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Arch Pediatr Adolesc Med. 2004;158:402.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

We read with great interest the article by Altman et al¹ regarding the association of abusive head injury and apparent life-threatening events (ALTEs). The authors should be commended on heightening awareness that nonaccidental trauma can initially appear to be an ALTE.

The study impetus was the finding of 5 patients with ALTEs ultimately diagnosed with abusive head injury. In these patients, "the initial history and physical examination revealed no apparent cause, but the discovery of retinal hemorrhages in 4 of the infants and the development of focal seizures in the fifth patient prompted further evaluation that led to the diagnosis of child abuse."^1(p1013) These cases represent the most challenging of all ALTEs—those infants who have a significant event by history yet lack obvious examination findings that would readily explain such an event.

In contradistinction with these cases, 3 of the 6 cases of abusive head injury in the study had . . . [Full Text of this Article]

Frank A. Maffei, MD
Rochester, NY

Karen S. Powers, MD
Rochester, NY

Elise W. van der Jagt, MD, MPH
Rochester, NY

Corresponding author: Frank A. Maffei, MD, Golisano Children's Hospital at Strong, Division of Pediatric Critical Care, 601 Elmwood Ave, Box 667, Rochester, NY 14642 (e-mail: frank_maffei@urmc.rochester.edu).

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Apparent Life-Threatening Events as an Indicator of Occult Abuse—Reply
Robin L. Altman and Donald A. Brand
Arch Pediatr Adolesc Med. 2004;158(4):402-403.
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