First of all, let’s make one thing perfectly clear. ALTE is not a diagnosis, rather it is a chief complaint – an event that occurred because of something else preceding it. Most are insignificant in the long term health of the child, but the prevalence is 0.5 to 1%, which makes them common enough to merit a thorough history and physical exam. There are multiple directions I could take a post on ALTE, but I thought that the best place to start would be with the history. Why? Well, it is the most likely thing that will net you beneficial information.
- Again, the history is critical. You’ll want to know what was the infant doing when it happened? Were they crying? feeding? Was it related to emesis? sleep? Where were they? And how long did it last (about a minute…)
- Was there an abnormal breathing pattern such as apnea, shallow breaths, gasping, increased repository effort, choking or gagging?
- Did any part of the baby’s body change color (face, torso, perioral/lips, limps, fingers and toes etc,.). And if so were they cyanotic, pale, gray, red or purple.
- How was their muscle tone? Were they limp? Did they have tonic posturing or rigidity? Were there rhythmic convulsions.
- Were the infant’s eyes open, closed, deviated or staring
- Were any interventions necessary and/or helpful? Back blows our abdominal thrusts, blowing in the face, vigorous tactile stimulation, rescue breath(s), CPR and or EMS activation
It is also important to assess whether or not this has happened before, and if so were the events similar. A history of previous ALTE should raise your suspicion for head trauma/child abuse – especially if the recurrent events feature the same, singular caretaker and require CPR (at least on history). Though gastroesophageal reflux is a suspected precipitating event, studies have not conclusively proven it to be associated. Even though GER can proceed the ALTE it is likely the laryngospasm – not aspiration – that leads to the concerning sequelae. A prenatal history, with careful attention to screening tests and imaging is important. A prior history f these events in other family members may clue you in to genetic/metabolic, cardiac or neurologic problems. You should also ascertain what medications and substances are in the home.