About 6 percent of full-term newborns experience an apparently life-
threatening event (ALTE)—a choking or gagging episode marked by apnea, color change or loss of muscle tone. In teaching CPR to parents whose babies had been hospitalized after such an episode, Mary Horn, RN, MS, RRT, began to notice a pattern: The babies almost always had smaller jaws.
Horn, a clinical nurse specialist in Surgical Programs at Children's Hospital Boston, noticed that the babies often put their hands to their chin, as if to thrust the jaw forward. She also noticed that ALTEs tended to happen when the jaw was pushed back, such as during feeding or when the baby was in a swing or car seat with the head tilted back. So she decided to conduct a case-control study using four different measurements of the mandibles of 25 infants with a history of ALTE and 47 healthy infants. Confirming her suspicion, the ALTE group had a significantly smaller mandibular size.
Horn believes that a smaller jaw makes it more likely that the tongue will fall back and obstruct the airway, and that the hand-to-chin posture is the baby's way of compensating. Based on her observations, reported in the October Journal of Pediatrics, Horn suggests that pediatricians note jaw size during routine exams to identify infants at risk for ALTEs. Parents can adopt techniques to prevent these frightening events, such as putting a thumb under the baby's chin while feeding in order to bring the tongue forward.
