Which physical examination finding would NOT be expected in a child with breath-holding spells?

In children experiencing breath-holding spells, a variety of physical examination findings are typically observed. One notable aspect is that these episodes often conclude with the child returning to a normal state, including vital signs returning to baseline after the spell. The child may demonstrate limpness during the episode as they lose muscle tone, which can be mistaken for a seizure or fainting. Loss of consciousness can occur, but it is generally brief and resolves once the breath-holding ends.

Abnormal neurological examination findings would not be expected in a child with breath-holding spells. These spells are typically benign and do not indicate an underlying neurological disorder. After the episode, the child usually recovers fully without any neurologic deficits or abnormalities on examination, making a normal neurologic exam consistent with the expected presentation following breath-holding spells. Therefore, the absence of abnormal findings in the neurological examination supports the diagnosis and differentiates it from more concerning medical conditions.