Alternative diagnoses in wheezing children

Alerting symptom or sign and possible diagnoses	Clinical clues
Wheeze present from birth
Structural abnormality:	Present immediately at birth. Constant wheeze with no variation
Bronchogenic cyst
Vascular ring
Intrabronchial narrowing
Laryngeal problem	Weak cry, stridor
Congestive cardiac failure	Signs of heart failure
GORD ± aspiration	History of GORD
Wheeze present shortly after birth
Bronchopulmonary dysplasia	History of prematurity or ventilation
Compromised host defence:
Immunodeficiency	Recurrent bacterial infections and failure to thrive
Cystic fibrosis	Persistent cough and poor nutrition
Primary ciliary dyskinesia	Persistent nasal discharge and otitis media
Sudden onset in previously well child
Aspiration of foreign body	History of aspiration in most. Unilateral reduced breath sounds
Persistent wet cough
Compromised host defence:
Cystic fibrosis	Poor growth, clubbing, abnormal chest shape, nasal polyps
Immunodeficiency	Recurrent bacterial infections and failure to thrive
Bronchiectasis	Purulent sputum
Postviral wheeze
Postbronchiolitic wheeze	Can persist for several months. Diagnosed in absence of other alerting signs
Obliterative bronchiolitis	Hyperinflation and fine crepitations. Disabling respiratory symptoms

GORD=gastro-oesophageal reflux disease.