According to the National Institute of Health, an apparent life-threatening event or ALTE is “an episode that is frightening to the observer and is characterized by some combination of apnea (central or occasionally obstructive), color change (usually cyanotic or pallid but occasionally erythematous or plethoric), marked change in muscle tone (usually limpness), choking, or gagging.” The infant who presents with a history of ALTE may have a normal physical examination and may act normal at the time of the evaluation. The causes of an ALTE are varied and include seizures, gastroesophageal reflux, anemia, arrhythmia, trauma, ingestion, metabolic derangements, hypoglycemia, congenital heart disease, and infection. These infants, especially those requiring vigorous stimulation or mouth-to-mouth resuscitation, may be at increased risk of subsequent death and therefore require hospitalization for observation and further evaluation. Basic evaluation in the emergency department should include a CBC, electrolytes, urinalysis, EKG, chest radiograph, and cultures from blood and urine. Further evaluation should be left to the inpatient physician or primary care physician depending on the patient's history, physical examination, and hospital course.