Definition and Causes of Apparent Life-Threatening Events (ALTE)

Definition of ALTE

By definition, an ALTE refers to a sudden event, often characterized by apnea or other abrupt changes in the child’s behavior. Symptoms of an ALTE include one or more of the following: apnea, change in color or muscle tone, coughing, or gagging.

Diagnoses Made in Children with an Apparent Life-Threatening Event

* Idiopathic (approximately 50 percent)

* Gastrointestinal – GI (most common, up to 50 percent of diagnosed cases)

• Gastroesophageal reflux

• Gastric volvulus

• Intussusception

• Swallowing abnormalities

• Other GI abnormalities

* Neurologic (approximately 30 percent)

• Seizure disorder

• Febrile seizure

• CNS bleeding

• Neurologic conditions affecting respiration (Budd-Chiari syndrome, hindbrain malformation, brainstem malformation)

• Vasovagal reflexes

• Hydrocephalus

• CNS infection

• Ventriculoperitoneal shunt malfunction

• Malignancy

* Respiratory (approximately 20 percent)

• Respiratory compromise from infection, respiratory syncytial virus, pertussis, mycoplasma, croup, other pneumonias

• Obstructive sleep apnea

• Breath-holding spells

• Conditions affecting respiratory control (prematurity, central hypoventilation)

• Vocal cord abnormalities, adenoid vegetations

• Laryngotracheomalacia

• Airway obstruction resulting from congenital abnormalities

• Foreign-body aspiration

* Cardiac (up to 5 percent)

• Arrhythmia

• Long QT syndrome

• Wolff-Parkinson-White syndrome

• Congenital heart disease

• Myocarditis

• Cardiomyopathy

* Metabolic abnormalities (less than 5 percent)

• Inborn errors of metabolism

• Endocrine, electrolyte disorders

• Other infections

• Urinary tract infection

• Sepsis

* Child abuse (less than 5 percent)

• Munchausen syndrome by proxy (suffocation, intentional salt poisoning, medication overdose, physical abuse, head injury)

• Smothering (unintentional or intentional)

* Other

• Food allergy (uncommon)

• Anaphylaxis

• Medication (prescription, over the counter, herbal remedies)