Clinical history

This should be taken from the parent/carer who witnessed the event.

  • General description of event to include:
    • Choking/gagging/vomiting
    • Awake/asleep (sleep-related breathing disorders include OSA and central sleep apnoea)
    • Position (supine/prone/side)
    • Muscle tone (stiff/floppy/normal)
    • Movement, incl. eyes (purposeful, repetitive)
    • Respiratory effort (incl.┬ádistress, SOB, pauses, apnoea)
    • Skin and lip colour (incl. cyanosis, pallor, plethora)
    • Duration and how it stopped (self-resolved/repositioned/stimulated/CPR)
    • Condition after event and whether back to normal
    • Preceding trauma or recent head injury
    • Any objects nearby that could cause suffocation
  • Feeding including when last fed, amount and type of feed and history of any reflux
  • Past medical history to include:
    • Gestational age (infants younger than 44 weeks can have apnoea of prematurity)
    • Perinatal history, including NICU/SCBU
    • Previous unexplained episodes
    • Previous resuscitation
    • Recent illness
  • Family history to include:
    • SUDI
    • BRUE in siblings
    • Cardiac problems including arrhythmias
    • Parental consanguinity
  • Social history

Gastro-oesophageal reflux is one of the commonest causes of symptoms similar to a BRUE presentation, causing symptoms via laryngospasm. It is an important one to exclude as it is a very treatable cause of a presentation similar to a BRUE, and may cause repeated episodes.

Features from the history that are suggestive of it are:

  • Episode occurred whilst infant was awake and supine
  • Occurred during feeding or shortly after feeding
  • Regurgitation or vomiting at time of event
  • Obstructive apnoea (infant making respiratory efforts but not breathing successfully)

Learning Bite:

Always consider NAI (e.g. drug ingestion, factitious illness, suffocation), especially if there are multiple or changing versions of the history. Take a detailed social history to include cohabiting family members, whether there is smoking/drug use at home, any mental illness at home and any social work involvement with the family.