Baby get stiff while crying what will probably diagnosis

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Here is a thorough answer based on authoritative medical textbook sources:

Baby Getting Stiff While Crying - Probable Diagnosis

This is the top diagnosis when a baby becomes stiff during or right after crying.

Classic features:

Typically occurs in children aged 6 to 18 months (can start as early as the first month of life and usually resolves by age 5-6)
Always triggered by an emotional event - pain, frustration, fright, or anger - which causes the child to cry
The child cries vigorously for a few breaths, then stops breathing during expiration
This leads to either cyanosis (bluish discoloration) or pallor (turning pale)
The baby then loses consciousness due to cerebral hypoperfusion/hypoxia
Stiffening (tonic posturing), a few clonic jerks, and even urinary incontinence can occur - making it look like a seizure
The episode is short, resolves on its own with gasping respirations, and the child quickly returns to normal

Two subtypes:

Feature	Cyanotic Type	Pallid Type
Trigger	Anger, frustration, fright	Mild pain or startle
Color change	Blue/cyanotic	Pale
Mechanism	Apnea → hypoxia	Excessive vagal tone → bradycardia → cerebral ischemia
Stiffening	Occasionally	Occasionally

Breath-holding spells are classified as a form of neurally mediated (neurocardiogenic) syncope, not epilepsy.

The key distinguishing point is the sequence of events:

In BHS: crying → apnea → cyanosis/pallor → then loss of consciousness and stiffening (provocation FIRST)
In epileptic seizure: stiffening/jerking occurs without a clear provocation, and there is no apnea/color change preceding it; postictal confusion is common afterward

The neurological exam and EEG are normal in breath-holding spells.

Condition	Key Distinguishing Features
Breath-holding spell (most likely)	Crying trigger, color change, short episode, self-resolving
Febrile seizure	Fever present, tonic-clonic activity, postictal drowsiness
Epileptic seizure	No clear trigger, no color change before stiffening, abnormal EEG
Reflex anoxic seizure	Pallid type BHS - vagally mediated, triggered by mild pain
Cardiac arrhythmia	Stiffening without crying trigger; abnormal ECG
Hypocalcemia/hypoglycemia	Metabolic cause; check labs
Gastroesophageal reflux (Sandifer syndrome)	Arching/posturing with feeding, not with crying

Thorough history: exact sequence of events - what happened before stiffening? Was there crying? Color change?
Physical exam: neurological exam (should be normal in BHS)
No urgent testing is needed if the history is classic for BHS - EEG and brain imaging are not routinely required
Reassurance for parents - BHS is benign and self-limiting
If pallid type is suspected or episodes are frequent, an ECG and iron studies (iron deficiency is associated with BHS) may be helpful
Up to 20% of children with BHS develop neurocardiogenic syncope later in life

Sources:

Tintinalli's Emergency Medicine: A Comprehensive Study, p. 879 (BREATH-HOLDING SPELLS section)
Bradley and Daroff's Neurology in Clinical Practice (MISCELLANEOUS CAUSES OF ALTERED CONSCIOUSNESS)

Note: This information is for educational purposes. Clinical evaluation by a physician is needed for any individual patient.

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