Apparent life-threatening episodes in children

An apparent life-threatening episode (ALTE) refers to a sudden and unexplained occurrence of breathing abnormality usually associated with colour change, choking or altered muscle tone. Most children are younger than 1 year old. ALTE is a cause for great concern to the parents and needs careful assessment to rule out any underlying serious illness. The evaluation of the affected child involves careful history taking, examination and relevant investigations. The most frequent causes are gastro-oesophageal reflux (GOR), respiratory infections including pertussis, seizures and urinary tract infections. Factitious illness is uncommon but well-recognised and needs to be considered, but no diagnosis is made for up to 50% of cases despite investigations. Most infants have no further episodes and remain well, but some have recurrent ALTE or may die and may be classified as sudden infant death syndrome (SIDS). Studies have failed to establish a clear association between ALTE and SIDS. Some children are discharged home with an apnoea monitor although there is no clear benefit in doing this. Adequate support to the family and follow-up is essential. Medical staff should be aware of the possibility of non-accidental injury and factitious illness.