A 12-month-old boy is brought by his parents after an episode of turning pale and losing consciousness for a few seconds after a sudden fright. There was no cyanosis, tonic-clonic movements, or postictal confusion. Development is normal. Physical examination is unremarkable. Which of the following is the most likely diagnosis?
- A Cyanotic breath-holding spell
- B Pallid breath-holding spell ✓
- C Generalized tonic-clonic seizure
- D Vasovagal syncope
Correct answer: B. Pallid breath-holding spell
Explanation
Pallid breath-holding spells are triggered by a sudden fright or minor injury. The child becomes pale and loses consciousness due to excessive vagal tone causing transient asystole, without cyanosis or tonic-clonic movements. Cyanotic breath-holding spells are triggered by anger or frustration and involve expiratory apnea leading to cyanosis. Generalized tonic-clonic seizures typically involve motor movements and a postictal state. Vasovagal syncope is more common in older children and adolescents.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.