Anal abnormalities in childhood myotonic dystrophy.

et al, recently reported 14 cases which they documented in this manner.' Within a period of six months we have seen three babies with ALTE from three unrelated families. All three had been discovered limp, cyanotic, and apparently lifeless during their afternoon nap. Petechial haemorrhages were found on the face and neck of two of the babies on admission. No other episodes occurred during observation in hospital or the follow up period. These would probably have remained unexplained unrelated cases were it not that when the third case was brought to the casualty department by the family doctor he was accompanied by the babysitter who had discovered the baby. She was recognised by one of the nursing staff as a regular attender at the casualty department with minor wounds that were suspected of being caused by automutilation and she had made several allegations of being attacked or raped. In the ensuing discussions it came to light that this woman was the babysitter who had also been involved in the first two cases. She has since been investigated by the police. However, in spite of strong suspicions of imposed upper airway obstruction of the babies by her, there has been insufficient evidence to bring her to trial. CVS as described by Southall et al2 would have failed in these cases, because it is usually only the parents or very close relatives who are allowed to be continually present with the baby in hospital. Very thorough history taking especially concerning the surrounding circumstances remains extremely important in investigating every case of ALTE especially if imposed upper airway obstruction is suspected.