Concerning Historical Features or Physical Exam Findings

	Concerning Historical Features
Family	Sudden unexplained death in first- or second-degree family members before age 35, and particularly as an infant Sibling with past BRUE/ALTE Long QT syndrome Arrhythmia Inborn error of metabolism or genetic disease
Environment	Exposure to toxic substances, drugs
Social	Recent stressors Recent illness, hospitalization, or surgery Previous child protective services or law enforcement involvement (i.e., domestic violence, animal abuse), alerts/reports for this child or others in the family Exposure of child to adults with history of mental illness or substance abuse

	Concerning Physical Exam Findings
General	Abnormal weight, growth, or head circumference Abnormal responsiveness to environment (sound, light) Developmental delay
Neuro	Loss of consciousness Mental status changes, somnolence, lethargy Tonic eye deviation or nystagmus Abnormal reflexes/symmetry of movement Abnormal tone not associated with feeding problems or breath-holding spells
HEENT	Craniofacial abnormalities (mandible, maxilla, nasal) Conjunctival hemorrhage Abnormal pupillary responses Congestion/coryza Blood in nares or oropharynx Torn frenulum Evidence of trauma or obstruction
CV	Tachycardia, bradycardia Hypotension, hypertension, hemodynamic instability
Respiratory	Tachypnea, bradypnea, apnea Noisy breathing (stridor, stertor, wheezing) Airway abnormality or congestion Respiratory dysrhythmias
FEN/GI	Choking, gagging Vomiting Reflux Poor oral intake Organomegaly, abdominal masses, distension, tenderness
GU	Any abnormalities
MSK	Evidence of trauma (fractures, rib tenderness, crepitus, deformity)
Skin	Color change (pallor, red, blue) Bruising, bleeding, petechiae Evidence of trauma

Tieder, J. S., Bonkowsky, J. L., Etzel, R. A., Franklin, W. H., Gremse, D. A., Herman, B., Katz, E. S., Krilov, L. R., Merritt, J. L., 2nd, Norlin, C., Percelay, J., Sapién, R. E., Shiffman, R. N., & Smith, M. B. (2016). Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants. Pediatrics, 137(5). https://doi.org/10.1542/peds.2016-0590

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.

Concerning Historical Features or Physical Exam Findings

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