THE SICK BABY AND CHILD: APPARENT LIFE THREATENING EPISODES (ALTE)

A number of babies have these episodes, which in the past have sometimes been called ‘near miss SIDS’. The baby is found limp, sometimes blue, sometimes unconscious or unresponsive and not breathing. Varying degrees of stimulation seem necessary to revive him, ranging from noise or gentle movement of a limb to full blown resuscitation including mouth to mouth. This is obviously a very frightening event for parents, and these babies are usually admitted to hospital for close monitoring and investigation.

The causes of these episodes are varied and include: convulsions (fits); choking episodes, sometimes due to gastro-oesophageal reflux (food coming up from the stomach and going down the wrong way); cardiac arrhythmias, where the heart loses its rhythm; apnoeic episodes where the baby ‘forgets’ to breathe, which is usually due to an immature central nervous system. Most often, no cause at all is found.

The relationship between ALTE’s and later SIDS is uncertain. If a cause is found for the episode, this is treated. If no cause is found, the parents are assured that it is unlikely to happen again. Sometimes an apnoea alarm is used for a time in case the baby stops breathing again. This is a mat containing wires that sense the movement the baby makes when he breathes. If the movement stops for a predetermined period of time, then an alarm is triggered. However, the use of apnoea alarms is not without its problems. They are not 100% reliable, and great anxiety is engendered in parents, who often say they lie awake at night listening for the alarm to go off.

The whole area of SIDS, ALTE’s and apnoea alarms is complex, and advice about home monitoring and other aspects of prevention of SIDS is best obtained from the local children’s hospital or your doctor.

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