Table 3

 Factors that may point towards maltreatment*9

*It is important to recognise that none of these findings are diagnostic of maltreatment, and in most instances no clear evidence of maltreatment will emerge.
ALTE, apparent life threatening event.
The American Academy of Pediatrics suggests that certain circumstances should indicate the possibility of intentional suffocation, including:
• previous recurrent cyanosis, apnoea, or ALTE while in the care of the same person
• age at death older than 6 months
• previous unexpected or unexplained deaths of one or more siblings
• simultaneous or nearly simultaneous death of twins
• previous death of infants under the care of the same unrelated person; or discovery of blood on the infant’s nose or mouth in association with ALTEs