• Apparent Life-Threatening Event



    An apparent life-threatening event (ALTE) is a set of symptoms in an infant that cause the caregiver to believe the child may be dying or has died. It may include disturbed breathing, change in color, choking or gagging. Cardiopulmonary resuscitation (CPR) may have been done at the time of the event.
    Infant Airway and Lungs
    Copyright © Nucleus Medical Media, Inc.


    The cause of ALTE is not always clear. Some causes of ALTE may include:
    • Digestive problems, such as gastroesophageal reflux disease
    • Neurological problems, such as a seizure disorder or problems with the breathing center in the brain
    • Respiratory problems, such as lung infection or something blocking the airway
    • Infections
    • Heart problems, such as an abnormal heartbeat
    • Problems with the endocrine system, which includes the glands and hormones
    • Metabolic problems, such as hypoglycemia
    • Child abuse

    Risk Factors

    Boys and babies younger than 1 year of age are at higher risk of ALTE. Other factors that may increase an infant’s risk of ALTE include:


    Symptoms may include:
    • Breathing that stops
    • Changes in skin color—blue, red, or pale
    • Change in muscle tone—floppy or tense
    • Choking
    • Gagging


    You will be asked about your baby’s symptoms and medical history, including what you noticed in the time leading up to the ALTE. A physical and neurological exam will be done.
    To look for potential causes of ALTE the doctor may order:
    • Blood and urine tests may be done to look for infections or other problems in the body’s fluids.
    • X-rays and ultrasounds may also be done to take images of your baby’s bodily structures.
    Other tests may include:


    Your child's condition may need to be observed short term in the hospital, especially if there have been previous events or the symptoms persist. If this was the first episode and your child is back to normal, you may be able to go home.
    Talk with your doctor about the best treatment plan for your baby. Options include observation and treating the underlying cause of the ALTE. If the cause is unknown, treatment involves monitoring the child for symptoms and teaching parents life-saving treatment (CPR).

    Life-saving Treatment

    CPR is a life-saving treatment that can be delivered by non-medical and medical people. It may restore breathing and blood circulation or help provide oxygen to the body until medical help arrives.
    Consider taking a class in infant CPR so you are prepared.

    Treating the Underlying Cause

    If a cause is found, then the underlying condition will be treated.


    In half of the babies who have an ALTE, the cause is not known. Home monitoring may be considered if advised by your baby’s doctor. A monitor can record your baby’s heart and breathing activity. An alert will sound if your baby is having another event. It may also sound for no reason (false positive). Your child will be followed closely long term.


    There is no known way to prevent an ALTE.


    Family Doctor—American Academy of Family Physicians http://familydoctor.org

    Healthy Children—American Academy of Pediatricians http://www.healthychildren.org


    Canadian Paediatric Society http://www.cps.ca

    Health Canada http://www.hc-sc.gc.ca


    Brief resolved unexplained event (BRUE). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T909988/Brief-resolved-unexplained-event-BRUE. Updated July 19, 2016. Accessed October 4, 2016.

    Apparent life threatening event ALTE. The Royal Children’s Hospital Melbourne website. Available at: http://www.rch.org.au/clinicalguide/guideline%5Findex/Apparent%5FLife%5FThreatening%5FEvent%5FALTE/. Accessed November 10, 2015.

    Clinical practice guideline: apparent life threatening event (ALTE). Prince Margaret Hospital website. Available at: http://www.pmh.health.wa.gov.au/development/manuals/clinical%5Fpractice%5Fguidelines/documents/alte%5Fcpg.pdf. Updated January 2009. Accessed November 10, 2015.

    Hall K, Zalman B. Evaluation and management of apparent life-threatening events in children. Am Fam Physician. 2005 June 15;71(12):2301-2308.

    7/28/2014 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T909988/Brief-resolved-unexplained-event-BRUE: Sarohia M, Platt S. Apparent life-threatening events in children: practical evaluation and management. 2014 Apr;11(4):1-14.

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