Iron supplementation effective for breath-holding attacks in children

Clinical question: 
How effective is iron supplementation for breath-holding attacks in children?
Bottom line: 
Compared with placebo or no therapy, iron supplementation (at 5mg/kg/day of elemental iron for 16 weeks) reduced the frequency and severity of breath-holding attacks (measured as loss of consciousness or convulsive movements) in children less than 18 years of age. Supplementation was of particular benefit in children with iron deficiency anaemia, responses correlating with improvements in haemoglobin values. Iron may still be of assistance in children who are not anaemic or who have low normal haemoglobin levels, but this has not been proven in subgroup analysis as only pooled data have been collected to date. The oral iron was generally well tolerated.
It is not known if the benefit of iron supplementation is sustained after three months or if therapy should be continued until the child grows out of the breath-holding episodes. One of the studies may have introduced bias by enrolling only children attending a tertiary children’s hospital.
Breath-holding attacks are paroxysmal events, affecting approximately 5% of healthy children. They are distinct from seizures and it is common for them to resolve spontaneously by the time the child reaches seven years of age.
Review CD#: 
June, 2010
Authored by: 
Brian R McAvoy