Evaluation of Eating Behaviors in Breath-holding Spells in Pediatrics: A Case-control Study

Aim: Breath-holding spells (BHS) are associated with various etiologies, including potential behavioral disorders. While factors like iron deficiency have been studied, the role of other micronutrients and specific eating behaviors remains under-investigated. Therefore, this study aimed to investigate vitamin deficiencies (folate and B12) and evaluate the eating behaviors of children with BHS. Methods: This prospective, single-center, case-control study was conducted between June and September 2024. The study included 35 patients with BHS and 35 age- and sex-matched healthy controls. Blood and vitamin levels were compared, and the Children’s Eating Behaviour Questionnaire (CEBQ) was administered to assess and compare eating patterns between the groups. Results: Logistic regression analysis was performed to identify significant predictors for being in the patient group. Each unit increase in folate was associated with a 33% reduction in odds ratio (OR=0.67, p<0.001), and each unit increase in hemoglobin was associated with a 69% reduction in OR (OR=0.31, p=0.007). Regarding eating behaviors, only the “slow eating” subscale was a significant predictor; each point increase on this scale decreased the odds of being a patient by 13% (OR=0.87, p=0.025), indicating that faster eating is a risk factor. Ferritin, vitamin B12, and other CEBQ subscales, including “emotional overeating” and “enjoyment of food”, were not significant predictors in the final model. Conclusion: This study identifies folate deficiency and anemia as significant risk factors for BHS. This study is the first to report that children with BHS exhibit specific eating behaviors, such as rapid eating. These findings suggest that the clinical management of children with BHS should include screening for folate deficiency and providing guidance on observed eating behaviors.