One of the scariest moments for any parent is when their baby stops breathing for several seconds or longer, for no apparent reason. Their skin may turn blue, and they suddenly become less responsive, and then just like that — poof! — it passes.
On Monday, the American Academy of Pediatrics introduced a new definition for the phenomenon: Brief Resolved Unexplained Events, or BRUE. The term replaces “Apparent Life-Threatening Events,” a description doctors have used since the mid-1980s, but that has been too broad to be of much use to pediatricians, and that may sound unnecessarily alarming.
“Kids aren’t born with a manual, and sometimes an infant does things that are normal for a baby, but that parents may not know are normal,” said Dr. Joel Tieder, an assistant professor of pediatrics at Seattle Children’s Hospital and an author on the new guideline.
“Oftentimes [parents] report some period of time when the baby stops breathing and maybe becomes pale or limp, but has no other symptoms. It usually lasts less than a minute and they’re back to normal,” Tieder explained. “Rarely, it can be a sign of an underlying medical condition that should be addressed.”
BRUE episodes happen in babies younger than 1, and can include one or more of the following: Skin color change (turning pale or blue), irregular or stopped breathing, unresponsiveness and a change in muscle tone. To be considered a BRUE, the event must resolve within one minute on its own.
The cause is unknown.
Decades ago, doctors worried that these episodes were a sign that a baby was prone to Sudden Infant Death Syndrome, or SIDS, but years of research have shown that is not true. And yet even today, fears that the episodes could keep recurring, or that they are a sign of a more serious problem, can lead doctors to do additional testing or even admit babies to the hospital. But further testing may not help, the guideline’s authors write, and could, in fact, put the baby at greater risk.
The goal of the new statement is to offer a more precise definition that better captures the fleeting nature of many of these events, and to lay out clear, comprehensive criteria for pediatricians to use in order to determine whether a brief unresolved event warrants closer attention and testing. It provides a classification system for pediatricians that simply did not exist before, Tieder said.
The statement, and that classification system, is directed toward doctors, but Tieder believes it has value for parents as well, if for no other reason than it helps spread awareness about BRUE. Parents should be reassured that these events, though frightening, are not a precursor to SIDS, and understand that testing and hospitalization are likely unnecessary.
But Tieder also added: “When you’re in doubt, you should always contact your child’s provider.”