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. distress, 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 born younger than 34 weeks have a high prevalence of 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.