Imposed upper airways obstruction

Abstract

Though uncommon, imposed upper airways obstruction (IUAO) is important as a differential diagnosis of infantile epilepsy. It is also extremely dangerous. Because most cases eventually involve the police and legal arguments and because consent for publication can rarely be obtained, IUAO is a difficult subject to write about and those making such a diagnosis may be persecuted [1]. That makes it difficult for the clinician to find convincing published evidence to help in making the diagnosis of IUAO. This discussion should be read in the light of these caveats. IUAO usually means intentional suffocation or smothering of an infant by the mother in the context of what Professor Roy Meadow [1] called Munchausen syndrome by proxy and I called ‘active’ Meadow syndrome [2]. The presentation is as unexplained seizures or syncopes or severe cyanotic attacks or apparently life-threatening events. Although as shown in Table 1 the clinical and monitoring features should make it easy to distinguish IUAO from the better understood alternative diagnoses, doctors still have great difficulty, perhaps because of fears of personal consequences [1]. In my opinion, the features in Table 1 make it unnecessary to undertake covert video surveillance [3] but Courts of law are daunting places of argument.