Cough and you'll miss it

Seana Molloy1, Gemma Batchelor2, Luke McCadden3

  • 1Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK seana.molloy@belfasttrust.hscni.net.

Insights

A 9-month-old boy experienced acute wheezing, initially resolving but returning with respiratory distress. This case highlights the importance of considering foreign body aspiration in young children with sudden onset wheeze.

Area of Science:

  • Pediatric Emergency Medicine
  • Respiratory Medicine

Background:

  • A 9-month-old boy with a history of cleft lip repair and awaiting palatoplasty presented with acute wheezing.
  • The child had mild eczema and a small patent ductus arteriosus (PDA), with no prior wheezing episodes.

Observation:

  • Initial presentation resolved spontaneously, with normal oxygen saturation and respiratory rate, leading to discharge with safety net advice.
  • The child re-presented two days later with cough, wheeze, and shortness of breath, exhibiting subcostal recession and reduced air entry on the right.

Findings:

  • Despite initial presentation, the second assessment revealed signs of respiratory distress without audible wheeze or crackles.
  • Vital signs remained stable with 98% oxygen saturation, but the respiratory rate increased.

Implications:

  • This case underscores the diagnostic challenge of foreign body aspiration presenting as acute wheeze in infants.
  • Prompt re-evaluation is crucial for infants with persistent or worsening respiratory symptoms after initial discharge.
  • Further investigation may be warranted to rule out underlying conditions or complications.

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