An 8 month old white female had undergone repair of a tracheo-esophageal fistula and was known to have an esophageal stricture and be intolerant of solids. Her mother was feeding her apple strudel, "the syrup only," when she began choking and had perioral cyanosis. She was taken to her Pediatrician who administered racemic epinephrine and sent her to the Emergency Room. In the ER she had several witnessed episodes of cyanosis.