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.