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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)

Related Criteria

Rochester Criteria for Identifying Febrile Infants at Low Risk for Serious Bacterial Infection

Causes of Bacteraemia and Meningitis in Young Children

Clinical and Laboratory "Low Risk" Criteria for Children Younger Than 3 Months with Fever and No Focus of Infection

Diagnostic Criteria for Cystic Fibrosis (CF)

Modified Bell´s Staging Criteria for Necrotizing Enterocolitis (NEC)



  1. McGovern MC, Smith MB. Causes of apparent life threatening events in infants: a systematic review. Arch Dis Child. 2004 Nov;89(11):1043-8. [Medline]

  2. Hall KL, Zalman B. Evaluation and management of apparent life-threatening events in children. Am Fam Physician. 2005 Jun 15;71(12):2301-8. [Medline]

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Created: January 24, 2006
Last Modified: 10/23/2010

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