TABLE 14.5 HISTORICAL FEATURES OF APNEA History Significant apnea Duration of event Greater than 20 sec or of any duration associated with pallor, cyanosis, and/or bradycardia Either, but apnea during sleep is more worrisome Pallor or cyanosis Seizure activity Hypotonia, hypertonia “He/she looked dead” Color change or hypotonia requiring cardiopulmonary resuscitation to improve If shortly after feeding, consider gastroesophageal reflux Association with sleep, trauma Was child asleep or awake? Color change Associated movements, posture, or change in tone Resuscitative efforts and response Interval since last feeding Where event occurred In many cases, the description of the event may be concerning, although the child appears well In this situation, hospitalization for further workup, as outlined next, is warranted A typical case might be the previously well 5-weekold child who was noted by the parents to be apneic during a nap The infant was described as limp and blue and “looked like he was dead.” There was no response to tactile or verbal stimulation for to 10 seconds, but after 15 to 20 seconds of mouth-to-mouth breathing, the child coughed, gagged, and began to breathe His color improved over the next 30 seconds, and the parents rushed him to the emergency department (ED) Although the baby now looks entirely normal, he may be at grave risk for experiencing another episode of apnea The medical history also may provide important information regarding infants at risk for significant or recurrent apnea The physician should ask specifically about previous similar episodes Information about prenatal and perinatal events, including gestational age, birth weight, labor and delivery issues, maternal health and medication exposures, and nursery course, is helpful A family history with specific reference to seizures, infant deaths, and serious illnesses in young family members also should be included Information regarding medications, including