polysomnography. It is performed in a hospital setting for 1-3 nights. In the evening, special sensors are put on the baby, which record all the body’s reactions at the moment of rest. The result of the survey reveals the number and duration of stops.

Babies in the first year of life experience confused, irregular breathing as the body adapts to environmental conditions. Before going to the doctor, record the number of breathing movements at rest, at home. For babies, frequency is measured by counting the number of times the chest rises over sixty seconds.

Respiration rates vary:

• up to 4 weeks – 35–55 breathing movements for 60 seconds;
• up to 8 weeks – 30–46;
• up to 36 months – 25–37;
• 4–9 years – 23–33;
• 10–12 years – 17–23.

Transfer the readings obtained as a result of counting at home onto paper and show it to the pediatrician. The complex of diagnostic measures includes consultation with an otolaryngologist, neurologist, and psychotherapist to exclude diseases.

Obstructive apnea in children with adenoids: causes, danger, treatment approaches

Almost all children have adenoids, but if they are small in size (first degree), they practically do not interfere with the passage of air through the respiratory tract of a sleeping child, and OSA does not occur.

At the same time, obstructive apnea syndrome of varying severity develops in 50% of children with larger adenoids. In the second degree, at the time of the deep phase of sleep, hypertrophied tonsils cover more than half of the lumen of the airways; in the third or fourth degree, they block them completely.

During sleep, large adenoids can almost completely block the access of air to the airways

• Always remember that your snoring child with adenoids has a 50% risk of stopping breathing forever one night!

Therefore, children's snoring, especially uneven snoring, accompanied by wheezing inhalation, increased movements of the chest and its depression, periodic stops in breathing, is a reason to immediately contact a specialist for advice and a special examination.

Case from medical practice:

Moscow somnologists drew attention to a video filmed by the mother of 3-year-old Maxim M. from Kaliningrad. The woman was desperately looking for an opportunity to help her son - and she was absolutely right. As it turned out, the baby was literally between life and death. With one look at the sleeping child, specialists immediately determined a severe degree of obstructive sleep apnea, which was confirmed by polysomnography. The examination revealed 140 (!) episodes of respiratory arrests per hour. Since OSA was caused by adenoids that relapsed after traditional surgery, ENT doctors joined in the treatment: Professor Rusetsky Yu.Yu. and candidate of medical sciences Latysheva E.N. The boy underwent endoscopic removal of the adenoids, after which the problem completely disappeared.

Sleeping Maxim before and after surgery

In general, when treating children with adenoids, ENT doctors adhere to the following rules:

• Grade 1 – no removal required.
• Grade 2 – examination is necessary to determine the presence of OSA and its severity.
• Grade 3-4 – surgery is indicated.

OSA can also develop in children with a pathological structure of the respiratory tract, for example, with a deviated nasal septum, cleft palate, hypertrophy (enlargement) of the root of the tongue, etc. In this case, as with severe adenoids, they resort to surgery.

In addition to polysomnography, SLIP endoscopy helps to decide on the choice of treatment tactics. During this study, the child is put into a light, close to natural, medicated sleep. After which, using a thin probe, his upper respiratory tract is examined to determine the presence of obstacles and determine their location.

Apnea Treatment Methods

Provokes respiratory arrest, tonsillitis, pharyngitis, adenoids. To eliminate the pathology, surgical treatment is performed. When the causes of the pathology are different, complex therapy is prescribed: rinsing the nose with saline solutions, instilling vasoconstrictor drops into the nose. A deviated nasal septum and a deformed jaw provoke attacks of cessation of breathing. The way out of the situation is plastic correction or the use of rehabilitation means.

For frequent attacks, infants are prescribed oxygen therapy. On the eve of going to bed, the baby puts on a mask connected by a tube to an oxygen cylinder. While sleeping, the baby receives oxygen through a tube through a mask, eliminating the risk of an attack.

Parents whose children suffer from sleep apnea should provide assistance to the infant during an attack. Carefully, without sudden movements or loud noise, wake up the child. Blueness of the skin is a reason to call an ambulance. If breathing is not restored, perform artificial respiration and chest compressions. Lack of breathing for more than 15 seconds requires medical intervention.

Expert opinion

It is prohibited to ignore attacks. Irregular, abnormal breathing causes oxygen deficiency in the brain, irritability, cardiovascular pathologies, retarded physical growth, and decreased mental activity.

Apnea attacks are life-threatening. Lack of breathing occurs for more than 30 seconds. During an attack, the baby may die. The danger of apnea is that attacks occur at night, during sleep. Parents do not always record changes and provide assistance. If you experience episodes of cessation of breathing, contact a specialist and get examined.

