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M. Gómez de Pablos Romero*, M. Sánchez Martín**
*Adjunto de Pediatría de la Clínica Universidad de Navarra (Pamplona),**Adjunto de Pediatría del Hospital Universitario La Paz
40. Resident-attending in the ED: Apnea in an infant
Resident: Mónica Gómez de Pablos Romero. Adjunto de Pediatría de la Clínica Universidad de Navarra. Pamplona
Attending: María Sánchez Martín. Adjunto de Pediatría del Hospital Universitario La Paz. Madrid
Resident: Good morning Dr. Simoni. I would like to talk to you about a patient.
Attending: Of course, Mary, go on.
Resident: It’s Oliver, an eleven-month-old boy that has been brought by his parents because of an episode of cyanosis and loss of consciousness half an hour ago. According to his parents, the boy was crying after he hurt himself, when suddenly he held his breath, his face turned blue, and he became limp and unresponsive. The episode lasted about 30 seconds, and he recovered quickly and spontaneously, but they came to the ER because they are very worried.
Attending: Alright. Was the boy fine previous to the episode? Did he have any fever, cold or any other symptoms?
Resident: No, the boy has been completely fine at all times.
Attending: Did the boy present any abnormal movements?
Resident: No, his parents told me he was completely limp during the episode, with no movements. Even though he is an infant, I also asked them about urine or bowel movements, and they told me that the diaper was clean when the boy recovered.
Attending: Is this the first time this happens? Does Oliver have any past medical history?
Resident: Yes, this is the first time this happens, and no, Oliver is a healthy boy with no past medical history. There is no relevant family history either.
Attending: Perfect, what about the physical examination?
Resident: Right now, the boy is asymptomatic, his vital signs are normal, and the physical examination, including neurologic exam shows no abnormalities.
Attending: So, do you have a diagnosis, Mary?
Resident: According to the anamnesis and physical examination, I would say that Oliver has had a breath-holding spell, but I wanted to confirm it with you.
Attending: Correct, this sounds like a typical breath-holding spell, with no alarm signs, that has resolved itself quickly. No tests are necessary but be sure to explain everything to the parents to calm them down. Call me if you need me.
Resident: OK Dr. Simoni, thank you.
…
Resident: Hello Mr. and Mrs. Declan. It seems like Oliver has had a breath-holding spell. These are frightening but innocuous episodic events that can affect infants and young children, mostly between 6 and 18 months of age. Typically, breath-holding spells are triggered by an emotion (for example, pain or anger). It is normal for there to be apnea (to stop breathing), color change and unresponsiveness or loss of consciousness. These events have to do with the child’s nervous system, and they are relatively common in otherwise healthy children
Mother: Wow, that sounds like a lot… Is he going to be OK?
Resident: Yes, Oliver will be fine. It is possible that episodes like this happen again, especially the first two years of life, but with time they will stop completely. This won’t affect his health or his development in any way, he is a healthy boy and he can lead a normal life.
Father: Thank you doctor, are there any alarm signs that we should look out for?
Resident: Yes, if the episodes take more than one minute to resolve, or if you notice any abnormal movements, you should bring him in straight away. In cases like this, a video might be helpful.
Mother: Thank you very much, doctor. Are we free to go?
Resident: Yes, you are free to go back home and enjoy the afternoon with your son.
Mother and father: Thank you, bye!
KEY WORDS
According to his parents: según refieren sus padres.
Held his breath (to hold one’s breath): contener la respiración.
Limp: flácido (hipotónico).
Unresponsive: sin respuesta (a estímulos).
Previous to the episode: previo al episodio.
At all times: en todo momento.
Bowel movements: deposiciones.
Diaper: pañal.
Breath-holding spell: espasmo del sollozo.
Frightening: que asustan / alarmantes.
Innocuous: inocuos.
Triggered: desencadenado.
Nervous system: sistema nervioso.
Development: desarrollo.
(To) lead a normal life: llevar una vida normal.
Abnormal movements: movimientos anormales.
Cryptorchidism and scrotal pathology 