Possible causes

Symptoms and findings

Suggested studies

Gastrointestinal causes

 GERD

 Aspiration

Vomiting

Blockage or coughing with food

pH metry

Video swallow study

Speech therapy assessment

Respiratory causes

 Viral infection/pertussis

 Aspiration/foreign body

 Anatomical airway alteration

Cor yza, cough, wheezing, fever, hypothermia

History of foreign body ingestion

Stridor, feeding difficulties, dysmorphisms (especially craniofacial dysmorphisms)

Viral panel, viral DIF

PCR testing for Bordetella

Endoscopic airway evaluation

Trauma

 Munchhausen syndrome by proxy

History of trauma, blood in the mouth or nose

Previous ALTE, SIDS in a sibling, discordant history

Radiological clinical evaluation

Rule out abuse

Clinical suspicion

Neurological/convulsive causes

Loss of consciousness

Eye deviation

Seizure, hypotonia/hypertonia

Microcephaly/macrocephaly

Dysmorphia

EEG

Brain echocardiogram

CT scan/brain MRI

Glycemia; Ca, P, Mg, PLD levels

Metabolic study

Emotional apnea

Suggestive clinical history without other findings (while awake)

Rule out associated anemia

Metabolic causes

Family history

Seizures

Feeding difficulties

Consciousness compromise

Dysmorphia

Glycemia

Lactate, ammonium, pyruvate

Aminoacidemia, aminoaciduria, etc.

Cardiovascular causes

 Congenital heart disease

 Arrhythmia

Feeding difficulties

Diaphoresis

Central cyanosis, syncope

ECG (QTc)

24-hour Holter monitoring

Doppler echocardiography

Infectious causes

 Meningitis

 Septicemia

 UTI

Fever, hypothermia, lethargy, and/or shock

Hemogram, blood culture PCR, complete urine, urine culture

Lumbar puncture

Medications or toxicity

Consciousness compromise

Lethargy, previous history

Toxicology screening of blood and/or urine

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