The Affective and Respiratory Syndrome (ARS) – the incidental short-term respiratory standstill at children developing at intensive emotional excitement. Attacks appear at peak of crying, severe pain, a fright after blow, falling. Affect suddenly stops, the child cannot inhale, becomes silent, becomes blue or turns pale, the tone of muscles falls. Sometimes there are spasms, faints. In several seconds breath is restored. Diagnostics is based on poll, survey of the neurologist, EEG, is supplemented with consultation of the psychiatrist, cardiologist, pulmonologist. Treatment is carried out by means of medicines, psychocorrection of methods of education.
Affective and respiratory syndrome at children
The name of a syndrome "affective and respiratory" came from two words: "affect" – intensive uncontrollable emotion, "respiratory" – belonging to breath process. ARS – violation of rhythm of a breath exhalation against the background of strong anger, crying, fear, pain. Synonymous names – an affective and respiratory attack, rolling in crying, an attack , breath delays. Prevalence of a syndrome makes 5%. The epidemiological peak covers children from six months to one and a half years. After five-year age attacks develop extremely seldom. Gender features do not influence pathology frequency, however at boys of manifestation disappear by 3 years, at girls more often – to 4-5.
ARS reasons at children
Children can feel anger, rage, offense, fear, but these emotions not always lead to respiratory violations. The reasons at strong affective excitement can become:
- Type of higher nervous activity. Lability, unbalance of nervous system are shown by hypersensibility, emotional instability. Children easily give in to affect, the vegetative component expressed.
- Hereditary predisposition. The positive family anamnesis is defined at 25% of the children having affective and respiratory attacks. Temperament, features of vegetative reactions is inherited.
- Education errors. Paroxysms are formed, supported by the wrong attitude of parents towards the child, his behavior, emotions. Development of a syndrome is promoted by permissiveness, education as an idol of a family.
- Internal and external factors. Attacks arise at influence of negative factors, can be provoked by the physical pain which is saved up by fatigue, nervous tension, feeling of hunger, frustration.
Up to five years children are incapable to treat critically the emotions and behavior, to constrain, control external manifestations. Frankness, frankness, expressivity become a basis of bright affective reactions. Crying, a fright provoke convulsive reduction of muscles in a throat. The state reminding a laryngospasm develops: the glottis is narrowed, almost completely blocked, breath stops. Sometimes in parallel there are tonic and clonic spasms – involuntary muscular tension, twitchings. In 10-60 seconds the attack stops – muscles relax, breath is resumed. Each attack develops on phases: affect increase, respiratory spasm, restoration.
Classification of affective and respiratory attacks is based on features and weight of clinical manifestations. Allocate four types of a syndrome:
- Idle time. The easiest form of an attack. It is shown by a breath delay at an exhalation. Develops as reaction to a trauma, frustration. Signs of violation of blood circulation, oxygenation are absent.
- Blue. It is observed at expression of anger, discontent, frustration. Faltering breath on a breath stops, appears cyanosis (cyanosis). At a breath delay more than 10-20 seconds the muscular tone decreases, there are convulsive reductions.
- Pale. It is noted after unexpected painful influence – blow, a prick, a bruise. At affect height the child turns pale, faints. Crying is shown poorly or is absent.
- Complicated. Begins as blue or pale type. In process of development there are clonic, tonic spasms, consciousness loss. Externally the attack is similar to an epileptic seizure.
ARS symptoms at children
Affective and respiratory manifestations begin during the crying, a fright, pain. The child breathes falteringly, suddenly becomes silent, fades, the mouth remains open. Rattles, hissing, clicks are heard. Manifestations are involuntary. Breath is interrupted from 10 seconds to 1 minute. The simple attack comes to the end 10-15 seconds later, additional symptoms are absent. after falling, blow is followed by a pobledneniye of skin, mucous membranes. Painful reaction develops very quickly, crying is absent or the first whimpers are heard. There is a faint, a low pulse or is not probed.