List of used literature:

• Giedd JN, Rapoport JL; Rapoport (September 2010). “Structural MRI of pediatric brain development: what have we learned and where are we going?” Neuron
• Poulin-Dubois D, Brooker I, Chow V; Brooker; Chow (2009). “The developmental origins of naïve psychology in infancy.” Advances in Child Development and Behavior. Advances in Child Development and Behavior.
• Stiles J, Jernigan TL; Jernigan (2010). “The basics of brain development.” Neuropsychology Review

When can apnea be dangerous for a newborn?

Interruptions during breathing, that is, apnea, occur quite often in children - and this is normal. Parents should not worry, but only if episodes of respiratory arrest last no longer than 10 seconds and occur no more than 10 times per hour.

Indeed, prolonged and frequent apneas can cause sudden infant death syndrome. Fortunately, they occur rarely - in one in a thousand babies. This dangerous disease, which has not been fully studied by specialists, most often affects children in the first year of life, and especially between 2 and 3 months.

What increases the risk of dangerous sleep apnea and infant death?

The immediate cause of child death is respiratory arrest. The risk increases when:

• newborn baby is premature;
• he already has other breathing problems or respiratory diseases;
• when a child sleeps on a mattress that is too soft, on his stomach, or has his sock covered (for example, with a blanket);
• the baby is a passive smoker or is exposed to any chemicals.

How to control a child's breathing?

To control the baby's breathing, parents listen to how he breathes, or even put a mirror to the baby's lips. A breathing monitor or baby monitor (or a 2-in-1 device) may be more convenient in such a situation. The breathing monitor monitors the child's breathing, and if there is a 20-second gap between breaths, it raises an alarm, which can save the child's life.

How to protect your baby from stopping breathing?

• Place your baby to sleep on his back - not on his side or stomach.
• Remember that the bedroom should be ventilated, the air in it should be humid, and the temperature should not exceed 20 degrees Celsius.
• Do not place pillows or soft toys near the child's head.
• Make sure that the child's face is not covered by the blanket.
• Buy a suitable mattress – it cannot be too soft.
• Don't smoke in the house.
• Buy a breathing monitor (especially if the baby has any problems, birth injuries, was born premature, or has frequent sleep apnea).

When should a child be seen by a doctor?

This is absolutely necessary if:

• he has stopped breathing, especially for longer than 10 seconds;
• the baby gets tired while breathing or you are confused by how he breathes;
• when breathing, you may notice active movements of the wings of the nose or retraction of the skin between the ribs;
• the newborn breathes more than 60 times per minute;
• he began to turn blue when crying;
• The child often has problems breathing evenly and freely.

What to do if a newborn suddenly stops breathing?

Place it on a hard surface (table, crib, floor). Tilt your baby's head back a little.

Call an ambulance

Start artificial respiration. To do this, you need to wrap your lips around the child’s nose and mouth, and gently blow air into the lungs twice – 1 breath every 3 seconds.

Check the pulse on the inside of your wrist. If you feel your heart racing, continue artificial respiration. If you do not feel the pulse, start a heart massage (lightly pressing on the middle of the chest at a distance of one finger below the nipple line), without interrupting artificial respiration (1 breath - 5 presses on the heart area).

Apnea in newborns - video

A child holds his breath during sleep or apnea in newborns

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Diagnosis and treatment

If a child frequently stops breathing, he must be shown to a doctor. To confirm the diagnosis, an instrumental study (polysomnography) is prescribed. It is carried out in stationary conditions. The duration of the procedure can be several days. Before going to bed, high-frequency sensors are installed on the baby’s body, with the help of which physiological processes in the body are recorded. In accordance with the results, the number of breathing stops and their duration are determined.

If a newborn baby has uniform and intermittent breathing, then this is often considered normal. Before visiting a doctor, it is recommended to measure the baby’s breathing rate at home. They do this visually. Parents watch how the newborn's chest rises. You can simply place your hand on the baby's chest and count the breaths.

Most often, night apnea occurs against the background of chronic tonsillitis or adenoiditis. That is why treatment of the pathological condition is carried out surgically to remove the tonsils.

If the cause of the pathological condition is impaired nasal breathing, then symptomatic therapy is necessary. For this purpose, vasoconstrictor medications can be used or the nasal passages can be washed with special preparations.

If you suspect a pathology, consult a doctor!

Respiratory arrest in young patients at night can occur due to abnormal development of the jaw and nose. In this case, surgical treatment is performed or special devices are installed for a certain period.

If infants have moderate or severe apnea, they are prescribed SINAP therapy. It consists of putting on an oxygen mask before going to bed, which is connected to an air supply apparatus using a tube. When using this therapy, the possibility of the baby stopping breathing is excluded.

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The method of therapy should be determined by the doctor in accordance with the age characteristics of the baby and the course of the pathology.