Causes of ARS in children

The name of the syndrome “affective-respiratory” comes from two words: “affect” – intense uncontrolled emotion, “respiratory” – referring to the process of breathing. 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, rolling in crying, an 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 five years of age, seizures develop extremely rarely. Gender features do not affect the incidence of pathology, but in boys the manifestations often disappear by 3 years, in girls – by 4-5.

Causes of ARS in children

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

  • Type of higher nervous activity. The lability, the imbalance of the nervous system are manifested by increased sensitivity, emotional instability. Children are easily affected by the vegetative component pronounced.
  • Hereditary predisposition Positive family history is determined in 25% of children with affective respiratory attacks. Inherited is the temperament, features of vegetative reactions.
  • Parenting mistakes. Paroxysms are formed, supported by the wrong attitude of parents to the child, his behavior, emotions. The development of the syndrome contributes to permissiveness, education as an idol of the family.
  • Internal and external factors. Attacks occur when exposed to negative factors, can be provoked by physical pain, accumulated fatigue, nervous tension, hunger, frustration

Up to five years, children are unable to critically treat their emotions and behavior, to restrain, control external manifestations. Frankness, directness, expressiveness become the basis of bright affective reactions. Crying, frightened provoke convulsive contraction of muscles in the larynx. A condition resembling laryngism is developed: the glottis narrows, almost completely closes, breathing stops.

Sometimes in parallel there are tonic and clonic convulsions – involuntary muscle tension, twitching. After 10-60 seconds, the attack stops – the muscles relax, breathing resumes. Each attack develops in phases: increase in affect, respiratory spasm, recovery.


The classification of affective-respiratory attacks is based on the characteristics and severity of clinical manifestations.

There are four types of syndrome:

  • Plain. The easiest form of attack. Manifested by breath holding when exhaling. It develops as a reaction to injury, frustration. Signs of circulatory disorders, oxygenation are absent.
  • Blue. Observed in the expression of anger, discontent, frustration. Intermittent breathing on inhalation stops, cyanosis (cyanosis) appears. When holding the breath for more than 10-20 seconds, muscle tone decreases, convulsive contractions occur.
  • Pale. It is noted after an unexpected painful impact – a blow, a shot, a bruise. At the height of affect, the child turns pale, faints. Crying is weak or absent.
  • Complicated. Begins as a blue or pale type. As it develops, clonic, tonic convulsions, loss of consciousness occur. Externally, the attack is similar to an epileptic seizure.
Symptoms of ARS in children

Affective and respiratory manifestations begin with crying, fright, pain. The child breathes intermittently, suddenly becomes silent, stops, the mouth remains open. There are wheezing, hissing, clicking. Apnea manifestations are involuntary. Breathing is interrupted for a period of 10 seconds to 1 minute. A simple attack is completed after 10-15 seconds, no additional symptoms. Apnea after a fall, shock is accompanied by blanching of the skin, mucous membranes. The pain reaction develops very quickly, there is no crying or the first sobs are heard. There is a faint, the pulse is weak or not palpable.

Affective and respiratory syndrome in case of negative emotions – insult, rage, frustration – is typical for babies of 1,5-2 years. Breathing stops at the moment of intense crying, screaming. Accompanied by blue skin, simultaneous hypertonia or a sharp decrease in muscle tone. The body of the child is arched or limp. Less often develop clonic convulsive muscle contractions (twitching). In all cases, there is an independent restoration of the respiration process, the color of the skin is normalized, the convulsions disappear. After a simple attack, the child quickly recovers – starts to play, run, asks for food. Long attacks with loss of consciousness, convulsions require a longer recovery. After the completion of apnea, the child cries silently, falls asleep for 2-3 hours.


Affective-respiratory syndrome does not represent an immediate danger to the child. Without adequate treatment, there is a risk of developing epilepsy – among patients with this disease, bouts of held breath in history are found 5 times more often than in the general population. This feature is explained by the innate ability of the brain to react sensitively to external and internal factors. Side effects of affective-respiratory syndrome are oxygen starvation of the brain, depletion of the central nervous system, manifested by asthenia, disorders of memory, attention, mental activity.


Clinical, instrumental and physical methods are used to diagnose affective-respiratory syndrome and its differentiation with other diseases occurring with attacks of respiratory disorders, convulsions. The leading specialists are a psychiatrist and a neurologist.

The diagnostic algorithm includes the following methods:

  • Poll. The neurologist and the psychiatrist listen to the complaints of the parent, ask clarifying questions about the symptoms of the seizures, duration, frequency, causes. Conduct primary differential diagnosis of ARS and epilepsy. The main criteria are spontaneity / provocation of paroxysms, increased agitation / independence from the general state, stereotype / variability of seizures, up to 5 years old / older.
  • Inspection. A compulsory physical examination is performed by a neurologist. The specialist assesses the safety of reflexes, sensitivity, the formation of motor functions, confirms the absence or presence of neurological pathology. With a fuzzy clinical picture, the paucity of parents’ complaints, a family history, a cardiologist , a pulmonologist, and an allergist will be examined to exclude cardiovascular diseases, asthma , allergies, and apnea syndrome in premature and low-weight babies.
  • Instrumental methods. Electroencephalography is performed to distinguish between affective-respiratory syndrome and epilepsy . Increased bioelectric activity is not typical for ARS. Electrocardiography allows to exclude heart disease, accompanied by respiratory arrest. Spirography is used to assess the functionality of the lungs, to identify the causes of respiratory spasm.
Treatment of ARS in children

Treatment of affective-respiratory syndrome is carried out in a complex. The help of a psychologist, psychotherapist is shown to all children and their families. The decision on the need for the appointment of pharmaceuticals is made by the doctor individually, depending on the severity of the symptoms, the age of the patient.

The following therapies are used:

  • Psychotherapy . Classes with a psychologist , psychotherapeutic sessions are aimed at correcting family relationships, developing effective educational tactics. Game trainings are focused on instilling autonomy in a child, the ability to resist frustration and stress factors.
  • Reception of medicines. Neuroprotectors, nootropics, sedatives, amino acids (glycine, glutamic acid), vitamins of group B are prescribed to children with affective respiratory syndrome. Severe recurrent seizures are stopped by tranquilizers.
  • Lifestyle correction. To prevent fatigue and irritability of the child, parents are recommended to rationally distribute the time of sleep and rest, to provide the child with sufficient physical activity and good nutrition. It is necessary to limit watching TV, computer games.
Prognosis and prevention

The prognosis of affective-respiratory syndrome is positive, the symptoms usually disappear by 5 years. Psychological techniques help to prevent attacks when interacting with a child: it is necessary to learn to anticipate emotional outbursts and to prevent them – to feed the baby in time, to ensure proper sleep, rest, active games, which allow to relieve emotional stress. Crying is easier to stop by switching attention, asking to perform an action (bring it, look, run away), rather than demanding an end to the expression of emotions. The phrases “do not cry out”, “not Noah” “stop now” only increase the affect. Children of two or three years should explain their condition, point out the irrelevance, the ineffectiveness of hysteria.

Affective-respiratory syndrome (ARS) – episodic short-term respiratory arrest in children, developing with intense emotional arousal. Apnea appear at the peak of crying, severe pain, fright after a blow, a fall. Affect suddenly stops, the child cannot inhale, becomes silent, turns blue or pales, muscle tone falls. Sometimes there are cramps, fainting. After a few seconds, breathing is restored. Diagnosis is based on a survey, examination of a neurologist, supplemented by EEG, consultation of a psychiatrist, cardiologist, pulmonologist. The treatment is carried out with the help of medicines, psycho-correction methods of education.

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