The affective and respiratory syndrome at negative emotions – offense, rage, frustration – is characteristic of kids of 1,5-2 years. Respiratory standstill occurs at the time of strong crying, shout. Is followed by a skin posineniye, a simultaneous hyper tone or sharp decrease in a tone of muscles. The body of the child is curved by an arch or obmyakat. Less often clonic convulsive muscular contractions (twitchings) develop. In all cases there is an independent restoration of process of breath, color of integuments is normalized, spasms disappear. After a simple attack the child is quickly restored – begins to play, run, asks food. Long attacks with consciousness loss, spasms demand longer restoration. After end the child quietly cries, falls asleep for 2-3 hours.
The affective and respiratory syndrome does not constitute direct danger to the child. Without adequate treatment there is a risk of development of epilepsy – with this disease attacks of the held breath in the anamnesis occur among patients by 5 times more often than in the general population. This feature is explained by knack of a brain sensitively to react to external and internal factors. Side effects of an affective and respiratory syndrome are oxygen starvation of a brain, TsNS exhaustion which are shown an adynamy, disorders of memory, attention, cogitative activity.
For diagnostics of an affective and respiratory syndrome and its differentiation with other diseases proceeding with breath violation attacks, spasms clinical, tool and fizikalny methods are used. Leading experts are the psychiatrist and the neurologist. The diagnostic algorithm includes the following techniques:
- Poll. The neurologist and the psychiatrist listen to complaints of the parent, ask the specifying questions of symptoms of attacks, duration, frequency, the reasons. Carry out primary differential diagnostics of ARS and epilepsy. The main criteria – spontaneity / paroxysms, increase at excitement/independence of the general state, stereotype/variability of attacks, age up to 5 years / are more senior.
- Survey. Obligatory fizikalny examination is conducted by the neurologist. The expert estimates safety of reflexes, sensitivity, formation of motive functions, confirms absence or existence of neurologic pathology. At an indistinct clinical picture, scarcity of complaints of parents, the burdened family anamnesis survey of the cardiologist, pulmonologist, allergist for an exception of cardiovascular diseases, bronchial asthma, an allergy, a syndrome at premature and small children is appointed.
- Tool methods. For distinction of an affective and respiratory syndrome with epilepsy the electroencephalography is carried out. The increased bioelectric activity is not characteristic of ARS. The electrocardiography allows to exclude the heart diseases which are followed by respiratory standstill. The spirography is used for assessment of functionality of lungs, identification of the reason of a respiratory spasm.
Treatment of ARS at children
Treatment of an affective and respiratory syndrome is carried out in a complex. The help of the psychologist, psychotherapist is shown to all children and their families. The decision on need of purpose of pharmaceuticals is made by the doctor individually, depends on weight of symptoms, age of the patient. The following methods of therapy are used:
- Psychotherapy. Occupations with the psychologist, psychotherapeutic sessions are directed to correction of the family relations, development of effective educational tactics. Game trainings are focused on inoculation to the child of independence, ability to resist to frustration, stressful factors.
- Reception of medicines. To children with an affective and respiratory syndrome neuroprotectors, nootropa, sedative medicines, amino acids (glycine, glyutaminovy acid), group B vitamins are appointed. Heavy recidivous attacks are stopped by tranquilizers.
- Correction of a way of life. For the warning of fatigue, irritability of the child to parents it is recommended to distribute rationally time of a dream and rest, to provide to the kid sufficient physical activity, good nutrition. It is necessary to limit viewing of the TV, computer games.
Forecast and prevention
The forecast of an affective and respiratory syndrome positive, symptoms usually disappear by 5 years. Psychological receptions at interaction with the child help to prevent attacks: it is necessary to learn to have a presentiment of emotional flashes and to prevent them – in time to feed the kid, to provide the full-fledged dream, rest, active games allowing to remove emotional pressure. It is simpler to stop crying switching of attention, a request to perform operation (bring, look, run), but not the requirement to stop manifestation of emotions. Phrases "do not roar", "do not ache" "stop now" only increase affect. Children of two-three years should explain their state, to point out irrelevance, inefficiency of a hysterics.