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Published on: October 3, 2025
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.
Abstract:
A 9-month-old boy presented to the emergency department with acute wheeze. He had a background of cleft lip repair at 4 months and was awaiting palatoplasty. He had mild eczema but had never had a previous wheezy episode, and was awaiting cardiology follow-up for a small patent ductus arteriosus (PDA). He had been at the child minder when symptoms began abruptly with no witnessed event. On assessment, the wheeze had resolved, saturations were 98% breathing air, respiratory rate was 34 breaths per minute and he was afebrile. He was discharged home with safety net advice.He represented 2 days later with cough, wheeze and shortness of breath. On examination, he had subcostal recession and there was reduced air entry on the right. There was no wheeze, crepitations or obvious organomegaly. Oxygen saturations were 98% breathing air, respiratory rate was 38 breaths per minute and he was afebrile. Oral amoxicillin was given.
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