Reflex asytolic syncope

The terminology to describe infantile syncopes is confusing and misleading. This personal review aims to make the topic accessible to the general paediatrician, and uses a simplified and I hope more comprehensible nomenclature. Reflex Asystolic Syncope (“RAS”) also known as Reflex Anoxic Seizures, and Reflex Expiratory apnoea Syncope and the difficulties in distinguishing them are described. The diagnosis rests mainly on a careful and detailed history. A 12-lead standard ECG is indicated in all children with transient loss of consciousness, but other investigations are only needed in severe, frequent and disabling cases. The differential diagnoses for these two reflex infantile syncopes (collectively also known as breath-holding spells) is explored, together with the advice and treatments available.