Clearly, more studies are required into silent (gastro-oesophageal) reflux in infants after (apparent life-threatening events) ALTE. If a high incidence is confirmed, the next step would be to establish the best medical therapy for reflux. Subsequently, a trial would be needed to show whether antireflux therapy reduced the rate of subsequent adverse events compared with conservative management. Such a study would require hundreds of infants to show a conclusive fall in the rate of recurrence of ALTE, thousands to document a reduction in subsequent mortality, and an intermediate number if both outcomes were combined.