Two children, ages 32 months and 19 months, with breath-holding spells that resolved after treatment for concomitant anemia, are reported from the University of Washington School of Medicine and the Children’s Hospital, Seattle. One child with B-thalassemia trait had a hemoglobin of 48 gm/L, hematocrit 0.15, and ferritin 42 ng/ml. The second patient with a cor triatriatum had a hemoglobin of 51 gm/L, hematocrit 0.18, and ferritin 3 ng/ml (normal, 15-160 ng/ml). Patient 1 was treated with an erythrocyte transfusion, and patient 2 received oral iron. [1]

COMMENT. The association between breath-holding spells and anemia was first reported by Holowach J and Thurston DL [2]. Iron deficiency anemia was noted in 23% of cases.

Reversible focal neurologic deficits were reported in a 14 year old female adolescent with severe iron deficiency anemia and bleeding from intestinal polyposis and hemorrhagic telangiectasia [3]. After transfusion with packed erythrocytes and treatment with oral ferrous sulfate, facial palsy resolved within 12 hours and a VI nerve palsy and somnolence cleared by the fifth day. A syncopal episode was not repeated. (See Progress in Pediatric Neurology I, 1991, p397-8).

IRON DEFICIENCY AND INFANT DEVELOPMENT is addressed in an editorial [4]. Moffatt and colleagues reported in this issue of the journal that iron deficiency caused lower developmental test scores in infancy. Iron therapy resulted in an increase of 30 points in mental scores and 24 points in motor scores in a double-blind, randomized, placebo-controlled trial conducted in Indonesia. The prevention of iron deficiency anemia during the first few years of life is important to assure optimal neurodevelopmental outcome and the avoidance of breath-holding spells.