Dr. Hands talks about Altered Life Threatening Events, also known as A.L.T.E.. He also explains how parents should react on A.L.T.E.
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Dealing with Altered Life-threatening Events The other type of spells that we refer to or often are referred to is ALTE. This is Altered Life-threatening Events. Now that’s what the concern is. Obviously an Altered Life- threatening Event would be sudden infant death syndrome or SIDS. That’s what we call aborted SIDS. This is where a patient is caught during a SIDS episode and prevented from dying by resuscitation. Most altered life-threatening events are really not altered life-threatening events. They are basically episodes that are self resolving and are not pre SIDS. In fact, events are almost never precursors to SIDS. SIDS is a fear everyone has with babies and few people have warning signs of SIDS. What are the spells that we are referring to? They are variation in breathing pattern, changes in color in the baby, muscle tone problems where the baby becomes limp or hypotonic, changes in alertness. Now obviously there are a lot of medical causes, choking spells are one. We have something that occludes the airway. Often the spell itself is called an airway protective event. What we mean by that is if the child gets something in their airway, what their body does to prevent a problem is they protect the airway by closing it off so that the foreign body cannot cause obstruction to the airway. They had in essence had an airway protective phenomenon. But in so doing they blocked off the airway. They change colors. They may even pass out. This is an airway protective event with no underlying pathology. It’s protection. Most of the spells that the parents had seen with their kids are nothing more than this. They are simply airway protective events. However, in some there are seizures that could present this way and there are various forms of apnea or decreased breathing associated even with slow heart rates, bradycardia. It’s very important to ascertain whether the child tried to breathe enough during this episodes, whether there is a normal color, whether the child is pale, blue or the child is red unless the child is able to recover fully on their own or did the child need resuscitation. And when was the recovery? Was it right afterward or did it take a long time to recover but right you’ve seen with the seizure when we talk about what’s called the postictal phase where they go to sleep after the seizure. So with this, a lot of questions the doctor will ask, the only person that can supply these answers and maybe the mystery of evaluating the spells is the parent. It’s also important that the parent will kind of establish the duration of the event. And again as I mention where the stimulation was required and if do they need it, do they respond. Spells are often classified the central apnea which comes from the brain and stops breathing, obstructive apnea which we referred to is obstructed airway and then mixed events. We’ve talked about the colors of spells. We’ve talked about alteration in tone. We’ve talked about spells with abnormal motor activity and they are usually seizure-like activity. When the spell is evaluated the history is so important of the acute event and you often asked the parents why didn’t you check the baby to begin with. What was going on? Was the baby asleep or awake when this thing occurred? Was the baby trying to breathe when this occurred? What was happening to the baby at the time this occurred? Was the baby dusky, pale, red, normal in color? These are all questions that are very important and also are there any unusual elements during the events. By and large, most of these spells end up in the emergency room. They end up with a perfectly normal baby after the spell and the conclusion is they are not seizures. They are simply airway protective events from mucus or whatever and the child is fine. It is just performing a normal physiologic function to protect the airway. Nevertheless, they can be serious and indicative of underlying serious problems but most of t