that a significant apneic episode has not occurred, the patient can be discharged after appropriate counseling of the parents and arrangements for close follow-up The evaluation of a young child with apnea, however, rarely will be so straightforward If historical information indicates that significant apnea has occurred, the infant can be at risk for a recurrence of this potentially lifethreatening event An aggressive search for an underlying cause is necessary and may include laboratory studies, lumbar puncture, chest radiograph, and EKG Hospital admission should be arranged for observation and further diagnostic evaluation A significant apneic episode in the absence of systemic disease leaves the emergency physician in a quandary There may not be an explanation for the event that satisfies the physician or the anxious parents Thus, referral to an available specialist or center may be required There is considerable practice variation in the inpatient evaluation and management of an ALTE The approach that is usually pursued is designed to identify known causes of primary apnea It generally includes in-hospital observation with monitoring, a chest radiograph, and/or an EKG More significant events warrant further evaluation This may include an evaluation of the CNS with an electroencephalogram (EEG), and in some cases, a sleep study Gastroesophageal reflux is often recognized clinically Barium swallow can help identify anatomic abnormalities but are not reliable for the diagnosis of reflux Esophageal probes to measure pH and intraluminal impedance are rarely required, but can be utilized during hospitalization if the diagnosis is unclear An ultrasound can identify hydrocephalus or intraventricular hemorrhage, though a CT or MRI would be indicated if inflicted head injury is suspected Home cardiorespiratory monitoring is beyond the scope of emergency practice, but is not routinely recommended It is for this reason the AAP recommends utilizing BRUE guidelines to minimize practice variation In many instances, a thorough history and careful physical examination will suggest that a significant apneic event has not occurred and that there is no serious underlying illness In this situation, the emergency physician should reassure and educate the family before discharging the patient The parents also should be given specific instructions regarding indications for another emergent ED visit and a close follow-up visit to a primary care provider Suggested Readings and Key References Eichenwald EC; Committee on Fetus and Newborn, American Academy of Pediatrics Apnea of prematurity Pediatrics 2016;137(1)